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Official websites use. Share sensitive information only on official, secure websites. Email: ryokyan saitama-med. A questionnaire survey was conducted to examine the sociodemographic characteristics of patients with OTC drugs overdoses visiting emergency departments at eight sites across the country. The habitual The proportion of OTC drugs obtained from physical stores was higher in the habitual group, whereas the nonhabitual group used more household medicines. Antipyretic analgesics were significantly more common in the nonhabitual group, whereas antitussive expectorants and antihistamines were significantly more common in the habitual group. This is the first multicenter study to determine the status of OTC drugs overdose patients treated at emergency departments of medical facilities in Japan. To prevent new overdoses of OTC drugs, continued detailed epidemiologic studies of patient backgrounds and drug acquisition routes, and investigation of the components of OTC drugs that cause dependency are necessary. Previously, OTC drugs could only be obtained from pharmacists in pharmacies and drugstores, but the enforcement of the revised Pharmaceutical Affairs Law in June lifted the ban on their online sales. Between April and March , when a state of emergency was declared because of the coronavirus pandemic and strict measures were implemented to prevent its spread, hospital visits for common illnesses and obtaining a prescription for medication became difficult. As a result, the demand for OTC drugs, especially cold remedies, antitussives, and analgesics, increased, and OTC drugs have become increasingly indispensable in daily life. Subsequently, owing to their easy accessibility, OTC drugs abuse has emerged as a social problem, 2 , 3 especially among the younger population. Notably, OTC drugs abuse has increased significantly in recent years. Some OTC drugs overdose patients have no history of psychiatric consultation. Since there is a possibility that adolescents may not receive appropriate mental health care even when they are in distress, it is extremely important to conduct surveys that include cases that do not involve psychiatric institutions to promote measures against dependence and abuse of OTC drugs, which will become a social problem in the future. In addition, the composition of OTC drugs in Japan differs from that of other countries. For instance, the prevalence of multidrug formulations, which is uncommon in other countries, the inclusion of ingredients, such as ephedrine, codeine, dihydrocodeine, bromovaleryl urea, pseudoephedrine, methylephedrine, which are listed by the Ministry of Health, Labor and Welfare with abuse potential, in OTC drugs and their ready availability to the general public, and the inclusion of caffeine as an ingredient in OTC drugs are all problems unique to Japan. From this perspective, Japan's own epidemiological studies would be highly beneficial. The Japanese Society of Clinical and Analytical Toxicology is an academic society of clinical and analytical toxicologists, consisting of physicians, pharmacists, and other researchers affiliated with hospitals, universities, and institutions. On February 16, , email letters were sent to 16 emergency medical facilities with emergency physicians who were members of the society, requesting their participation in an epidemiological study on overdose of OTC drugs on a large scale. The study participants were patients who presented to an emergency facility between May and December due to an overdose of OTC drugs and who agreed to participate in the study, even if the patient was underage. In this study, we obtained written consent from all patients. In cases involving underage patients, we provided explanations using assent statements and obtained written consent from both the patients and their guardians. OTC drugs are medications that can be purchased at pharmacies without a prescription from a doctor. Although caffeine tablets can be purchased in Japan as either OTC drugs or supplements, both types of caffeine were included in this study. Overdose or excessive use was defined as taking a dose higher than the recommended dosage. Patients who confessed overdosing with OTC drugs, had witnessed overdosing of these drugs, or were found to be in possession of residual drugs at the scene were included in this study. The doses of OTC drugs were estimated from patients' confessions, empty boxes, bottles, or packages found around the patient at the scene. A pilot questionnaire was tested for simplicity in terms of understanding and the time required for completion. Physicians at the participating emergency facilities were required to search for all patients fulfilling the above conditions and to complete the questionnaire for every appropriate patient. The sociodemographic characteristics of patients with OTC drugs overdose were evaluated. A total of patients from eight emergency medical facilities who consented to participate in this study We did not exclude any patients. In terms of occupation, 43 A total of Furthermore, 87 Notably, 33 We compared the patients' backgrounds between the two groups Tables 1 and 2. The number of patients transported by ambulance owing to overdose of OTC drugs is increasing each year, with some patients experiencing repeated overdoses. At first glance, it may seem that the patients are not lonely, given that the majority of the patients in our study It is possible that they may have experienced feelings of isolation within their homes and in wider society due to a lack of sufficient time or opportunity for active conversation, even when housemates or family members were present. In the future, a more detailed survey of