Use Of Over-the-counter Medications Research Articles

Characteristics of elderly patients who consider over-the-counter medications as safe

There is a lack of studies evaluating the factors which influence the perception of safety of over-the-counter (OTC) medications by elderly patients. The aim of our questionnaire survey was to evaluate the perception of the risk of OTC medications by elderly patients and to identify patient-associated characteristics which determine elderly persons who consider OTC medications as safe. 25 community pharmacies in different regions of the Slovak Republic. A 54-items questionnaire was provided to patients aged ≥65 years who were purchasing at least one OTC medication during the period from May 2010 to November 2010. The questions elicited information on (a) self-assessment of health status; (b) basic characteristics of OTC medications use (e.g. frequency, duration); (c) patients' knowledge on OTC medications; (d) participants' perception of the risk of OTC medications; (e) the list of OTC and prescription-only medications taken; and (f) sociodemographic characteristics of respondents. Of the 793 questionnaires distributed, 519 were finally included in the statistical analysis (response rate of 65.4 %). Women were prevailing in the analysed group (n = 361; 69.6 %). The average age of participants was 72.2 ± 5.6 years. Majority (n = 392, 75.5 %) of the respondents considered OTC medications as safe. Multivariate analysis (binary logistic regression) revealed that elderly patients who considered OTC medications as safe were characterised by use of OTC medications every day (OR = 2.09), preferring a wide range of such drugs in pharmacies (OR = 2.86), considering such medications as effective (OR = 10.33), obtaining information on OTC drugs from pharmacists (OR = 1.91) and willingness to possibly purchase OTC medications outside pharmacies (OR = 3.35). On the other hand, allergic conditions as a reason for purchasing OTC medications (OR = 0.23), recommendation of a physician regarding the choice of OTC medications (OR = 0.51) and considering concurrent use of several medications as a factor increasing the risk of adverse drug reactions (OR = 0.62) emerged as important factors that decreased the probability of elderly patients considering OTC medications as safe. The survey identified various factors that influenced the perceptions of the safety of OTC medications by the elderly and indicated that pharmacists represent the most trusted source of information about OTC medications.

A Unique Case of Acute Hepatitis Developing after Fo-Ti Root Ingestion

Purpose: The use of dietary and herbal supplements by adults in the United States increased from 23 million to over 38 million users between 1997 and 2002. Although herbal products are thought to be safe by many people, they may have biological activity that can lead to “therapeutic misadventures”. We describe one such case. A 26 year old woman from the Philippines presented with two days of non-bloody, non-bilious vomiting and abdominal pain that started after an alcoholic binge. She denied having any medical problems, prior heavy alcohol use, or any similar episodes in the past. She had been taking an over the counter (OTC) beauty supplement “RejuviCare™ - hair and nail formula” the contents of which included Fo-Ti root (Polygonum multiflorum) for the past three months. She denied any illicit drug use. On examination, the patient's vital signs were stable and she was afebrile. Abdominal examination was significant for mild right upper quadrant tenderness without any guarding or rigidity. Pertinent laboratory data included Aspartate aminotransferase/Alanine aminotransferase (AST/ALT) 3357/2887 U/L, Alkaline phosphatase 56 U/L, Gamma-glutamyl transferase 72 U/L, total bilirubin 1.3 mg/dl, conjugated bilirubin 0.5 mg/dl, albumin 4.5 g/dl. The complete blood count, serum chemistry, coagulation profile, viral hepatitis serologies, iron panel, ferritin, ceruloplasmin, alpha one antitrypsin, anti nuclear antibody, and tissue transglutaminase antibody were normal. Anti smooth muscle antibody and anti mitochondrial antibody were mildly elevated with titers of 1:40 and 1:20 respectively. Liver ultrasound was normal. A liver biopsy revealed scattered foci of lobular necroinflammation, aggregates of ceroid containing macrophages, no evidence of chronic liver injury, grade 2/4 inflammation, and stage 0/4 fibrosis. These findings were consistent with acute toxic liver injury. The herbal medication was discontinued and serial liver function tests showed gradual improvement and complete normalization after three weeks. Liver toxicity with the use of herbal medication containing Fo Ti root is rare in the reported literature. Fo Ti root has been thought to contain an alkaloid that may have rejuvenating effects on brain cells, nerves and endocrine glands. The side effects of this remedy are unknown and are considered safe for use by many people. There have been two other cases reporting a cholestatic hepatitis with the use of Fo Ti root. Our case is unique in that it is the first reported case with a hepatocellular hepatitis and normal bilirubin. This case points to the importance of a detailed history in assessing patients with acute hepatitis as patients often fail to mention the use of OTC medications.

