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Official websites use. Share sensitive information only on official, secure websites. This article was submitted to Addictive Disorders, a section of the journal Frontiers in Psychiatry. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Abuse of non-opioid analgesics NOA is associated with serious health consequences. However, due to inconsistent definitions of NOA abuse, prevalence estimates for the German population are unclear. This study aimed to estimate the month prevalence of NOA abuse among self-medicated users of these drugs in the general German population and to identify risk factors. Data are from the Epidemiological Survey of Substance Abuse, a nationally representative sample with 9, individuals aged 18—64 years. Multiple logistic regression was performed to examine associations between NOA abuse and sociodemographic, behavioral, and health-related variables. The weighted month prevalence of NOA abuse was Extrapolation of the proportion of individuals abusing NOA to the German population aged 18 to 64 is 3,, individuals or 6. Inexplicable physical pain, being underweight, depression, hazardous alcohol use, daily smoking, illegal drug use, and frequent use of NOA one or more times per week and daily use were associated with an increased probability of NOA abuse. The use of cannabis was associated with a lower probability of NOA abuse. Abuse of NOA is highly prevalent in the German population. Against the background of increasing self-medication of NOA, healthcare providers need to be aware of potential risk factors of abuse to better identify and prevent this problem. Keywords: non-opioid, analgesics, abuse, self-medication, epidemiological survey, over-the-counter. Non-opioid analgesics NOA , like non-steroidal anti-inflammatory drugs or antipyretic analgesics such as paracetamol i. NOA are mainly used for the treatment of mild to moderate acute and chronic pain. In Germany, NOA can only be purchased in local or online pharmacies, always with the involvement of a pharmacist or a pharmacy technician 2. However, a few OTC drugs, such as vitamin supplements and herbal drugs, are available outside of pharmacies at places like drugstores or supermarkets. In Germany in , The top five most frequently sold OTC analgesics in generated a total sale of 67 million package units corresponding to 9. Of all OTC drugs available only in pharmacies, Analyses of survey data show that Besides their positive analgesic effects, NOA also carry the risk of adverse events such as gastrointestinal, cardiovascular, hepatic, renal, cerebral, or pulmonary complications when used inappropriately 6 — Results of a study of the Poisons Information Center in Erfurt Germany show that the three most frequent single drug exposures of NOA were caused by paracetamol, ibuprofen, and acetylsalicylic acid Studies show that the risk of inappropriate use of these drugs is strongly enhanced by self-medication compared to prescribed use 12 — As NOA are easily accessible and widely used in the general population, it is important to know their potential for inappropriate use abuse, or even dependence. In previous literature the terms more often found, and frequently used interchangeably, are abuse and misuse with several definitions existing for each. In international epidemiological studies, abuse is generally defined as the use of NOA for non-medical recreational purposes such as to achieve mind-altering effects 13 , 15 — 19 , while misuse is largely defined as the use of NOA for a legitimate medical reason but taken in a higher dose or for a period of time longer than recommended 10 , 13 , 15 , 16 , 20 , In other studies, abuse has been defined as taking a drug together with another substance, like alcohol 22 , or substituting the drug with another one because the drug the individual is dependent on is not available Misuse has also been defined as using a medicine for the treatment of symptoms other than the drug is intended 22 , or when administering the drug in a manner other than recommended e. Thus, there is a lack of a standardized definition for the abuse and misuse of NOA. In Germany, one study on inappropriate NOA use was limited to a specific form of abuse, namely medication overuse headaches 25 , and did not focus on abuse or misuse in general. However, the code F Persistent use of these substances often involves unnecessary contact with medical professionals or supporting staff and is sometimes accompanied by harmful physical effects of the substances. Attempts to dissuade or forbid the use of the substance are often met with resistance; for laxatives and analgesics, this may be in spite of warnings about or even the development of physical harm such as renal dysfunction or electrolyte disturbances. We also aimed to identify risk factors associated with NOA abuse, to gain knowledge on their association with NOA-related problems. Data are from the Epidemiological Survey of Substance Abuse, a population-representative cross-sectional study investigating substance use and substance use disorders among German-speaking 18 to year-olds in the German population. A two-stage selection approach was applied. First, sample points i. Data were collected through a standardized self-report questionnaire that was completed either on paper, through a telephone interview, or online, depending on the preference of the participant. The response rate was The total study sample comprised 9, individuals with For the present analysis, we selected individuals who used NOA in the last 12 months and reported that the NOA were not exclusively prescribed by a medical doctor. Abuse of NOA was defined based on the code F Individuals that self-reported the use of NOA during the last 12 months were categorized as abusing NOA if they reported to meet one or more of the following criteria: 1 NOA were often taken in larger amounts or over a longer period than intended, 2 a persistent desire or unsuccessful