Consumers' perceptions about risk of and access to nonprescription medications

Objectives: To examine how consumers balance the principles of safety with regulatory access to pharmaceuticals and to identify respondent characteristics, including prior misuse of nonprescription medications, that are associated with a preference for nonprescription status. Design: Cross-sectional survey within-subject attitudinal analysis. Setting: Large midwestern metropolitan region of the United States. Participants: Convenience sample of 553 members of the general public. Interventions: Anonymous self-administered surveys with hypothetical vignettes in which a heartburn or antihypertensive drug could be available without a prescription but in doing so would entail an increased risk (1/100,000, 1/10,000, or 1/1,000 chance of heart attack) to the user that would not be present with the medical care afforded by prescription drug status. Main Outcome Measure: Proportion of respondents preferring nonprescription availability. Results: Overall, 33%, 19%, and 11% of respondents preferred nonprescription availability when the additional risks of a heart attack with nonprescription availability were 1/100,000, 1/10,000, and 1/1,000, respectively. Risk tolerance did not differ between the heartburn and antihypertensive vignettes. Although preference for nonprescription status was significantly greater among respondents who were men (42% versus 28%) and white (42% versus 32%), and a statistical trend was evident among respondents with higher self-reported health (37% versus 27%) and a college education (36% versus 28%), most of these differences did not persist on multivariate analysis. Conclusion: A substantial minority of the public appears willing to accept considerable risk to gain greater access to pharmaceuticals. Heterogeneity among the general public with regard to how safety and access to nonprescription medications should be balanced challenges policy makers working to design responsive yet appropriate regulatory policies.