MTM services within community health centers

INTRODUCTION Pharmacists are well-trained, yet often underutilized within the primary care delivery system to identify, resolve, monitor and prevent medication-related problems (MRPs). Medication therapy management (MTM) is a term which describes a broad range of services that are provided by pharmacists to optimize individual patients’ therapeutic outcomes. The MTM care process includes conducting a comprehensive patient medication assessment to identify appropriateness of drug therapy, developing and documenting a care plan to achieve patient-specific goals of therapy and performing followup evaluation to resolve drug therapy problems. When structured to allow patients, pharmacists, physicians, and other caregivers to coordinate efforts toward achieving drug therapy treatment goals, MTM services can improve clinical outcomes, improve patient medication adherence, enhance medication safety, and stabilize or reduce health expenditures. In the state of Connecticut, a network of pharmacists provides diverse clinical services in various healthcare settings. Recently, this network provided MTM services within community health centers across the state; the network and process of MTM implemented is described here.

Misuse of over-the-counter medications among community-dwelling older adults and associated adverse drug events

Objectives The objective of this study was to examine the rates of occurrence of misuse of over-the-counter (OTC) medications in community-dwelling older adults. In addition we examined whether those who misused OTC medications had higher numbers of adverse drug events (ADEs). Methods The study was a cross-sectional study conducted in retirement homes and senior community centres in Houston, Texas, USA. Participants were community-dwelling older adults who (1) resided in retirement homes or visited senior community centres, (2) were responsible for managing their own medication regimens and (3) consumed OTC medications. Information regarding the use of OTC medications, conditions for which the OTC medication was used, ADEs and demographics was obtained using a combination of a self-administered questionnaire and a series of open-ended questions. Key findings Data were analysed using descriptive statistics, and chi-square and t tests. The response rate for the study was 66.5%. Approximately 18% of respondents misused OTC medications, and 23% experienced at least one ADE following consumption of OTC medications. Occurrence of ADEs was higher in patients who misused OTCs compared to those who did not. Conclusions Analyses indicated that older adults participating in this study misused OTC medications. As expected, those who misused OTC medications had higher numbers of ADEs. Results from this study highlight the need to monitor the appropriateness of use of OTC medications in community-dwelling older adults. This will enable more effective medication management in the older adult population.

Knowledge Gaps and Misconceptions About Over-the-Counter Analgesics Among Adolescents Attending a Hospital-Based Clinic

Although many adolescents use over-the-counter (OTC) analgesics, their knowledge about these drugs is unclear. This study evaluates misconceptions and knowledge gaps about OTC side effects, risks, and interactions among adolescents attending a hospital-based clinic. Adolescents aged 14 to 20 years presenting to an outpatient clinic were surveyed using a computer-administered instrument. Participants answered questions regarding their use of specific OTC medications and knowledge of side effects, risks, and interactions of these drugs. A summary score of percent correct answers on knowledge questions was created, and univariate and multivariate statistical techniques examined differences between groups. Ninety-six adolescents completed the survey. Most (78%) adolescents had used OTC medications in the previous month. The most frequently reported OTC medications used were analgesics, including ibuprofen (46%), and Tylenol (45%); acetaminophen ingestion was reported by 15% of respondents. Although 35% reported knowing what acetaminophen is, 37% of these did not correctly identify acetaminophen and Tylenol as the same medication. The average overall knowledge score was 44%. In regression models including demographics, and OTC product use, older adolescents had higher overall average knowledge scores. Hispanic teens had less reported use and lower knowledge scores than adolescents of other race/ethnicities. Most adolescents use OTC analgesics, but many are confused about generic and brand name forms. There were also significant knowledge gaps about OTC use, side effects, and contraindications, especially for acetaminophen. Clinicians should be aware of the potential for OTC medication misuse by adolescent patients.

