Community Pharmacists' Challenges with Non-Codeine OTC Cough Syrup Abuse Among Nigerian Youths

Non-prescription cough syrups containing active ingredients like diphenhydramine and dextromethorphan are widely available in Nigeria without a prescription. However, their misuse among youths aged 15-35 is a growing public health issue. This study surveyed 45 community pharmacists in Lagos, Ogun, Ondo, Rivers, and Abuja to understand their challenges in addressing this problem (response rate: 75%, 45 out of 60 invited). Results show that 66.7% of pharmacists often or sometimes see youths buying large quantities of these syrups, with diphenhydramine linked to 77.8% of suspected abuse cases. Common signs of misuse include purchasing multiple bottles (66.7%) and suspicious behaviour during sales (66.7%). Pharmacists face barriers such as regulations allowing over-the-counter (OTC) sales (44.4%), fear of losing customers (11.1%), and feeling they lack authority to refuse sales (22.2%). While 44.4% regularly counsel youths on misuse risks, none reported adverse effects to the National Agency for Food and Drug Administration and Control (NAFDAC). Reasons for not reporting include unclear processes (33.3%) and lack of time (22.2%). Despite challenges, 55.6% of pharmacists feel confident identifying abuse signs. Suggested solutions include stricter regulations (77.8%) and mandatory counselling for young buyers (66.7%). This study highlights the need for better regulations, improved drug monitoring, and more support for pharmacists to tackle this public health challenge.