Community pharmacists' role towards the prevention and management of over- the- counter and perscription- only medicines misuse:A systematic review

The misuse of over the counter and prescription-only medicines is a growing global public health concern, with significant implications for patient safety and healthcare systems. Community pharmacists, due to their accessibility and pharmaceutical expertise, are uniquely positioned to address this issue. This systematic review explores the role of community pharmacists in the prevention and management of over the counter and prescription-only medicines misuse, with a focus on their knowledge, attitudes, barriers, facilitators, and current interventions. <br/><br/>Following PRISMA guidelines, twelve studies were included from diverse geographical contexts, including high-income countries and low- and middle-income countries. Thematic analysis was guided by the COM-B model, categorising findings into Capability, Opportunity, and Motivation. Results revealed widespread misuse of opioids, sedatives, and codeine-based over the counter products, often driven by self-medication, chronic pain, and limited healthcare access. Pharmacists reported significant knowledge gaps, discomfort initiating misuse-related conversations, and fear of litigation. Barriers included time constraints, lack of training, poor interprofessional collaboration, and weak regulatory support. <br/><br/>Facilitators such as real-time prescription monitoring systems, access to electronic medical records, and targeted training were identified as critical enablers. Pharmacist-led interventions included restrictive dispensing, patient counselling, and interprofessional referrals. However, their effectiveness depends on systemic support and policy reform. <br/><br/>This review underscores the need for context-specific, pharmacist-focused strategies—particularly in low- and middle-income countries like Nigeria—where regulatory gaps and resource limitations persist. It advocates for enhanced training, supportive legal frameworks, and integrated care pathways to empower pharmacists as frontline actors in substance misuse prevention. <br/><br/>