Pharmacists' Experiences With Cases of Suspected Drug Misuse: A Cross-Sectional Study

Medication misuse is a major public health concern, with community pharmacies playing a vital role in addressing it. This study assessed Swiss pharmacists' awareness, experiences, risk factors, and knowledge gaps regarding potential drug misuse cases.

An electronic survey was sent to the Swiss Pharmacists Association (pharmaSuisse) members and to 23 cantonal pharmacists' associations individually. The anonymous SurveyMonkey® survey covered pharmacists' demographics, pharmacy characteristics, suspected frequently misused substances and profiles of potential persons with a substance use disorder. Data were analyzed using the complete case approach. Univariable tests and multivariable regression models investigated potential predictors of suspected misuse rates.

Of 1560 pharmacies, 188 (12%) responded with 207 pharmacists participating (64% <51 years, 78% women). All 198 responders (100%, 198/198) indicated suspicion of misuse cases throughout their career, with 47% (85/181) reporting >6 suspected cases in the past 3 months. Benzodiazepine-like anxiolytics and sedatives (80%, 151/188), as well as nasal decongestants (63% 117/186) and opioids (50%, 92/186), were reported as the most frequently suspected substances. Potential persons with a substance use disorder were described by the majority as independent of sex (90%, 163/181) and age (69%, 126/182). Commonly reported signs of suspected misuse were repeated visits (94%, 176/188), refusal of alternatives (78%, 146/188), and request for larger quantities (76%, 142/188). No significant differences were found between the number of suspected cases in the past 3 months based on pharmacists' characteristics (age, sex, education, position), pharmacy's location (eg, city/countryside), or additional services (eg, night shifts).

Virtually all participants reported suspected medication misuse, albeit in varying frequencies. Anxiolytics/sedatives, nasal decongestants, and opioids were the most common classes reported to be subject to potential drug misuse. Guidelines for handling suspected misuse cases are needed, informed by further research using structured data beyond pharmacist-reported incidents, such as pharmacy dispensing records, and hospital or emergency department data.