Drug and dietary interactions of the new and emerging oral anticoagulants

Oral warfarin is associated with extensive food and drug interactions, and there is a need to consider such interactions with the new oral anticoagulants (OACs) dabigatran etexilate, rivaroxaban and apixaban. A literature survey was conducted using PubMed, EMBASE and recent abstracts from thrombosis meetings to identify publications related to food, drug and dietary supplement interaction studies with dabigatran etexilate, rivaroxaban and apixaban. Clinical experience regarding food interactions is currently limited. Regarding drug-drug interactions, dabigatran requires caution when used in combination with strong inhibitors or inducers of P-glycoprotein, such as amiodarone or rifampicin. Rivaroxaban (and possibly apixaban) is contraindicated in combination with drugs that strongly inhibit both cytochrome P450 3A4 and P-glycoprotein, such as azole antimycotics, and caution is required when used in combination with strong inhibitors of only one of these pathways. Important drug interactions of the new OACs that can lead to adverse clinical reactions may also occur with non-steroidal anti-inflammatory drugs and antiplatelet drugs, such as aspirin and clopidogrel. Over-the-counter (OTC) medications and food supplements (e.g. St. John's Wort) may also interact with the new OACs. Given the common long-term use of drugs for some chronic disorders, the frequent use of OTC medications and the need for multiple treatments in special populations, such as the elderly people, it is essential that the issue of drug interactions is properly evaluated. New OACs offer significant potential advantages to the field of venous thromboprophylaxis, but we should not fail to appreciate their lack of extensive clinical experience.

Use of over-the-counter medicines in children

Abstract Objective To assess the reasons for over-the-counter (OTC) medicine use in children and the sociodemographic factors influencing this choice of self-care rather than GP consultation. Method Questionnaires were sent to the home address of a randomly generated list of children under 12 years of age from three GP practices in the East Midlands selected to represent bottom, middle and top tertiles of deprivation on the basis of the Jarman score. Analysis using chi-square and Mann-Whitney tests was used to identify associated factors (number of carers in the home, number of children, deprivation score, parent/carer's age, age and number of children in the house) of the responses. Setting Primary care setting in the East Midlands region of England. Key findings From 424 completed questionnaires returned (response rate 61%), 413 parents/carers had purchased OTC medicines. Fifty-one different products had been purchased, with analgesic/antipyretic and cough/cold remedies the most frequently bought. The most commonly reported reasons for parent/carer initiated medication were to avoid troubling the GP with minor childhood ailments (79% of respondents) and to have medicines available in case of future need (74%). Cost was a barrier to buying OTC medicines for the more deprived. Advice-seeking behaviour was associated with the symptom, the number of children, affluence and the age of the child. Conclusion Parent/carer initiated use of OTC medication is widespread, particularly for analgesic/antipyretic and cough/cold remedies. Differences in advice-seeking behaviour are associated with the presenting symptom and a variety of sociodemographic factors.

