Many patients are under the false assumption that there are no risks, adverse effects (AEs), contraindication, or potential drug interactions posed by taking OTC medications. This stems from their easy access, relatively affordable cost, and use for self-treatable symptoms.

Unfortunately, OTC accessibility and the lack of guidance from a prescriber for their use coupled with these false assumptions can often lead to misuse and even abuse of these medications. However, most OTC medications were once available as prescription-only, although usually in higher strengths, and thus pose a threat for AEs given their mechanisms of action.

Although some OTCs are sold in a variety of retail outlets, most sales occur in community pharmacies. Given the ubiquity of OTC use and a greater emphasis by patients on self-treatment, one of the more important roles of pharmacy personnel is to ensure their safe and effective use. To ameliorate the potential for abuse and addiction with OTC drugs, pharmacists rely heavily on pharmacy technicians to recognize a potential problem during their initial interactions with patients who present to the pharmacy. 

Pharmacy technicians are the persons that most patients first encounter when purchasing OTC medications or even browsing the aisles. Although technicians are already juggling myriad job responsibilities, they may be encouraged to peruse the OTC medications section to offer assistance to patients.

These patients are often confused by brand and generic names, particularly with the labeling often used for these products, with tags such as “new formulation,” “only product with [ingredient name]”, along with nighttime and daytime formulations, extra strength, extended relief, and so on. For example, patients likely have very little idea that among cough and cold remedies, there are only a handful of active ingredients in various combinations and quantities that compose the entire array of the hundreds of products available.

Without knowledge of advanced pharmacology, technicians know enough to point out facts such as this. This will not only make patients better users of OTC medications, but likely engender greater trust and loyalty to the pharmacy. There is nothing to suggest that good business practices and effective patient care don’t mix.

Of course, there are other issues that transcend merely optimal use and patients’ simpler questions. Technicians must be educated and trained on when to involve the pharmacist and referring patients to pharmacists even further ensures trust and optimal medication use.

This is particularly the case for issues around proper dosing and potential interactions, which are even more salient for patients who are pregnant, pediatric patients, and those with compromised renal function or immune systems, as even certain OTCs can be problematic for these patients. The important thing is that technicians can serve as an effective liaison between the patient and the pharmacist.

The better that technicians are made aware of how to serve in this capacity, the better they will be at performing these jobs. Some basic knowledge of drug names and ingredients is helpful, but so are communication and triaging skills.

Technicians should become aware of the most commonly abused OTC drugs. These include certain antihistamines, cough medicines, analgesics, laxatives, and decongestants, with analgesics such as ibuprofen and acetaminophen being the most frequently misused drugs.1-3

For example, 1 in 4 patients would exceed the recommended dose of acetaminophen by taking 1 or more OTC products containing it as the active ingredient and thus overdosing.2 Technicians can exercise vigilance when selling OTC drugs in these categories to reduce inappropriate use and informing the pharmacist when a patient purchases 2 medications with the same active ingredient. This is where the technician’s basic knowledge of OTC drugs comes in handy.

Additional methods technicians can address general indicators of OTC misuse and abuse is by being aware of patients who purchase unusually large quantities of a product and taking note of how frequently a patient may come in to purchase the same drug.4 Technicians can keep track of OTC purchases in their patient profiles and bring to the attention of the pharmacist any red flags that may stir caution and oversight.

This raises the issue of documentation and is among the important value-added responsibilities that effective technicians can bring to the table. Although prescription medications inherently become part of the patient’s medication record, it is important for technicians to document patients’ use of OTCs.

Some of this information might become important data in prescription drug monitoring programs (PDMPs). This is not always easy, as OTC purchases might be completed at the front register or might take place during very harried times at the prescription counter.

However, every bit of documentation can help to optimize medication use. And knowing that patients may make OTC purchases elsewhere further underscores the need for effective medication-history taking and use of open-ended questioning by technicians while engaging patients.  

Pharmacy technicians can play an important role in safe and effective use of OTCs by patients. It requires their basic knowledge of drug products, coupled with skills in communication and knowledge of law and ethics, along with effective delegation and training by their pharmacist supervisors.

About the Authors
Ashley Saclolo, MS, is PharmD Candidate at Touro University California College of Pharmacy.
Shane P. Desselle, RPh, PhD, FAPhA, is professor of Social/Behavioral Pharmacy at Touro University California College of Pharmacy.

References
  1. Sansgiry S, Bhansali A, Bapat S, Xu Q. Abuse of over-the-counter medicines: A pharmacist’s perspective. Integrated Pharmacy Research and Practice. 2016. 6:1-6. doi:10.2147/iprp.s103494.
  2. Wolf MS, King J, Jacobson, K, Di Francesco L, Bailey SC, et al. Risk of unintentional overdose with non-prescription acetaminophen products. Journal of General Internal Medicine. 2012;27(12):1587-1593.
  3. Kaufman DW, Kelly JP, Battista DR, Malone MK, Weinstein RB, Shiffman S. Exceeding the daily dosing limit of nonsteroidal ant inflammatory drugs among ibuprofen users. Pharmacoepidemiol Drug Saf. 2018;27(3):322-331.
  4. Halasi S. Misuse of OTC products. Retrieved May 21, 2020, from https://www.canadianhealthcarenetwork.ca/files/2009/10/tt_ce_e_apr_may07.pdf.