the circumstances surrounding patients who have overdosed on OTC drugs may facilitate a deeper understanding of the challenges they face and enable them to communicate these challenges to their families and supporters, thereby enhancing the environment for preventing overdose of OTC drugs. The dissemination of drug information and impressions of drug use by influential people on social media and other media plays a part in spreading information to individuals in a variety of wider geographical areas. Adolescents often encounter trials and tribulations that may lead to risky behaviors, such as drug use, in search of social connections and solutions. In this study, Similarly, the survey conducted by Matsumoto et al. According to the results of a nationwide survey conducted by the Ministry of Health, Labor and Welfare in , 9 the most common reason for purchasing OTC drugs in stores pharmacies, drugstores, etc. However, this also suggests that pharmacists can act as gatekeepers in physical stores and interact with customers, potentially preventing OTC drugs abuse among adolescents. Further detailed research on the route of drug acquisition is crucial for developing preventive measures against OTC drugs overdoses. Conversely, patients in the nonhabitual group were more likely to use drugs that were available nearby, such as in the possession of housemates. Antipyretic analgesics were selected significantly more frequently by the nonhabitual group. Antipyretic analgesics contain ingredients such as caffeine and acetaminophen, which can cause organ damage if overdosed, therefore strict vigilance on medicines, including OTC drugs, by housemates may be an important aspect of preventing overdoses. Antitussives, expectorants, and antihistamines were selected significantly more often by the habitual group. Antitussives, expectorants, and antihistamines have different effects depending on the dose, and their use for relaxation is a worldwide concern. With repeated abuse, the cravings for addictive substances become compulsively repetitive and uncontrollable, leading to withdrawal symptoms with autonomic symptoms and tolerance. This study revealed that one of the contributing factors to overdosing on OTC drugs is the psychological isolation experienced by some young people despite their social lives. In order to do this, it is first necessary for us to ascertain their reasons for using OTC drugs. Then, the support—medical, administrative, educational, or all—that the patient needs must be identified. In addition, if repeated overdose behavior is in part a craving for addictive substances, 16 then psychotherapy, pharmacotherapy, or treatment should be sought rather than regulation and punishment. Currently, treatment programs for OTC drugs dependence remain lacking, and they must be established with the cooperation of medical, government, and educational institutions. There were a few limitations in this study. First, it is important to note that these results are based on a limited sample of only eight facilities, and it is possible that there are many more cases of OTC drugs overdose across the country. Additionally, it is likely that there are cases that have not been reported to medical facilities. In the future, conducting detailed surveys for each of various districts would be desirable. We are unable to identify the same patient who overdosed repeatedly during this period because patients' identity information was not collected during data collection. In addition, it included a group of patients transported to a limited number of facilities. Although poisoning patients should be managed at tertiary emergency centers, some patients were transported to secondary emergency facilities instead. Since many of the collaborating institutions in this study were tertiary facilities, patients of mild severity might have been missed. Repeated overdoses may be due to dependency syndrome. The establishment of treatment programs for repeated overdoses is crucial in the future. Ryoko Kyan designed the study, developed the main conceptual ideas, and drafted the manuscript with assistance from Yoshito Kamijo, Takuya Shimane, Toshihiko Matsumoto, and Michiko Takai. All study participants, or their legal guardian, provided informed written consent prior to study enrollment. We would like to thank the eight participating facilities with members of the Japanese Society for Clinical Analysis and Toxicology for providing data. Luke's International Hospital. Psychiatry Clin Neurosci Rep. Raw data were generated at Saitama Medical University Hospital. Derived data supporting the findings of this study are available from the corresponding author R. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. PCN Rep. Find articles by Ryoko Kyan. Find articles by Yoshito Kamijo. Find articles by Saeko Kohara. Find articles by Michiko Takai. Find articles by Takuya Shimane. Find articles by Toshihiko Matsumoto. Find articles by Hidetada Fukushima. Find articles by Shogo Narumi. Find articles by Takuyo Chiba. Find articles by Toshiki Sera. Find articles by Norio Otani. Find articles by Yasumasa Iwasaki. Open in a new tab. Comparison of the drugs taken by the habitual and the nonhabitual groups. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Internet purchase yes. Social networking system yes. Relief of mental distress yes. Nothing in particular yes. Antipyretic analgesics yes. Antitussives and expectorants yes. Hypnotic sedative yes. Antivertigo medicines yes. Agents to prevent drowsiness caffeine preparation yes. Herbal medicine yes. Anhydrous caffeine yes. Chlorpheniramine maleate yes. Dextromethorphan hydrobromide hydrate yes. Aspirin acetylsalicylic acid yes. 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