Management of prescription and nonprescription drug use during pregnancy

Objective. To assess screening and treatment patterns of obstetrician-gynecologists regarding medication use during pregnancy.Methods. A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network.Results. The response rate was 58%. Most respondents reported always asking pregnant patients about use of over-the-counter (OTC) (86%) and prescription (98%) drugs; 24% reported not always asking about alternative medications. Far fewer reported always asking nonpregnant patients about use of alcohol (67%), illegal drugs (51%) and OTC medications (52%) than pregnant patients. Two-fifths (41%) reported prescribing a medication during pregnancy for which they had insufficient information about potential effects on the fetus; nearly half (47%) reported that there are medical conditions for which they would like to prescribe medications but do not due to insufficient safety information. Physician responses indicate that they are less likely to refer pregnant than nonpregnant patients to a specialist for treatment of certain conditions.Conclusions. These results indicate that obstetrician-gynecologists sometimes prescribe medications for pregnant patients under less than optimal conditions and emphasize the importance of generating up-to-date information on effects of medications during pregnancy and having it readily available to health care providers.

Self-Medication of Upper Gastrointestinal Symptoms: A Community Pharmacy Study

Upper gastrointestinal (GI) symptoms are a common reason for self-treatment with over-the-counter (OTC) medication. However, data are scarce on the typology of GI complaints for which individuals seek self-medication and, more importantly, on the prevalence of alarm symptoms in this population. To investigate: (1) the nature of GI symptoms that people intend to self-medicate, (2) prevalence of alarm symptoms, (3) adherence to referral advice given by the pharmacist, and (4) self-reported efficacy and frequency of use of OTC medication for minor complaints. This descriptive study was performed in 63 community pharmacies. Participants (N = 592, aged 18-82 y) completed a questionnaire to assess symptom characteristics and previous medical consulting. Based on this information, the pharmacist referred subjects to a physician or advised self-treatment. Four weeks later, participants were presented a follow-up questionnaire evaluating their adherence to referral advice or efficacy of self-treatment. The most frequently reported GI symptoms were burning retrosternal discomfort (49.2%), acid regurgitation (53.2%), and bothersome postprandial fullness (51.2%). At least one alarm symptom was present in 22.4% of the individuals, with difficulty in swallowing being the most prevalent (15.4%). Although 21% of the customers were referred, only 51.7% of these contacted a physician. Almost all (95.1%) of the remaining customers who were advised self-treatment reported symptom relief with the OTC drug obtained. Mild GI symptoms will mostly resolve with self-treatment. Yet, the value of pharmacist counseling on OTC treatment should be recognized, as community pharmacists can play an important role in distinguishing symptoms that warrant further medical examination.

Medication and Supplement Use by Older Americans

Older adults are heavy users of prescription medications, but how often they use over-the-counter (OTC) medications and dietary supplements is less clear. In a community-based, cross-sectional survey, 3005 adults (age range, 57–85; 49% male; 81% white) described their use of prescription and OTC medications …

Effective Over-the-Counter Acne Treatments

Acne is the most common disease of the skin, yet only a fraction of acne sufferers are treated with prescription products by physicians. There is, however, a large and expanding market for over-the-counter (OTC) medications, many of which are not only effective but also well tolerated and cosmetically elegant. Given the presence of OTC acne medications on the television, the Internet, and store shelves, patients will be acutely aware of these OTC remedies and will have questions. Patients will expect dermatologists to advise them regarding products to use either as a sole therapy or in combination with prescription drugs. Recently, combinations of OTC acne medications in treatment regimens or "kits" have gained popularity and appear to have increased patient compliance. Quality-of-life outcomes from OTC medication use, in at least one study, have demonstrated good benefit. The most common OTC ingredients include benzoyl peroxide, a potent antibacterial agent, and salicylic acid, a mild comedolytic and antiinflammatory medication. Other, less-common OTC ingredients include sulfur, sodium sulfacetamide, and alpha hydroxy acids. Zinc, vitamin A, tea tree oil, and ayurvedic therapies also are available OTC for acne. Additional and better studies are needed to clarify the benefit of these latter medications.

