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A growing body of evidence suggests that criminal activities associated with drug trafficking networks are a progressively important driver of forest loss in Central America. However, the scale at which drug trafficking represents a driver of forest loss is not presently known. We estimated the degree to which narcotics trafficking may contribute to forest loss using an unsupervised spatial clustering of 15 spatial and temporal forest loss patch metrics developed from global forest change data. We distinguished anomalous forest loss from background loss patches for each country exhibiting potential 'narco-capitalized' signatures which showed a statistically significant dissimilarity from other patches in terms of size, timing, and rate of forest loss. We also compared annual anomalous forest loss with the number of cocaine shipments and volume of cocaine seized, lost, or delivered at country- and department-level. For Honduras, results from linear mixed effects models showed a highly significant relationship between anomalous forest loss and the timing of increased drug trafficking (F = 9.90, p = 0.009) that also differed significantly from temporal patterns of background forest loss (t-ratio = 2.98, p = 0.004). Other locations of high forest loss in Central America showed mixed results. The timing of increased trafficking was not significantly related to anomalous forest loss in Guatemala and Nicaragua, but significantly differed in patch size compared to background losses. We estimated that cocaine trafficking could account for between 15% and 30% of annual national forest loss in these three countries over the past decade, and 30% to 60% of loss occurred within nationally and internationally designated protected areas. Cocaine trafficking is likely to have severe and lasting consequences in terms of maintaining moist tropical forest cover in Central America. Addressing forest loss in these and other tropical locations will require a stronger linkage between national and international drug interdiction and conservation policies.

Background: The safety of pharmacotherapy for geriatric patients is an essential aspect of the demographic perspective in view of the increasing size of this population. Non-opioid analgesics (NOAs) are among the most popular and often overused over-the-counter medications (OTC). The reasons for drug abuse are common in the geriatric population: musculoskeletal disorders, colds, inflammation and pain of various origins. The popularity of self-medication and the ability to easily access OTC drugs outside the pharmacy creates the danger of their misuse and the incidence of adverse drug reactions (ADRs). The survey included 142 respondents aged 50–90 years. The relationship between the prevalence of ADRs and the NOAs used, age, presence of chronic diseases, and place of purchasing and obtaining information about the mentioned drugs were evaluated. The results of the observations were statistically analyzed using Statistica 13.3. The most commonly used NOAs among the elderly included paracetamol, acetylsalicylic acid (ASA) and ibuprofen. Patients consumed the medications for intractable headaches, toothaches, fevers, colds and joint disorders. Respondents indicated the pharmacy as the main location for purchasing medications, and the physician as the source of information for selecting the therapy. ADRs were reported most frequently to the physician, and less frequently to the pharmacist and nurse. More than one-third of respondents indicated that the physician during the consultation did not take a medical history and did not ask about concomitant diseases. It is necessary to extend pharmaceutical care to geriatric patients that includes advice on adverse drug reactions, especially drug interactions. Due to the popularity of self-medication, and the availability of NOAs, long-term measures should be taken to increase the role of pharmacists in providing effective, safe health care to seniors. We are targeting pharmacists with this survey to draw attention to the problem of the prevalence of selling NOAs to geriatric patients. Pharmacists should educate seniors about the possibility of ADRs and approach patients with polypragmasy and polypharmacy with caution. Pharmaceutical care is an essential aspect in the treatment of geriatric patients, which can contribute to better results in their existing treatment and increase the safety of medication intake. Therefore, it is important to improve the development of pharmaceutical care in Poland in order to enhance patient outcomes.

