Pharmacists Must Encourage All Patients to Read Over-the-Counter Medication Warning Labels
Misuse of an OTC medication doesn’t usually result in death, but such a tragedy occurred 10 years ago when a popular high school track star treated her typical aches and pains with excessive amounts of topical products containing methyl salicylate. Patients are more likely to read warning labels now than they were a decade ago, but many still routinely use more than the recommended dose.
Beyond actually reading over-the-counter medication warning labels, there’s another problem—reading a label doesn’t mean patients understand or comply. That’s where pharmacists are essential. Your outreach may be the only opportunity for patients to learn about the safe use of OTC medications.
Extent of the Ever-Expanding OTC Market
Sales of OTC medications have steadily increased over the last four decades. The upward trend will continue as the US population keeps growing, the number of aging baby boomers continues to rise, and as the transition from prescription to OTC status adds an estimated 100 ingredients, indications, or dosage strengths to the market every year.
One number puts the market into perspective: OTC medications account for $84 million in sales—every day—which reflects a significant number of customers who rely on your pharmacy.1 An article in the April 2010 issue of US Pharmacist said that if only 2 percent of self-treating patients visited primary care practitioners instead of using OTC products, physician office visits would increase by an unmanageable 62 percent.2
Here’s a snapshot of OTC users:
- 81 percent of adults turn to OTC medicines as their first-line treatment for minor ailments.3
- 73 percent of adults prefer to self-treat rather than visit a physician.
- 35 percent use OTC medications on a regular basis.4
- Adults over the age of 65 account for about 40 percent of OTC drug use.
- Seven out of 10 parents have given their child an OTC drug at night.
This segment of the market is large and strong enough to provide a stable and substantial revenue stream, but it also comes with responsibility. Sixty-six percent of patients need help simply choosing the right product because they feel overwhelmed by the multitude of choices. Then once they have a product in hand, you can’t assume they’ll read the label, which means your intervention—whether a simple reminder to read the label or more in-depth—is vital.
Do Patients Read—and Understand—OTC Warning Labels?
In October 2015, the Consumer Healthcare Products Association reported that consumers correctly read labels on OTC medications, a statement that was based on results from an online Harris Poll. That poll found that 91 percent of adults read “any portion” of the label “at least sometimes.”5 It also said that 75 percent of consumers read the ingredients, which is up significantly from the 44 percent reported on a survey conducted by the National Council on Patient Information and Education (NCPIE) in 2003.6 The NCPIE also reported that:
- 8 percent of adults don’t read any portion of the label.
- 32 percent take a higher dose than the recommended amount.
- 18 percent exceed the number of recommended daily doses.
The problem with statistics is that they miss the human factor. It’s one thing to say that consumers “correctly” read labels, but these studies haven’t explored whether patients understand what they read and comply with the recommendations. Unfortunately, there aren’t many research-based answers to those concerns, but two studies offer some insight.
In 2012, the results of a survey completed by 1,206 Italian adults were published. Most were aware of the potential for side effects from OTC medications, but 42 percent were confused about the concept of contraindications versus side effects and they couldn’t determine dosages.7 Additionally, 64 percent didn’t know about the risks of taking painkillers if they had hypertension. The overall conclusion was that consumers had “incomplete awareness” of risks related to OTC products.
Research published in October 2016 came from a joint effort between experts at the T.H. Chan School of Public Health at Harvard University and the School of Medicine at the University of Wollongong in New South Wales.8 After surveying 262 consumers who purchased over-the-counter NSAIDs containing ibuprofen, they found that the participants could identify ibuprofen as the active ingredient and knew the recommended intervals between doses. But several red flags were raised:
- One-third didn’t know the maximum daily dose.
- One-third weren’t aware of contraindications.
- Fewer than 50 percent recognized potential side effects.