Use/misuse of over-the-counter medications and associated adverse drug events among HIV-infected patients

Background Self-medication practices and polypharmacy are common among human immunodeficiency virus (HIV)-infected patients. Inappropriate use of over-the-counter (OTC) medications potentiates the risk for drug misuse and adverse drug events (ADEs). Objectives To investigate use and misuse of OTC medications in HIV-infected patients and determine related ADEs. Methods A nonexperimental cross-sectional field study design was used. Study subjects were HIV-infected patients from a local HIV clinic in Houston, TX. Information on subject demographics, OTC medication use, and ADEs experienced were obtained using combined self-administered questionnaire and personal interview techniques. Misuse was divided into 3 categories: strength/frequency misuse, length misuse, and condition misuse. Data were analyzed using descriptive and Chi-square analyses. Results A total of 215 completed surveys were obtained, with a net response rate of 63.6%. The mean (±SD) age of the respondents was 45 (±8.32) years and 69% were males. Analgesics/antipyretics (64.2%) were the most commonly used OTC medications of which nonsteroidal agents accounted for the greatest proportion (38.4%). Of the respondents, 80 (37.2%) misused OTC medications. The highest incidence occurred in length misuse (46.3%), followed by strength/frequency misuse (45.6%), and condition misuse (8.1%). Categories of misuse overlapped in 30 cases (20.1%). Thirty-six (16.7%) participants experienced at least one or more ADEs related to OTC medication use/misuse. Occurrence of ADEs was significantly higher in patients who misused OTC medications compared with those who did not ( P < .05). Conclusions Analgesics/antipyretics were the most commonly used OTC medications by HIV-infected patients. The incidence of misuse and ADEs associated with OTC medications were documented with the sample. Keeping in mind the limitations of study design, our findings suggest that misuse of OTC medications in HIV-infected patients may increase the incidence of ADEs experienced.

Don't Ask, Don't Tell: Parental Nondisclosure of Complementary and Alternative Medicine and Over-the-Counter Medication Use in Children's Asthma Management

Introduction Parent–health care provider (HCP) communication is an important component of pediatric asthma management. Given the high prevalence of complementary and alternative medicine (CAM) and over-the-counter (OTC) medication use among this population, it is important to examine parental nondisclosure of these asthma management strategies. Method One-time interview and 1-year retrospective medical record review with 228 parents of 5- to 12-year-old children with asthma enrolled from six pediatric primary care practices examining parental nondisclosure of CAM and OTC medication use, reasons for nondisclosure, medical record documentation of CAM usage, and association between parent-HCP relationship and nondisclosure. Results Seventy-one percent of parents reported using CAM and/or OTC medication for children's asthma management, and 54% of those parents did not disclose usage. Seventy-five percent “did not think” to discuss it. Better parent-HCP relationship led to decreased nondisclosure. Discussion HCPs can play an important role in creating an environment where parents feel comfortable sharing information about their children's asthma management strategies in order to arrive at a shared asthma management plan for the child, leading to improved asthma health outcomes.

Factors Associated with the Use of Over-the-Counter Medications in Cases of Acute Gastroenteritis in Hamilton, Ontario

Monitoring over-the-counter (OTC) medication sales may provide an accurate, reliable way to observe trends and detect aberrations in community health status. This study assessed demographic and symptomatic factors associated with the use of OTC anti-nauseants (AN), anti-diarrheals (AD), and rehydration therapies (RT) in cases of acute gastroenteritis (GE).Data on 351 cases of self-reported, acute GE obtained from a population-based telephone survey were analyzed. The four outcomes of interest were use of an OTC 1) AD, 2) AN, 3) RT, and 4) use of at least one of the three. The association between each factor of interest and the use of OTC treatments was assessed.Of the 351 cases, 110 (31%) used at least one OTC AD, AN, or RT for their illness. The most significantly associated factor was primary symptom group: cases with both vomiting and diarrhea were 3.6 times more likely to use at least one of the three OTC medications than cases with either vomiting or diarrhea only. Other factors associated with the use of at least one OTC were being female (OR=1.97), being 10-14 years of age iOR=l 1.22), and use of antacids in the 28 days prior to illness (OR=2.31).This study provides the first published assessment of factors associated with the use of OTC medications by community cases of GE. Those who use OTC medications for their illness appear to differ from those who do not. This information can inform health officials, and aid development of pharmacy-based syndromic surveillance.

