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Over the counter medication

June 2005

Foreword
The Board of Science, a standing committee of the British Medical Association (BMA) provides an interface between the medical profession, the government and the public. One major aim of the board is to contribute to the improvement of public health, and it has developed a wide range of policies on the health of specific groups such as children and the elderly.

At the BMA’s 2004 annual representative meeting a motion on over-the-counter (OTC) medication was debated and referred to the Board of Science for further consideration. In commissioning this report, the Board decided that given the many changes in the field of OTC medication, a report setting the specific issues within the wider context would be valuable.

Increasing patient involvement in the diagnosis and treatment of common ailments has led to a greater interest in and encouragement of self-care and an increase in the use of non-prescription drug products commonly referred to as OTC medications. OTC medications now account for about £2 billion of the £11 billion spent in the UK on medication and may be used to prevent, treat or cure ailments from cardiovascular conditions (eg simvastatin) to common aches and pains (eg paracetamol). The largest expenditures are for analgesics and skin treatments [go to reference 1].

The availability of OTC medications has increased both through the creation of new preparations and the reclassification of existing substances. Between 1983 and 1999 there were 72 reclassifications from Prescription only medicine to Pharmacy (POM to P) (Royal Pharmaceutical Society of Great Britain 2000). The government has recently pledged to double the rate of reclassification and work to increase the availability of OTCs for common complaints [go to reference 2].

The purpose of this report is to provide an analysis of the current trends in OTC medications, as well as current treatment and prevention strategies using OTC medications, followed by recommendations for improving these strategies. This information will be of use to a variety of groups including health professionals seeking advice on helping patients and policymakers seeking to improve or introduce legislation in this area.

Introduction
Over-the-counter (OTC) medicines have traditionally been used to treat self-limiting minor ailments. The scope for treating such conditions has been extended by the switch from prescription to OTC status of effective treatments and this is likely to continue. The global trend towards, and encouragement of, increased self-care including self-management of long-term conditions, is likely to affect the range and availability of OTC medication in the future. A strategic approach will be needed to integrate OTC medication with the wider NHS.

Like all treatment interventions, OTC medicines bring both benefits and risks. Potential benefits to the public include enabling people to take control of their own illnesses and rapid and convenient access to treatments. Potential risks include adverse effects and the possible misuse of certain medicines. Potential benefits to the healthcare system include more efficient use of physician capacity through the transfer of consultations about minor ailments to pharmacists and nurses, as well as increased individual responsibility and empowerment in the context of minor ailments.

Shaw and Baker have suggested the term ‘Involved Patients’ to denote active involvement in treatment choices and self-management of health (Shaw & Baker 2004) and this is apposite for self-medication with OTC medicines.

Health professionals need to routinely ask about any OTC medicines the patient has tried or is taking. If more OTC medicines intended for long-term or intermittent use are to become available, safety would be improved by documenting the use of such medicines. Until shared electronic access to information becomes possible, a patient-held record would be a means whereby different people involved in the patient’s care could see information about OTC use. Challenges inherent in such a record are its acceptability to the public, as well as the documentation of third party purchases, or those purchases that are to stock the home medicine chest.

Appropriate information provided on medicine packaging and patient information leaflets should be used to improve the public understanding of the benefits and risks of OTC medicines. User testing of both is essential to ensure this objective is met.

Footnotes
[1] PAGB. OTC Medicines Sales figures 2003. www.pagb.org.uk/media/downloads/downloads.asp?mode=doc&id=223 Accessed 18 August 2004
[2] PAGB. OTC Medicines Sales figures 2003. www.pagb.org.uk/media/downloads/downloads.asp?mode=doc&id=223 Accessed 18 August 2004