efforts to cut down or control NOA use, 3 continued NOA use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance, or 4 craving, or a strong desire or urge to use NOA. Descriptive statistics were applied to examine the sample and compare participants with and without NOA abuse. The mode of administration i. Interactions between NOA abuse and age, sex, education, BMI category, or daily smoking were tested for statistical significance. Inspection of Variance Inflation Factors ensured that the predictor variables were not collinear. Weights were used to account for sample differences in the distribution of age, gender, and education relative to the population, as well as their representation of the federal states and districts Data analysis was performed using Stata An alpha level of 0. Data were available on 4, individuals reporting self-medication of NOA. Of these, individuals were excluded due to missing information on key variables resulting in a final analytical sample of 4, individuals for the multiple logistic regression model. Baseline characteristics of the final sample are shown in Table 1. A total of Sociodemographic, behavioral- and health-related characteristics of individuals using NOA and individuals included in multiple logistic regression analysis. This corresponds to a weighted month-prevalence of Extrapolating the proportion of individuals abusing NOA to the German population aged 18 to 64 years yields an estimated number of 3,, individuals or a prevalence of 6. Of the individuals with a diagnosis of NOA abuse Comparison of sociodemographic, behavioral, and health-related characteristics between individuals abusing NOA and those taking NOA, but not abusing them, are shown in Table 2. Individuals abusing NOA showed statistically significant higher rates of unemployment and poverty compared to non-abusers. NOA abusers were more likely to suffer from inexplicable physical pain and depression compared to non-abusers. Further individuals abusing NOA were more likely to be underweight, overweight, or obese and less likely to have a normal BMI value. Additionally, abusers of NOA reported significantly more hazardous alcohol use, daily smoking, illegal drug use, and opioid analgesic use, compared with non-NOA-abusers. Finally, participants abusing NOA also reported a significantly higher frequency of NOA use compared with non-abusers. Sociodemographic- behavioral- and health-related characteristics of abuser and non-abuser of non-opioid analgesics NOA. Inexplicable physical pain, being underweight, having depression, engaging in hazardous alcohol use, smoking daily, using illegal drugs, and frequent use of NOA i. In contrast, the use of cannabis was associated with a lowered probability for NOA abuse. To our knowledge, only three studies have investigated the problematic use of NOA in Germany. One study investigated drug-related problems in the self-medication of OTC drugs, including OTC analgesics, identified by community pharmacists at the time the drug was dispensed Findings of this study showed that the overall prevalence of drug abuse or using the drugs longer than intended was The authors additionally reported that the overall prevalence of taking the wrong dosage was 6. The second study, a review article, showed that the prevalence of medication overuse headaches i. While all patients with a positive diagnosis of NOA dependence showed at least one sign of physical dependence i. Of the participants diagnosed with NOA dependence, To our knowledge, there is only one international study that has investigated NOA abuse specifically. In this study, Kouyanou, Pither 44 investigated chronic pain patients attending specialized pain clinics in South London. According to the authors, 5. Most previous studies focused exclusively on inappropriate use of OTC analgesics 15 , 45 — However, because countries differ in terms of which analgesics are classified as OTC medicines, the possible inclusions of non-NOA drugs render comparisons with our study difficult. For example, in some countries e. These opioid-containing drugs have a higher risk for abuse and dependence due to their pharmacological properties and were not considered in our study. For instance, in these countries, OTC analgesics can be purchased in local supermarkets or at gas stations which might create the impression to the public that these drugs are safer than prescription-only drugs, potentially resulting in higher rates of frequent and problematic use Finally, the use of inconsistent definitions of abuse and misuse leads to different results in the estimation of NOA abuse between studies 19 , The development of standardized substance abuse terminology is urgently needed to compare prevalence estimates between countries When interpreting our findings in light of previously published work, most of the results regarding risk factors could be confirmed. We found the frequent use of NOA i. Findings of a Finish study showed that frequent use of OTC analgesics is highly related to the frequency of pain symptoms, with a positive association between daily analgesic use and the frequency of pain symptoms Given the fact that the frequent use of these drugs above a certain threshold has no additional positive effect, but rather increases side effects e. In accordance with the findings of other studies, our study found daily smoking to be a risk factor for NOA abuse 5 , 54 , One possible explanation might be that smoking causes many health problems e. In line with the findings of Abbott and Fraser 23 , we found a significant association between hazardous alcohol use and NOA abuse. Additionally, epidemiological data indicate that the risk for negative health consequences, like gastrointestinal complications, more than double in the case of concurrent use of alcohol and non-steroidal anti-inflammatory drugs compared to the single use of these substances This seems quite concerning considering that Germany is among the top ten countries worldwide with the