Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

© 2021 Schifano, Chiappini, Miuli, Mosca, Santovito, Corkery, Guirguis, Pettorruso, Di Giannantonio and Martinotti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). https://creativecommons.org/licenses/by/4.0/Background: Over the past 20 years or so the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications and decongestants, are reportedly the most popular in being diverted and misused. Objective: Whilst the current related knowledge is limited, the aim was here to examine the published clinical data on OTC misuse, focusing on: antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate); dextromethorphan (DXM)- and codeine-based cough medicines; and the nasal decongestant pseudoephedrine. Methods: A systematic literature review was carried out with the help of Scopus; Web of Science databases; and the related grey literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261). Results: After completion of the selection, eligibility and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organised according to the specific OTC recorded. Most articles focussed here on DXM (n=54) and diphenhydramine (n=12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported. Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant and ad hoc preventative actions should be designed and implemented.Peer reviewe

New Psychoactive Substances and Suicidality: A Systematic Review of the Current Literature

Submitted 23 April 2021. Minor revisions requested 31 May 2021. Revisions submitted 3 June 2021. Accepted 3 June 2021. Epub 6 June 2021.Background and Objectives: Over the past twenty years a large number of New Psychoactive Substances (NPS) has entered and modified the recreational drug scene. Their intake has been associated with health-related risks, and especially so for vulnerable populations such as people with severe mental illness, who might be at higher risk of suicidality or self- injurious behaviour. This paper aims at providing an overview of NPS abuse and effects on mental health and suicidality issues, performing a literature review of the current related knowledge, thereby identifying substances that more than others are linked to suicidal behaviours. Materials and Methods: A comprehensive and updated overview of the literature regarding suicidality and NPS categories has been provided. An electronic search was performed, including all papers published up to March 2021, using the following keywords "NPS" OR "new psychoactive substances" OR "novel psychoactive substances" OR "synthetic cannabinoids" OR "phenethylamines" OR "synthetic cathinones" OR “tryptamines” OR “piperazines” OR “new synthetic opioids” OR “designer benzodiazepines”) AND ("suicide" OR "suicidality") NOT review NOT animal on the PubMed, Cochrane Library, and Web of Science online databases. Results: Suicidality and self-injurious behaviour appear to be frequently associated with some NPS such as cathinones, synthetic cannabinoids, and new synthetic opioids. Results are organised according to substances recorded. Conclusion: The growing use of NPS has become a significant clinical issue, posing increasing concern and challenges for clinicians working in both mental health and emergency departments. Thus, considering the associations between NPS and suicidality or self-injurious behaviours, areas where suicide-prevention efforts and strategies might be focused are the early detection, monitoring and restriction of NPS.Peer reviewe