Over‐the‐Counter Drug Use by Medicare Beneficiaries in Nursing Homes: Implications for Practice and Policy

To examine over-the-counter (OTC) medication use by Medicare beneficiaries in nursing homes and to assess evidence of substitution of OTC medications for prescription (Rx) medications by residents with no Rx coverage and Medicaid. Cross-sectional multivariable analysis. Medicare beneficiaries included in the nationally representative Medicare Current Beneficiary Survey in 2001. Seven hundred eighty-nine Medicare beneficiaries with 1 or more months in a nursing home. Proportions of residents using Rx and OTC medications per resident-month and counts of drugs used within selected therapeutic classes. Study subjects were high users of Rx (98%) and OTC (94%) drugs. The average resident was administered 8.8 unique medications per month (5.9 Rx and 2.9 OTC medications). Twelve therapeutic classes accounted for 93.9% of OTC medication use by residents, but Rx use was also high in some of these same classes. For example, 70.3% of all subjects used nonopioid OTC analgesics, and 19.0% used nonopioid Rx analgesics, and 13.8% used OTC antacids/antiulcer agents, whereas 35.8% used Rx products in this class. The highest overlap was in the category of cough and cold medications, of which 19.3% used OTCs and 20.1% used Rx drugs. Multivariate regression analyses applied to users of drugs in each these three therapeutic classes found no evidence that Rx coverage influenced the choice of OTC versus Rx-only medications. OTCs represent an important component of the therapeutic regimens of nursing home residents, but utilization rates are insensitive to drug coverage. That may change with the implementation of the Medicare Part D drug benefit.

Utilization of Over the Counter (OTC) Medication for Symptom Control in GERD Patients on Prescription (RX) Medication

Objective: To determine the utilization of supplemental OTC medication used by patients also taking Rx medication for GERD. Methods: 1062 male (38%) and female (62%) adults aged 35-74 years with a diagnosis of heartburn/acid reflux, or at least 2 episodes weekly of moderate to severe symptoms rated as 3 or higher on a symptom severity scale (0 = very mild, 7 = very severe), were randomly recruited from a large, previously established Web database. Inclusion criteria included current Rx ± OTC medication use. Results: Rx histamine-2 receptor antagonist (H2RA) users are significantly more likely than PPI users to use supplemental OTC medication (36% vs 27%, respectively, P<.05) Currently OTC H2RAs are used by 7% of Rx users, whereas 29% have used them in the past. Antacids are significantly more common than OTC H2RA or OTC PPIs (P<.05). Overall, 30% of acid reflux sufferers currently using Rx therapy also use concomitant OTC therapy. A small number of Rx H2RA and PPI users supplement with medications in the same class, available as OTC. Of the Rx users on PPI therapy, those taking omeprazole are most likely to use an OTC concomitantly. Conclusions: Patients on Rx H2RAs use significantly more OTC products for symptom relief than those on Rx PPIs. These data support the conclusion that Rx PPIs are significantly more effective in GERD symptom control than Rx H2RAs.

Computer Networking to Enhance Pharmacist-Physician Communication

Background: The use of technology to enhance communication about patients' drug therapy has been advocated by physician and pharmacist associations in Canada. The objective of this pilot study was to demonstrate the proof of concept for an electronic network linking pharmacists and community family physicians in order to exchange information about patients 65 years of age or older who were taking five or more medications regularly. Methods: Three community family physicians, 40 of their patients, and three community-based pharmacists with whom the patients most frequently filled their prescriptions participated in the study. Pharmacist-physician pairs were connected through a secure dial-up electronic network. Patients met with the pharmacist to review their medications, including over-the-counter (OTC) products, and the pharmacist generated an electronic profile for the physician. The physician could respond electronically to the pharmacist with edits in order to arrive at a consensus profile for each patient and to discuss discrepancies or drug-related problems. Electronic communication was followed for four months, after which interviews were conducted with the pharmacists and physicians. Results: Patients were mostly female (65%) and were 74.9 years of age on average. Physicians and pharmacists accessed the network a total of 144 times and 96 times, for an average duration of 7 minutes and 41 minutes, respectively. Physicians noted the benefit of learning about their patients' OTC medication use and about issues such as lack of compliance. The most common barrier to using the electronic communication system was lack of time. Conclusion: The electronic linkage was found to be useful. Further evaluation of the effectiveness of this communication system is needed. Patients' access to their electronic medication profile should also be considered for future projects of this type.

