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\begin{document}

\title{\textbf{Medicine misuse: a systematic review and proposed hierarchical
terminology}}



\author[1]{Allison Singier}%
\author[1]{Pernelle Noize}%
\author[2]{Driss Berdai}%
\author[2]{Amelie Daveluy}%
\author[1]{Mickael Arnaud}%
\author[2]{mathieu Molimard}%
\author[1]{Bernard Begaud}%
\author[1]{Francesco Salvo}%
\affil[1]{University of Bordeaux}%
\affil[2]{CHU de Bordeaux Service de Pharmacologie Medicale}%


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  \date{May 22, 2024}


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\begin{abstract}
\textbf{Aim:} Although medicine misuse is a public health issue, it has
multiple meanings in the medical literature. This study aimed to
characterize, classify and identify the most appropriate definitions of
medicine misuse. \textbf{Methods:} A systematic review was performed in
Medline, ISI Web of Science, SocINDEX, PsycInfo, PsycArticles, and
Psychological and Behavioral Sciences Collection, using keywords related
to \emph{misuse}, \emph{appropriateness}, and \emph{medicine} between
November 1st, 2008 and November 1st, 2018. Additional searches were
conducted in websites of regulatory agencies and public health
institutions. Two authors independently selected studies providing both
definitions and examples of misuse, while a third resolved
disagreements. Definitions were used to propose a hierarchical
classification based on initiator, intent, purpose, and context of
medicine misuse. The study is registered on PROSPERO: CRD42018115789.
\textbf{Results:} Of 2,901 identified records, 44 were included. A total
of 63 definitions and 60 examples of misuse were retrieved. When the
prescriber is \emph{initiator} and according to \emph{intent}, potential
medicine misuse referred to ``intentional or unintentional prescribing
not in line with clinical evidence''. Based on \emph{context}, he could
prescribe medicines not clinically justified, i.e. ``overprescribing'',
or prescribe indicated medicines incorrectly, i.e. ``misprescribing''.
Among other groups of definitions, those overlapping with drug abuse or
medication use errors were considered out-of-scope. \textbf{Conclusion:}
This systematic review provides a comprehensive overview of the terms
and definitions used to characterize medicine misuse and could serve as
a basis for a terminology that makes clear distinctions between
\emph{misuse}, \emph{abuse}, and \emph{errors}.%
\end{abstract}%



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