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Official websites use. Share sensitive information only on official, secure websites. Email: aguadebeber11 yahoo. Among the subjects included in this survey, Of these, Six were excluded for unknown ingredients. By comparing these groups, we found that many of the multiple products group consisted of young women who were recently treated for drug problems. Many subjects in the group also had a short treatment period. OTC products are easily accessible drugs of abuse for young women in Japan. The results of this study indicate the necessity to reconsider the educational approach for preventing drug abuse, which has focused on illicit drugs. The study also indicates that some OTC products, which contain ingredients banned overseas due to their harmful effects, are still sold in Japan and that abusers for those products exist. Measures by the government are considered urgently needed. We compared single product abusers with multiple product abusers of OTC and conducted a detailed investigation of the clinical characteristics of OTC abusers in Japan. Because they are easily available directly OTC or online without a prescription, they are generally deemed safe. However, considering the fact that the awareness of the safety of medicines and the relevant responsibility are left to the citizens, the use of OTC products poses a matter of concern. There is a risk of the onset of adverse events if the instructions and dosage are not followed. Some abusers use excessive amounts of OTC products that act on the central nervous system in order to obtain a psychoactive effect, though the excessive intake of these drugs can lead to extremely dangerous health conditions. In recent years, the abuse of OTC products is becoming a worldwide problem. In Hong Kong, 2. In Japan as well, the abuse of OTC products is becoming a problem in medical practice. In psychiatric practice, the number of people who underwent treatment at a psychiatric medical facility due the intake of OTC drugs increased approximately 6. In both studies, which were performed in 12 and during the period from through , 13 the most frequently overdosed drugs were benzodiazepines, followed by antipsychotic drugs. In recent years, however, there has been a trend toward an increase in emergency cases due to overdosing on OTC products, and it has been suggested that they may surpass the number of cases caused by benzodiazepines and antipsychotic drugs. It was also found that among them were individuals who overdosed on multiple OTC drugs. The improved access to OTC products may increase the risk of abuse of such drugs. For instance, it has been found that in Spain and in the United Kingdom, where medications that contain codeine are commercially available, the abuse of codeine is approximately 8 and 4 times, respectively, higher than in Germany and Italy, where medications that contain codeine are not available without a prescription. As some examples, increasing number of drugs fell under the OTC category, such as loxoprofen sodium in , and in , the restrictions for the online sale of OTC products were loosened. All of these measures can be said to be policies that aimed at facilitating citizen's access to OTC products. In Japan, the efforts that are made by drugstores for preventing abuse as a result of the improved access to OTC drugs are not sufficient. There are differences regarding the ingredients that are regulated and the types of OTC products that are abused in each country, but it is found that five major drug groups are frequently abused across the world; namely, combination analgesics codeine, etc. When selling OTC products that contain these ingredients, it is required to check whether the product was already purchased at another store and the reason for buying the product, and there are restrictions regarding the quantity to be sold. In case the customer is young e. As mentioned earlier, in recent years, the number of patients who abuse OTC products has been rapidly increasing in Japan, but there are still many aspects of their clinical characteristics are not well understood. In addition, the relationship between the abuse of OTC drugs and the abuse of other psychoactive substances, and differences between those who abuse a single OTC product and those who abuse multiple OTC products are also unknown. Outside of Japan, there have already been reports that OTC product abuse is associated with illicit drug abuse or prescription drug abuse as well as alcoholism 4 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ; however, to the best of our knowledge, there are no studies on differences in the clinical characteristics of single and multiple OTC product abusers neither in Japan nor abroad. The results of the survey have served as important basic data when planning the numerous drug abuse countermeasures that have been implemented to date. This survey is always performed in a similar fashion as in the previous years. Before the survey is performed, the target facilities are informed by postal mail about the purpose and method of this survey, requested to cooperate with the survey. Information is collected by having the psychiatrists who directly treated each case transcribe clinical information from the medical record it is difficult to identify individual patients into a questionnaire. In the survey, in addition to the items described earlier, questions for obtaining detailed information about the use of OTC products were added. The attending physicians were asked to select the category that applied to the respective patient multiple answers were possible. Of the subjects in the NMH Survey who used OTC products as main drugs at the time of survey, a total of were included in this study except for the six subjects on whom details regarding the OTC product used are unknown. Comparison between the group that used only a single ingredient and the group that used multiple ingredients: OTC product abusers were divided into the group that used only a single ingredient single product group and the group that used multiple ingredients multiple products group , and then the following three comparisons were made:. For this study, SPSS ver. The patients gave informed consent and their anonymity preserved. This study conformed to the provisions of the Declaration of Helsinki. In the NMH Survey, There was a total of cases, and of these cases were considered eligible. Among these were Of all these subjects, The breakdown of the multiple products group was as follows: 43 Breakdown of the ingredients that were used by OTC product abusers is shown in Table 1. The COD group consisted of Regarding all ingredients that were identified, significant differences were observed between the single product group and the multiple products group, and in particular patients who belonged to the DXM group, the ALU group, the DPH group, and the CAF group were frequently observed in the multiple products group. Comparison of the classification of OTC products that were used by the single product group and the multiple products group. Attributes and clinical characteristics were compared between the single product group and multiple products group in subjects who abused OTC products. Table 2 shows the results obtained by comparing subject attributes. Regarding the biological sex composition, it was found that the proportion of women was significantly higher in the multiple products group With regard to the age composition, the proportion of subjects who were in their 10s or 20s was significantly higher in the multiple products group There were also no differences regarding current alcohol problems. Moreover, no differences were observed between the two groups regarding