Misuse of prescription and over-the-counter drugs to obtain illicit highs: how pharmacists can prevent abuse

Stefania Chiappini, Amira Guirguis, John Corkery, Fabrizio Schifano

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There have been increasing reports of misuse of a range of prescription and over-the-counter (OTC) drugs for recreational purposes. The use of psychoactive pharmaceuticals and ‘pharming’ are new, widespread phenomena involving the non-medical use of prescription and OTC drugs, which are recreationally used to achieve psychoactive effects either on their own or in combination with other substances.
This article provides an overview of the topic, focusing on a range of medicines (e.g. prescription medicines such as quetiapine, gabapentinoids, Z-drugs, bupropion, venlafaxine and over-the-counter medicines such as loperamide, dextromethorphan, benzydamine, promethazine, chlorphenamine, diphenhydramine and hyoscine butylbromide) that have emerged as misused and diverted, or are already described through the literature, as well as recorded by drug users’ online websites reporting new trends and experimentations of drug abuse.
This rapidly changing drug scenario represents a challenge for pharmacy, psychiatry, public health and drug control policies. Moreover, possibly resulting from the COVID-19 pandemic, drug use habits and availability have changed, causing a shift in behaviours relating to both prescription and OTC medicines. Healthcare professionals should be aware of potential prescription drugs diversion, recognise misuse cases, consider the possibility of polydrug misuse, and prevent it where possible. Pharmacists can prevent and reduce drug abuse, and should be involved in evidence-based actions to detect, understand and prevent drug diversion activities and the adverse effects of drug misuse.
Original languageEnglish
Article number7943
Pages (from-to)1-27
Number of pages27
JournalThe Pharmaceutical Journal
Issue number7943
Early online date17 Nov 2020
Publication statusPublished - 18 Nov 2020


  • drug abuse
  • prescription drug misuse
  • over-the-counter drug abuse
  • novel psychoactive substances (NPS)
  • pharmacovigilance


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