"Social medication" and the control of children: a qualitative study of over-the-counter medication among Australian children.

The aim of the study was to identify the patterns of use of over-the-counter (OTC) medications among children. The study used a qualitative design, with in-depth interviews of 40 parents with children <5 years of age. There were 3 striking and readily apparent themes in the use of OTC medications among children. One was the administration of OTC medications as a form of "social medication," to give parents control over children's behavior that they perceived as fractious and irritating. A related theme was the use of OTC medications to reduce the inconvenience to the parents of having a sick child, again giving parents greater control and better time-management abilities. Finally, acetaminophen was considered by many parents to have almost miraculous properties in calming, sedating, and lifting the mood of children. The use of OTC medications for the treatment of minor ailments among children is widespread, despite the lack of evidence of efficacy of the most commonly used medications and the potential for toxicity. With the increasing propensity to look to medication as a means of supporting changing lifestyles, there is an urgent need to review the prevalence and effects of social medication.

Factors Associated with Women's Medication Use.

Health IssueResearch has consistently shown that while women generally live longer than men, they report more illness and use of health care services (including medication). In the literature, the reasons for women's elevated medication use are not clear. This paper investigates the associations between over-the-counter (OTC) and prescription (Rx) medication use and selected social and demographic variables in men and women.Key findingsWhile a larger proportion of women than men used medication throughout the study, the proportion of people using medication did not increase. The use of OTC and Rx medication increased by number of physician visits for women and men.Medication use increased with age, chronic disease and number of physician visits, and decreased with the perception of good to excellent health. The relationship with other factors varied for women and men depending on their education level, income and social roles. For women, the social roles of being married or previously married, being employed or being a parent did not increase their likelihood of medication use. Reported income adequacy is not associated with the chances of mediation use among highly educated women, but for women with low levels, medication use increases as income adequacy decreases.Data Gaps and RecommendationsMore complete data are needed about social roles and their relation to mediation use. Data that would allow an assessment of the appropriateness of OTC and Rx drug use or the reasons for such use need to be collected. More research is needed to better understand the distribution and determinants of specific medication use.

Patient characteristics associated with nonprescription drug use in intentional overdose.

Over-the-counter (OTC) medications remain freely available to suicidal patients, despite their potential lethality and common use in suicide. The study's main objective was to identify patient characteristics, particularly psychiatric diagnosis associated with the use of OTC medications in intentional overdose. We retrospectively reviewed 95 charts from patients who presented to St Paul's Hospital from August 1, 1997, to July 31, 1998, with a discharge diagnosis of intentional drug overdose. Univariate analysis was carried out to identify potential risk markers for OTC medication use, and logistic regression was performed using these variables. When the variables age, sex, and concurrent psychiatric diagnoses were controlled, use of OTC medications in overdose was significantly lower in patients with a DSM-IV diagnosis of substance abuse (OR 0.11, P = 0.005) and in those who possessed prescription medications at the time of overdose (OR 0.18, P = 0.007). Most patients in this cohort (82%) had at least 1 of these 2 traits. Although not statistically significant, younger patients appeared more likely to choose OTC medications for overdose. Suicide-prone patients with a diagnosis of substance abuse and who possess prescription medications are unlikely to use OTC medications in overdose. For this cohort, this represents a relatively small proportion of patients whom clinicians should consider to be at greater risk for attempting suicide when using OTC medication, especially acetaminophen.