Depression is a growing public health problem in the European Union (EU), with many individuals turning to self‐medication (SM) to manage their symptoms. This cross‐sectional study uses data from the third wave of the European Health Interview Survey (EHIS; 2018–2020) to examine the prevalence and determinants of SM among people with recognized depression and depressive symptoms. A total of 25,701 respondents were analyzed. Prevalence of SM among individuals with recognized depression and symptoms of depression in the EU is 38.46% in men and 46.84% in women, varying considerably between countries. An important finding of this study is the impact of medication availability, with access to over‐the‐counter (OTC) medications outside of pharmacies nearly doubling SM likelihood (adjusted odds ratio [AOR] = 1.98). Additionally, the results reveal marked differences in how these men and women self‐medicate. Specifically, women are more likely to self‐medicate with depressive symptoms versus recognized depression (AOR = 1.28), whereas the opposite is observed in men (AOR = 0.69). Among women, younger age groups with depression symptoms are particularly likely to self‐medicate (15–24 AOR = 1.60; 25–44 AOR = 1.93) and the results reinforce education as a strong predictor of SM (higher education vs. no education AOR = 5.63). Visits to medical/surgical specialists are also linked to SM in women (AOR = 1.32). This study also highlights potentially concerning relationships between SM and alcohol use in men with recognized depression (AOR = 1.42) and prescribed medicine (AOR = 1.68). Differences are also observable in the effect of employment on SM (AOR = 1.45) in men with depression symptoms and women with recognized depression. In contrast, physical activity (PA; high vs. low AOR = 1.32) and healthcare barriers (distance/transportation issues AOR = 1.89 in women; AOR = 1.55 in men, inability to afford care AOR = 1.38) display similar positive associations in men and women. Taken together, these findings underscore the complex and multifaceted nature of SM and point to potential gaps in depression care across the EU, emphasizing the need for gender‐sensitive public health strategies and a closer look at OTC medication access.

Background Croatia is one of the European Union (EU) countries where low-dose codeine products (LDCP) can be purchased over the counter (OTC) directly from community pharmacists without a prescription. The misuse and dependence potential of OTC LDCP have raised growing public health concerns. As the first point of contact for patients seeking these medications, pharmacists play a critical role in identifying misuse and implementing harm-reduction strategies. However, little is known about the experiences and perspectives of pharmacists in Croatia regarding codeine addiction. This study aimed to examine the experience of pharmacists in Croatia with patients addicted to over-the-counter codeine and their attitudes toward potential remediation strategies. Methods A cross-sectional study was conducted between October 18, 2021, and December 23, 2021. Eligible participants were pharmacists, members of the Croatian Chamber of Pharmacists, employed in community pharmacies in Croatia. The data were collected via an online questionnaire that examined the attitudes and experiences of pharmacists in Croatia regarding OTC medicines containing codeine and the demographic characteristics of pharmacists. Results Out of 2800 active pharmacists in Croatia, 594 participated in the study (21% response rate). The majority (92%) saw patients who regularly purchased high quantities of OTC products containing codeine and for whom pharmacists suspected they could be addicted to this medicine. Most participants occasionally talked to patients about possible codeine abuse and addiction. Two-thirds of participants did not report suspected adverse reactions associated with OTC codeine use to the national pharmacovigilance system, despite patients indicating a potential link. More than half of the participants noted that codeine-containing medicines should be switched from OTC to prescription-only status. Conclusions This study showed that 92% of pharmacists in Croatia encountered patients who may be misusing or are dependent on OTC codeine products. However, they indicated limited engagement in formal reporting or intervention. The findings highlight the need for more precise guidelines, enhanced pharmacist education, and consideration of regulatory changes, such as reclassifying codeine-containing medicines to prescription-only status, to support pharmacists in mitigating risks associated with codeine misuse.

Purpose In recent years, the misuse of over‐the‐counter (OTC) medications has been increasing in psychiatric clinical settings in Japan. This study aimed to compare individuals who misuse codeine (COD) with those who misuse dextromethorphan (DXM) to clarify the clinical characteristics of DXM misusers and to consider the support measures needed for this population. Methods We used data from the 2024 National Survey on Drug‐Related Disorders in Psychiatric Inpatient Facilities. Individuals who primarily misused OTC containing COD (COD group) and DXM (DXM group) were extracted from the database. We examined demographic characteristics, ICD‐10 subcategories, and comorbid psychiatric disorders and compared the two groups using Fisher's exact test. Factors associated with DXM misuse were further analyzed using multivariable logistic regression. Results The study included 160 individuals in the COD group and 72 in the DXM group. Compared with the COD group, the DXM group had higher proportions of females and younger individuals, as well as higher rates of drug use within the past year and a history of self‐harm or suicide attempts. The DXM group also showed significantly higher comorbidity rates of “acute intoxication” and “mood disorders (F3)” based on ICD‐10. In the multivariable logistic regression analysis, younger age (AOR = 2.558, 95% CI: 1.218–5.371), acute intoxication (AOR = 2.73, 95% CI: 1.254–5.942), and comorbid mood disorders (AOR = 2.201, 95% CI: 1.146–4.227) were significantly associated with DXM misuse. Conclusion These findings highlight the importance of acute‐phase management, assessment of comorbid psychiatric disorders, and interventions that include suicide‐risk evaluation in supporting individuals who misuse DXM. Furthermore, preventive education incorporating perspectives on mental‐health‐focused suicide prevention, as well as regulatory measures for OTC medication sales, are urgently needed. In Japan, DXM abuse among young women has become a significant public health issue.

