Opthalmic drug abuse and misuse in Jordan: An Observational Study from Community Pharmacies in Amman.

Background: There has been a trend in the past five years in Jordan for ophthalmic anticholinergic preparations to be misused or abused. This is done mainly to experience mental altering effects such as mood changes, euphoria or hallucinations. Such products are mostly obtained from community pharmacies without a prescription. Objectives: This study aimed to observe the requests of ophthalmic preparations in community pharmacies in Amman, Jordan, and evaluating the most popular and frequently requested ophthalmic drops suspected of abuse. Also, it aimed to describe the current methods that Jordanian community pharmacists use to manage such requests. Methods: A prospective cross-sectional observational study was conducted between November 2016 and January 2017 at sixteen different community pharmacies in Amman. All ophthalmic products requested were observed during this period. Results: A total of 140 ophthalmic product requests for 130 customers were observed. Dry eye was the most common complaint for which the customer requested the medication (n = 30, 23.1%) and direct self-medication (ie-requesting the product by name), was the most frequent method of purchase (n = 63, 48.5%). In 19 cases (14.6%), product requests were suspected to be for non-medical (ie-abuse) purposes. Most of the suspected cases were for Pentolate® (n = 11, 57.9%), whereas 7 were for Prisoline® (36.8%) and 1 for Naphcon-A® (5.3%). The majority of observed cases were for products requested without a prescription (n = 16, 84.2%), and in 12 cases out of which, sale was refused (63.2%). Conclusion: More effort and enforcement of pharmacy regulation for safe dispensing is needed to reduce the abuse of ophthalmic products. Educating pharmacists and ophthalmologists would help raise awareness and control the type of drug abuse

The Misuse and Abuse of Ophthalmic Preparations:a Scoping Review of Clinical Case Presentations and Extant Literature

The emergent trend of misuse and abuse of ophthalmic drugs is a public health concern. Common ophthalmic preparations contain anticholinergics, antihistamines, decongestants, anesthetics, and vasoconstrictive and topically applied nonsteroidal anti-inflammatory drugs. Misuse and abuse relates to their effect in causing euphoria, relaxation, hallucination, and reduction of depression symptoms. A scoping review of literature was conducted using Arskey and O’Malley (International Journal of Social Research Methodology 8(1):9–32, 2005) framework for mapping extant literature on the current knowledge of the issue. Four themes emerged: abuse of cycloplegics and mydriatics, misuse and abuse of topical ophthalmic anesthetics, misuse of topical ophthalmic vasoconstrictive and topically applied nonsteroidal anti-inflammatory drugs (NSAIDs), and public and pharmacist views on ophthalmic drug abuse/misuse. The review underscores the complex motives for misuse and abuse, availability of ophthalmic products, self-medication practices, presence of co-morbidities, and low public awareness which harms the important role of health professionals regarding suspected misuse of these common products

Ophthalmic Drug Abuse: Knowledge, Attitude, and Practice of Ophthalmologists in Jordan

This study was conducted to provide a background regarding knowledge, attitude and practice (KAP) of ophthalmologists in Jordan regarding ophthalmic products abuse and misuse. A cross-sectional self-reported survey was conducted among a sample of ophthalmologists of all ranks who were working at different hospitals, centers and clinics in Jordan. A total of 137 valid questionnaires were returned (response rate = 69.1%). The majority of respondents were male (73.7%) and between 20 and 40 years old. Only 47.4% of our sample knew the correct difference between the definitions “abuse” and “misuse”. The majority of participating ophthalmologists (87.6%) reported that ophthalmic drugs were liable to abuse. Ophthalmologists 40 years or younger had more knowledge about ophthalmic products abuse than their older counterparts (p<0.05). Most ophthalmologists (67.2%) reported Pentolate® eye drop (Cyclopentolate) as the top ophthalmic product liable to abuse. This study provided, for the first time, background regarding the knowledge, attitude and practice of ophthalmologists about this relatively uncommon and alerting type of drug abuse. Moreover, it highlighted the importance of increasing awareness of ophthalmologists and community pharmacists who dispense such drugs about the issu

Perspectives of frontline professionals on Palestinian children living with sibling and parental drug use in the UNRWA camps, Jordan

Context: The occupied Palestinian territories (oPt) consists of the non-contiguous West Bank including East Jerusalem and the Gaza Strip. It is densely populated within these confines, and has a unique socio-economic context characterized by political and economic tensions. Around 2.2 million Palestinians are displaced and living in the ten UNRWA refugee camps in Jordan. Palestinian communities are exposed to a double burden of disease caused by the severe economic, social and health consequences of Israeli occupation and resultant displacement. Exposure to political violence, economic hardship, fragmentation of Palestinian families, unemployment, trauma and community stress underpin a reported rise in drug abuse.. Method: A qualitative study using focus groups (n=3) with a convenience sample of health care and educational professionals was conducted in two UNRWA camps (Al-Zarka, Al-Wehdat) in Jordan. Guided discussions explored the experiences of these professionals in working with Palestinian families and children affected by substance/drug use and drug use disorder in the home. Data were analysed using thematic analysis (TA). Results: Five themes emerged from the TA. These were: 1)Access to drugs was perceived to be relatively easy in the camps; 2) Attitudes towards drugs appear to have desensitised, yet stigma persists; 3) Families of drug users are affected by fear, social and economic poverty, with significant physical and psychological cost to children; 4) Causes of substance/drug use in Palestinian communities living in Jordanian UNRWA camps is multifactorial; 5) Solutions are multi-faceted and indicative of the need for prevention and support for those at risk, and affected. Conclusions: Threats to UNRWA from the current political climate and the reducing investment in services may exacerbate this public health and security issue. For an evidence based approach to have credibility in the camp communities, there is a need for accurate, factual information, along with robust epidemiological data, relating to the extent, characteristics and harms associated with drug use