highest per capita consumption of alcohol Our results showed a significant positive association between illegal drug use and NOA abuse confirming the findings of Fingleton and colleagues 17 who reported a positive correlation between illegal drug use and OTC medicine abuse in the United Kingdom. Most interestingly, in our study cannabis use was associated with a lower probability for NOA abuse. Researchers have shown that cannabis is frequently used, in addition to NOA, for pain management 63 , Thus, we attribute this finding to support that, rather than take NOA for pain, participants instead consumed cannabis. Likewise, our finding of the association between inexplicable physical complaints and a higher probability for NOA abuse was not surprising and could be confirmed by previous research In line with the findings of Benotsch, Koester 18 our results indicate that depression is a strong predictor for NOA abuse. As a previous study showed, depression and chronic pain have a complex relationship with depression occurring more often in patients with chronic pain than in healthy controls Additionally, studies found that some people are using NOA to treat other symptoms than pain, like stress, anxiety, sleep disturbances, and depression Finally, we found a significant association between being underweight and NOA abuse. This might be explained by the fact that being underweight is associated with chronic pain and is often comorbid with mental disorders like depression Early detection of problematic use of NOA is essential to avoid subsequent harm to the patient. In self-medication, pharmacists play a particularly important role as they can provide direct advice. According to these guidelines, detailed information on the potential risks of medications during consultation is essential. Inquiring about previous medication use, as well as pointing out that these medications should only be used for the recommended period, in addition to a referral to a medical doctor on suspicion of abuse, is essential Further prevention strategies might imply careful screening of patients who receive addiction treatment or cognitive behavioral therapy for alcohol abuse, polysubstance use, or mental health concerns. Our findings are subject to some limitations. All data are based on self-reported information, which is known to be prone to response biases such as underreporting or providing socially desirable answers. Another shortcoming is that with the present cross-sectional study design some population groups with increased rates of substance use are not or are insufficiently covered. This primarily concerns individuals older than 64 years, homeless people, as well as inmates or people who are accommodated in medical institutions We also chose a conservative approach in setting the threshold to when a participant is characterized into showing abuse or not. As participants only had to fulfill one out of four criteria, it might be that some individuals met only one criterion, even though they are not abusing their drugs. This might have led to an overestimation of NOA abuse. Unfortunately, we were not able to control for individuals suffering from chronic pain e. While the proportion of NOA use without a medical prescription among pain patients may be low, these individuals who regularly need NOA seem to have a high risk for abusing these drugs and we believe are important to include in our study. The present study provides estimates for NOA abuse in self-medicated users and the German adult population aged 18 to 64 years. Our findings indicate that there is a substantial number of individuals showing signs of abuse according to the definition of the ICDGM. Against the background of increasing self-medication and the fact that abuse of these drugs is strongly associated with negative health consequences, this should be treated as a public health concern. Efforts are needed to raise public awareness about the risks of inappropriate use of these drugs to prevent subsequent harm to NOA users. Several factors were identified that increased the probability of NOA abuse. Healthcare providers should be aware of these risk factors and take early preventive action. Since pharmacists are key in preventing inappropriate use in self-medication, they should explicitly point out potential risks and side effects in consultations with customers. Finally, there is an urgent need to develop a consistent terminology regarding the use, misuse, and abuse of NOA, in addition to an accompanying operationalization and measurement instrument. These measurement tools are needed to better identify the mechanisms underlying inappropriate use of these drugs and thus better target prevention strategies at an early stage. Publicly available datasets were analyzed in this study. Further enquiries can be directed to the corresponding author. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. CR analyzed and interpreted the data and wrote the initial draft of the manuscript. LK designed the study. All authors gave important feedback in revising the manuscript, commented on various versions of the article, and approved the final version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. 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. Front Psychiatry. Find articles by Christian Rauschert. Find articles by Nicki-Nils Seitz. Find articles by Sally Olderbak. Find articles by Oliver Pogarell. Find articles by Tobias Dreischulte. Find articles by Ludwig Kraus. Received Jan 28; Accepted Mar 10; Collection date Open in a new tab. Female 0. Middle 1. Poverty Yes 1. Municipality size Rural a Ref. Small town b 1. Hazardous alcohol use Yes 1. Daily smoking Yes 1. Illegal drugs use Yes 2. Cannabis use Yes 0. Opioid analgesic use Yes 1. Paper-pencil PAPI 1. 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.

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Mannheim buying MDMA pills

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Mannheim buying MDMA pills