Background: The need for workplace substance use prevention programmes globally and in South Africa is driven by the growing problem of substance use and the associated burden on the health and welfare of employees, their families and organizations. Substance use, which include the non-medical use of medications (both prescription and over-the counter), remains widespread and is a major cause of mortality and a risk factor for non-communicable diseases (NCDs). Method: Twenty in-depth semi-structured qualitative interviews were conducted with employed women in treatment or shortly out of treatment for the non-medically indicated use of over the counter or/and prescription medications (NMIU). These interviews were conducted face-to face with women residing in the Western and Eastern Cape provinces of South Africa. Thematic analysis using NVIVO was used to analyse data collected. Results: The findings from this study suggest that previous use of legal or illegal substances and challenging life experiences underpin pathways to the non-medical use of over-the-counter and prescription medications among employed women. Factors found to contribute to misuse relate to a lack of understanding on risks, and health professional prescribing practices, while mitigators to harmful use were related to increased awareness and understanding harmful practices, the need for improved access and referral to specialist treatment as well as prevention programmes for women. Conclusion: With the improved understanding of the issues surrounding the NMIU of over-the-counter and prescription medications among employed women, the need for interventions to prevent misuse and inadvertently dependency is highlighted.

BackgroundOver-the-counter medications (OTC) are safe and effective when patients follow the patient’s information leaflet (PIL) instructions and/or the instructions given by healthcare professionals (HCPs). However, OTC medications could be harmful and unsafe when individuals do not follow the given instructions and/or when their understanding about the proper use of OTC medications is incorrect. This study aimed to investigate the knowledge and perceptions of people regarding paracetamol use in the Republic of Cyprus.MethodsThis cross-sectional study, which belongs to quantitative research methods, included participants visiting community pharmacies in the following three cities of the Republic of Cyprus: Nicosia, Limassol and Larnaca. Participation in the study was voluntary and anonymous. Participants responded to the survey-based questionnaire, which concerned their knowledge and views on paracetamol use. After the data collection, responses were tabulated and analysed statistically.ResultsThe original compound was shown to be more well-known compared to generics. A notable percentage of respondents—ranging between 13.0% (N = 49) and 29.8% (N = 112)—answered incorrectly that broadly used non-steroidal anti-inflammatory drugs (NSAIDs) contain paracetamol. Furthermore, a remarkable percentage of respondents (71.5%, N = 269 and 50.3%, N = 189, respectively) falsely believed that two widely used combination products in the market of Cyprus (Paracetamol and Hyoscine-N-butylbromide; Paracetamol and Codeine and Caffeine) did not contain paracetamol. A notable percentage of participants (27.6%, N = 100) believed that paracetamol causes low toxicity. More than a third of the respondents (40.2%, N = 149) drink alcohol together with or slightly after consuming paracetamol products. This viewpoint was linked with the participants’ attitude towards consuming paracetamol medications after drinking alcohol (OR for consuming alcohol versus not consuming alcohol 0.100, 95% CI 0.044–0.225, p = 0.000).ConclusionsTo the best of our knowledge, this is the first study conducted in the Republic of Cyprus on this topic. Paracetamol is frequently consumed by individuals, both in its generic and original forms. However, the study showed that respondents often misperceive NSAIDs and paracetamol-containing medications. In addition, it is identified that there is a lack of education among people about the safe and effective use of paracetamol, namely, indications, potential side effects, maximum daily dose, alcohol consumption, and the potential risks of hepatotoxicity. The study contributed to the current published literature as it showed that there is a significant public health issue, for which appropriate measures can be established by the respective Authorities of Cyprus.

