Over‑the‑Counter Opioid‑Containing Antitussives in Derna, Libya: A Cross‑sectional Survey of Pharmacy Sales and Misuse Indicators

• Abdelaziz H. Bennasir

  Department of pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, University of Derna, Derna, Libya

  Author

• Maka A. Alokaly

  Department of pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, University of Derna, Derna, Libya

  Author

• Hadeel R. Mahfouz

  Department of pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, University of Derna, Derna, Libya

  Author

• Albatoul A. Eldressi

  Department of pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, University of Derna, Derna, Libya

  Author

Over‑the‑counter (OTC) antitussives that contain opioid or opioid‑like compounds (notably codeine and dextromethorphan) are readily available in many communities, creating potential for misuse and dependence. In Derna, Libya, anecdotal evidence suggested heavy local use of certain OTC cough preparations.  To describe the availability and sales patterns of common OTC antitussives in Derna pharmacies and to identify local indicators of misuse or non‑therapeutic use.  A structured, anonymous questionnaire was administered to pharmacy staff across Derna between November and December 2022. The instrument focused on the most sold OTC antitussives, typical purchaser demographics, quantities requested, selling times, and whether staff treated suspected abusers differently. Data were entered and analyzed using SPSS; descriptive statistics are presented.  Seventy‑nine pharmacies participated (response rate 79%). The most commonly reported product sold was Tusskan (76/79, 96.2%), while codeine‑containing preparations accounted for 3/79 (3.8%). Purchasers were predominantly male (77/79, 97.5%); the majority were aged 31–45 years (56/79, 70.9%), with the remainder aged 15–30 years (23/79, 29.1%). Most pharmacists (68/79, 86.1%) reported higher sales in the evening. More than half of purchasers requested more than two packets per visit (41/79, 51.9%). At the pharmacy level, daily sales most often reached five bottles (56/79, 70.9%), and monthly sales were commonly reported as ≥ 50 bottles (79/79 combined: 46 reported 50, 33 reported >50). Only 11/79 (13.9%) of pharmacists said they dealt with suspected abusers the same way as other customers.  Signals consistent with non‑medical use high sales volume of a single product (Tusskan), frequent evening purchases, predominantly male adult users requesting multiple packets were observed in Derna. These findings underscore the need for improved local surveillance, pharmacist training in identification and management of OTC misuse, public education, and consideration of regulatory measures for high‑risk OTC antitussives

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