treatment details, including history of psychiatric hospitalization, private rehab facility utilization experience, and recovery program participation status. Table 3 shows the results obtained by comparing the history of extensive drug use between the two groups. The number of subjects with a history of the abuse of other drugs was significantly higher in the single product group This study was an attempt to elucidate the clinical characteristics of OTC product abusers who have become a social problem in Japan in recent years by comparing single and multiple OTC product abusers. The following is our discussion on the results that were obtained in this survey. In this study, there was a significantly high number of subjects in the multiple products group who applied to any of the six OTC product classification categories. Of course this is a logical result because subjects in the multiple products group used overlapping OTC products that fall under several drug classification categories. On the other hand, in the multiple products group, a higher proportion of subjects This suggests that both in the single product group and the multiple products group, common cold drugs and antitussive medications which contain codeine are the primary OTC products that are abused, and that in the multiple products group, OTC drugs containing other ingredients are also used while codeine containing products are primarily used. Although it is difficult to make simple comparisons with data from overseas because the regulations and availability of OTC products vary between countries, these results are partially consistent with those from overseas. In previous studies conducted overseas, codeine containing products as well as dextromethorphan and diphenhydramine were listed as OTC products with a high risk of abuse 18 ; therefore, it is suggested that these are products for which measures for preventing abuse should be considered regarding their commercial availability. On the other hand, sales of bromovalerylurea and allylisopropylacetylurea are prohibited in many countries due to their harmful effects and potential for dependency, and there are only very few reports on the abuse of these substances in previous studies conducted overseas. In this sense, the fact that OTC drugs that contain these dangerous ingredients are still sold in Japan, and that there are in reality people who abuse these products, must be taken seriously. Measures by the national government are considered urgent. In this study, subjects in the multiple products group were significantly younger than those in the single product group, and this was also reflected in the shorter duration of treatment for drug problems in the multiple products group. There was also a high proportion of women in the multiple products group. Women frequently use analgesic agents for menstrual pain on a daily basis, and this may reduce the psychological barriers to use OTC products and result in a greater readiness to abuse them. In addition, in Japan, inexpensive cosmetics have been sold at drugstores in recent years, and drugstores have become familiar places for young women. This may increase their access to abusable drugs, let them become interested in various OTC products, and have an impact on their motivation to try them out. In this study, many subjects in the single product group had a history of abuse of other substances, and in particular the history of stimulant abuse was significantly common. This suggests that the single product group included subjects who chose OTC products since there is no risk of being arrested, instead of using illegal drugs such as stimulants. Although this cannot be proven based on the results of this study, it is possible that the single product group included individuals who selected OTC products as a substitute for methamphetamine the main ingredient in stimulants that are abused in Japan in expectation of the pharmacological effects of methylephedrine, which is a stimulant ingredient and is contained in many codeine containing cough medicines and common cold drugs. In this study, many individuals with disorders of adult personality and behavior as comorbid condition were observed in the multiple products group. It is generally pointed out that among the various kinds of personality disorders PD , antisocial PD and borderline PD are associated with substance abuse, 35 , 36 that antisocial PD is in particular often observed in men 37 and borderline PD in women, 38 and that the abuse of illegal drugs is frequently observed in patients with antisocial PD while the abuse of sedative drugs is often observed in patients with borderline PD. In addition, the impulsivity, which is characteristic for borderline PD, may stimulate the desire to try out just any kind of OTC products. Finally, we describe the limitations of this study. This study has several limitations, but the following two are the main limitations. First, in this study, OTC products were classified into six categories for convenience. This is because there is a wide variety of OTC products in Japan that often contain multiple ingredients, and it is difficult to classify them only based on ingredients as some products have overlapping ingredients. For instance, antitussive medications and combination cold drugs, which are often abused in Japan, contain not only dihydrocodeine but multiple ingredients such as methylephedrine, chlorpheniramine, and caffeine, but in this study they were collectively classified as codeine group. Moreover, antitussive medications and common cold drugs, which do not contain dihydrocodeine but contain methylephedrine only, which is subject to the regulations of the Stimulants Control Act as stimulant raw material, were classified as other products group in this study. In future studies, the methods for classifying OTC products should be carefully considered. There should be many OTC drug abusers who do not visit a medical institution, and it is believed that the actual number of OTC product abusers is even higher. Finally, as described earlier, it is difficult to properly assess and incorporate OTC product abusers in cases in psychiatric practice; therefore, the number of cases that was included in this study was only small. It is necessary to conduct studies that include more cases in the future. Despite these limitations, we believe that this study has important clinical significance because at the current moment this is a very rare research which elucidated the clinical characteristics of OTC drug abusers, who have rapidly increased in recent years and have become an urgent issue in Japan. Measures by the government are urgently needed. All authors read and approved the final manuscript. Neuropsychopharmacol Rep. The data that support the findings of this study are available in the Supporting Information. 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. Find articles by Yuko Tanibuchi. Find articles by Soichiro Omiya. Find articles by Takashi Usami. Find articles by Toshihiko Matsumoto. Open in a new tab. 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. History of psychiatric hospitalization due to drug problems. Has been at a private rehab facility due to drug problems. Withdrawal state with delirium. Other mental and behavioral disorders. Comorbid mental disorder multiple items could be selected. Organic, including symptomatic, mental disorders. Schizophrenia, schizotypal disorder, and delusional disorder. Behavioral syndromes associated with physiological disturbances and physical factors. Intellectual disabilities mental retardation. Behavioral and emotional disorders with onset usually occurring in childhood and adolescence.
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