“The Most High-Risk People are Given the Most High- Risk Drugs in the Most High-Risk Way”: Experiences of Treating Problematic Over the Counter and Prescription Only Medication Use in Substance Misuse Services

Misuse of over the counter (OTC) and prescription only medicines (POM) is increasingly recognised as a public health and medicines safety concern. Pharmacists and specialist substance misuse services (SMS) are often the first to encounter emerging patterns of problematic use, yet little is known about SMS staff experiences in supporting affected adults. This study explored their experiences to inform pharmacy focused practice and policy. Ethical approval was obtained. Confidential semi structured interviews were conducted with staff across five community adult English SMS. Audio recordings were transcribed verbatim and analysed thematically using NVivo®. Twenty interviews with varied professionals achieved data saturation. Three overarching themes emerged: (1) characteristics of OTC/POM misuse; (2) distinct groups of people affected; and (3) negative experiences and concerns. Dependence on orally administered opioids (particularly co-deine containing products) benzodiazepines and gabapentinoids predominated. Polypharmacy including illicit substance use was also reported. Withdrawal symptoms frequently perpetuated misuse, and abrupt supply cessation created additional risks. Routine enquiry about OTC/POM misuse and provision of tailored harm reduction inter-ventions are essential. Findings highlight opportunities for enhanced pharmacist in-volvement in early identification and medicines optimisation. Further research should examine whether dedicated OTC/POM pathways are required and explore differences in demographic and treatment needs across medicine types.