Tips for Pharmacist Intervention
Until future studies can show that a majority of people purchasing OTC medicines read—and understand—the label, pharmacists need to develop a plan to reach out to their OTC patients. While the primary goal is to promote optimal health and protect them as much as possible from adverse effects, don’t lose sight of the secondary goal—the long-term value of being the community pharmacy known for helping people navigate the perplexing world of OTC medicines. Here are a few ideas for OTC medication outreach:
- Encourage label reading: Half of your patients don’t read the label before using an OTC medication for the first time. Put up signs that show how to read the label or give a reminder to read the instructions. As always, let them know the pharmacist is available to help.9
- Help in the aisle: Roughly 66 percent of patients admit they have a hard time choosing an OTC medication. Grab their attention with strategically-placed signs that acknowledge the challenge and suggest asking for help.
- Target older patients: A large portion of OTC users are elderly patients who are at a higher risk for adverse effects due to polypharmacy. Another concern is that they’re self-treating conditions that need a physician’s attention, so pharmacists must quickly assess the patients’ symptoms before recommending OTC products.
- Advocate for teens: While the risk for drug abuse is well known, be aware that teens may overuse medications commonly used to treat headaches and muscle pain. One small study suggested that overuse of pain medications may be a warning sign of other health conditions that should be assessed by health professionals.10
- Recommend safe dosages: Patients typically take more than the recommended dose because they think it will bring relief more quickly or because they didn’t get relief from the normal dose. Whether through personal counseling or posters placed near the OTC products, reinforce the point that more is not better—and to ask the pharmacist.
Remember That Patients “Don’t Know What They Don’t Know”
The title of the 2016 study said that patients “don’t know what they don’t know.” It’s estimated that only half of all patients actually read the label when they take an OTC medication for the first time. In other words, they need better advice and information even if they don’t know it. Counseling for OTC products should be part of the care offered by pharmacists.
Pharmaceutica North America provides topical over-the-counter products to treat pain and inflammation, as well as prescription lidocaine ointment, diclofenac sodium, and Fluocinonide. Contact us today to talk about how we can support your pharmaceutical needs.
- “The Rise of Medicine in the Home: Implications for Today’s Children,” March 2016, http://www.poison.org/~/media/files/pdf-for-article-dowloads-and-refs/safekids-medicine-safety-2016.pdf?la=en ↩
- “Patient Counseling: A Pharmacist in Every OTC Aisle,” April 2010, https://www.uspharmacist.com/article/patient-counseling-a-pharmacist-in-every-otc-aisle ↩
- “OTC Medication Safety,” June 2015, http://www.pharmacytimes.com/publications/otc/2015/otcguide-2015/otc-medication-safety ↩
- “Over-the-Counter Medications: Use in General and Special Populations, Therapeutic Errors, Misuse, Storage and Disposal,” 2011, http://www.acpm.org/?OTCMeds_ClinRef ↩
- “New US Survey Confirms That US Consumers Correctly Read the Label Before Using an OTC Medicine,” October 2015, http://www.wsmi.org/new-us-survey-confirms-that-us-consumers-correctly-read-the-label-before-using-an-otc-medicine/ ↩
- “Attitudes and Beliefs About the Use of Over-the-Counter Medicines: A Dose of Reality,” 2003, http://www.bemedwise.org/survey/summary_survey_findings.pdf ↩
- “Factors That Influence Italian Consumers’ Understanding of Over-the-Counter Medicines and Risk Perception,” June 2012, https://www.ncbi.nlm.nih.gov/pubmed/22119713 ↩
- “Consumer Knowledge About Over-the-Counter NSAIDs: They Don’t Know What They Don’t Know,” October 2016, https://www.ncbi.nlm.nih.gov/pubmed/27774735 ↩
- “Counseling Patients on Choosing and Using OTCs,” July 2013, http://www.pharmacist.com/counseling-patients-choosing-and-using-otcs ↩
- “High Use of Over-the-Counter Analgesic: Possible Warnings of Reduced Quality of Life in Adolescents – A Qualitative Study,” March 2016, https://www.ncbi.nlm.nih.gov/pubmed/26949372 ↩