Table 2 Factors, reasons and circumstances involved in OTC medicines misuse, abuse and dependence

OTC medicines

(not specified)

Self-management of symptoms

Previous medical prescribing/treatment

Past use of illicit substances

Past alcohol dependency

Ongoing medical prescribing/treatment

Reasons for taking overdose:

Severe symptoms

The belief that the recommended dose would not be adequate to relieve the symptom

The belief that a stronger dose would relieve symptoms faster

Previous experience

Behavioural risk factors

Doctor/pharmacy shopping

Internet pharmacy purchases

Excessive dosages and extended use

Daily use

Polypharmacy

Suspected misusers and abusers are mostly chewing Khat or carrying it with them while presenting at pharmacies [36]

Miscellaneous risk factors:

Educational level

Religion (Muslims were reported more than Christians) [47]

Occupation

Non-medical college students [64]

Knowledge about OTC medicines was significantly associated with risky practice

Cooper [50]

Abood and Wazaify [36]

Hopkins et al. [49]

Tesfamariam et al. [47]

Al Kubaisi et al. [64]

Codeine-based analgesics

To manage physical chronic pain (such as arthritis, migraine, or relieve pain following surgical interventions)

To manage psychological conditions including depression, anxiety, and stress-related conditions

To avoid the symptoms of acute opioid withdrawal

To gain a pleasurable sensation

Self-harm/suicide

To improve sleep

To Feel-good effect or to curb craving

To treat infections/coughs and colds [39]

Behavioural risk factors

Doctor/pharmacy shopping

Excessive daily dosages and extended use

Faking or exaggerating symptoms to get a prescription for codeine

Poor social support (such as lone parenting, marital and relationship disharmony, childhood experiences of a negative divorce process, unemployment, and low self-esteem)

Roussin et al. [18],

Nielsen et al. [38],

Agyapong et al. [39]

Van Hout et al. [40]

Kimergard et al. [41]

Paracetamol

Persistent use to treat pain (musculoskeletal pain, headache pain, dental pain)

Behavioural risk factors:

Doctor/pharmacy shopping

Excessive dosages and extended use

Limited literacy

Misunderstanding of OTC acetaminophen product information in community dwelling adults that independently associated with both impaired visual acuity and low literacy skills

Roussin et al.[18]

Wolf et al.[48]

Hopkins et al.[49]

Mullen et al. [46]

Loperamide

To avoid the symptoms of acute opioid withdrawal

To gain a pleasurable sensation

Self-harm/suicide

Lee et al. [32]

Dextromethorphan

Recreational use

Suicide attempt

To get mind alerting effect

for the believe that it helps women to more likely get conceived as it made secretions more receptive to sperm’ (one respondent) [19]

Risk factors

Personal problems

Living alone and relationship problems

Problems at work/school –Curiosity

Accidental administration

Koziarska-Rościszewska et al. [42]

Pringle et al. [43]

Fingleton et al. [19]

Sedative antihistamines

To improve sleep and relaxation

To achieve mental-altering effects

Circumstance in which individuals abuse antihistamine

Mixing the medication with drinks (e.g. soft drinks, alcohol) or with water-pipes (Narghile)

Abraham et al. [44]

Wazaify et al. [35]

Fingleton et al. [19]

OTC analgesics

To manage tiredness, stressful situations and discomfort

To cure hangovers

As an alternative for the appropriate medicine

Risk factors

Sex (female)

Age over 55 years

Low health status

Wojta-Kempa and Krzyzanowski [37]

Haemorrhoid products

Misused for facial skin care purposes

Fingleton et al. [19]

Sore throat preparations

Misused for its pleasant taste

Fingleton et al. [19]