Background Dependence to prescription and over-the-counter (OTC) drugs represents an increasing public health and clinical problem both in England and internationally. However, relatively little is known about those affected, particularly in relation to their management at drug dependence treatment centres. This study aimed to explore the views and experiences of health care professionals (HCPs) working in formal drug treatment services in relation to supporting clients with prescription and OTC drug dependence. Methods An exploratory, qualitative design was used involving semi-structured telephone interviews. 15 staff were recruited using purposive sampling to represent a variety of different professional roles, funding (NHS, charity and local government) and geographical locations across England. Transcribed interviews were analysed using Braun and Clarke’s six stage thematic analysis. Results Current services were considered to be inappropriate for the treatment of OTC and prescription drug dependence, which was perceived to be a significantly under-recognised issue affecting a range of individuals but particularly those taking opioid analgesics. Negativity around current treatment services involved concerns that these were more suited for illicit drug users and this was exacerbated by a lack of specific resources, funding and commissioning. There was a perceived variation in service provision in different areas and a further concern about the lack of formal treatment guidelines and care pathways. Participants felt there to be stigma for affected clients in both the diagnosis of OTC or prescription drug dependence and also attendance at drug treatment centres which adversely impacted service engagement. Suggested service improvements included commissioning new specific services in general practices and pain management clinics, developing national guidelines and care pathways to ensure equal access to treatment and increasing awareness amongst the public and HCPs. Conclusions This study reveals considerable negativity and concern about current treatment services for prescription and OTC drug dependence in England from the perspective of those working in such services. Policy and practice improvement are suggested to improve outcomes for this neglected group in relation to increasing funding, guidelines and awareness.

In recent years, the non-medical use of prescription drugs (without a doctor’s prescription) has increased dramatically. Less attention has been paid to the intentional misuse of over-the-counter (OTC) medications. Misuse of OTC medications has negative health consequences similar to those of illicit drugs, including psychosis, tachycardia, seizures and agitation. When mixed with alcohol or other drugs, these medications can also be dangerous: OTC-related emergency room visits increased 70 % from 2004 to 2008. This study examined the intentional misuse of OTC medications, the non-medical use of prescription drugs, the use of alcohol and illicit drugs, and psychological factors in two samples of young adults (ages 18–25) from different areas of the United States (Total N = 1,197). Overall, 18.6 % of the Colorado sample and 13.0 % of the Virginia sample reported lifetime misuse of an OTC medication. Participants who reported misusing OTC medications were also significantly more likely to report using marijuana, ecstasy, cocaine, and non-medical use of prescription analgesics, stimulants, anxiolytics, and sedatives. Participants who reported misusing OTC medications were more than twice as likely to report hazardous alcohol use, relative to individuals who denied misusing OTC medications. Individuals who had misused OTC medications scored significantly higher in sensation seeking and hopelessness and reported more symptoms of depression, anxiety, and somatic distress, relative to those who denied OTC misuse. Results suggest that a considerable minority of young adults are jeopardizing their health with the misuse of OTC medications as part of a pattern of polysubstance use.

To date, there have been few surveys of psychotropic and antiepileptic drug (AED) prevalence in individuals with autism-spectrum conditions. We surveyed 747 families in the Autism Society of Ohio regarding the use of psychotropic drugs, AEDs, and over-the-counter (OTC) preparations for autism. In all, 417 families (55.8%) replied. A total of 45.6% were taking some form of psychotropic agent (including St. John's wort and melatonin), whereas 11.5% were taking AEDs, and 10.3% took OTC autism preparations. The most common psychotropic agents included antidepressants (21.6%), antipsychotics (14.9%), antihypertensives (12.5%), and stimulants (11.3%). Some 51.6% were prescribed psychotropic drugs or AEDs, and 55.4% took psychotropic drugs, AEDs, or autism supplements. Demographic variables frequently found to be associated with medication use included greater age, more severe autism, more severe intellectual handicap, and housing outside the family home. Whereas there is empirical support for the use of some of these psychotropic agents in autism, others are being prescribed with minimal research support. OTC autism preparations were used in substantial numbers of individuals, despite limited research support and the possibility of toxic effects.