Unintentional misuse of prescription medicines”, bpacnz, Oct, 2018.
Medicine misuse is generally described as: “using a medicine
in a manner or dose other than prescribed”. This definition
encompasses people who obtain medicines for the sole
purpose of gaining a “high” (i.e. without a legitimate indication
for the medicine) or for diversion (i.e. selling to others).
However, the more common scenario in a primary care setting
is a person who is using a medicine for the purpose it was
prescribed, but at a higher dose, increased frequency or for a
longer duration than indicated.
Medicines with a higher potential for misuse include opioids
(e.g. oxycodone, morphine, tramadol and codeine), sedatives
and hypnotics (e.g. benzodiazepines and zopiclone), other
CNS depressants (e.g. gabapentin, pregabalin) and stimulants
(e.g. methylphenidate). However, almost all medicines have
potential for misuse.
The reasons why people misuse prescription medicines are
multi-factorial and complex, including psychological and
biological factors, coping mechanisms for pain and other
symptoms, lack of family and social support, adverse living
circumstances and challenging or traumatic life events.
When any medicine is prescribed, especially those that have
the potential for misuse, the responsibility lies with the
prescriber to set the boundaries for use by ensuring that the
patient understands why, how and when to use it and for how
Pharmacists also have an opportunity to educate patients
about strategies to avoid losing control of their use of
a medicine. Pharmacists can reinforce the messages of
responsible medicine use that were originally outlined by the
prescriber. There are also a number of strategies specific to
pharmacy practice aimed at reducing the misuse of medicines,
e.g. training staff to recognise potential medicines misuse and
having set protocols in place, restriction maximum quantities
for sale to individual customers, referring certain requests
to the senior pharmacist and liaising with other pharmacies
and general practices in the area. The patient-pharmacist
interaction can strongly influence decision-making in terms
of what over-the-counter medicines are purchased and
how they are used, e.g. considering the accurateness of the
patient’s self-diagnosis and direct-to-consumer advertising
resulting in inappropriate product selection and discussing
misconceptions or a lack of information about risk.
- What strategies have you found work well in your
pharmacy to help avoid unintentional misuse of
medicines? What are the areas of improvement that you
could work on?
- In your experience are there particular situations or
characteristics of interactions with patients that might
make you more cautious when dispensing or selling
some medicines to some patients? If so, how do you
respond in these kinds of situations?
- How easy is it to liaise with prescribers and/or other
pharmacies if there are concerns about prescription
- Medicines Control (Ministry of Health) can provide advice
about the legislative requirements under the Misuse of
Drugs Act 1975 and the Medicines Act 1981. A restriction
notice can also be issued through Medicines Control.
Have you ever needed to contact Medicines Control? Or
had experience with patients under a restriction notice?
Do you think these measures help patients, prescribers
and pharmacists to address prescription medicine
- Overall, how effective do you feel in being able to help
prevent prescription and over-the-counter medicine
misuse? Has reading this article made you feel more
confident in identifying and managing medicine misuse?