Awareness and practices of community pharmacists toward dextromethorphan misuse in Jeddah, Saudi Arabia: implications for regulation and public health.

Background: Dextromethorphan (DXM) is an over-the-counter cough suppressant with recognized potential for misuse and abuse when taken at supratherapeutic doses. Community pharmacists are well positioned to identify and prevent such misuse, yet limited data exist from Saudi Arabia regarding their awareness, dispensing practices, and views on regulation. Methods: A cross-sectional survey was conducted among community pharmacists in Jeddah, Saudi Arabia, using a self-administered questionnaire. Descriptive statistics were used to summarize responses, and logistic regression was applied to identify factors associated with perceived increases in DXM sales and the adoption of restriction strategies. Results: A total of 252 pharmacists participated. Most respondents recognized DXM misuse as a local problem (206; 81.8%) and believed sales had increased over the preceding 2 years (131; 52.0%). Peer influence and social media promotion were identified as common drivers of misuse (206; 81.8%). The majority reported adopting restrictive dispensing practices, including refusal to sell to suspected abusers (178; 70.6%), and expressed strong support for tighter legal controls (230; 91.3%) and public awareness campaigns (198; 78.6%). Logistic regression showed that requests for non-OTC DXM products were associated with perceived increases in sales (OR = 2.13; 95% CI = 1.18-3.85; Conclusion: Community pharmacists in Jeddah demonstrated awareness of DXM misuse and recognized the role of social and digital influences in promoting it. Their broad support for regulatory restrictions and preventive campaigns indicates readiness to contribute to public health strategies. Nonetheless, limited confidence in managing suspected cases highlights the need for targeted training and continued research across multiple regions to inform effective regulatory and educational responses.