OBJECTIVES: Greece goes through a major economic crisis and a reform program, in the context of which an aim is to cut by half drug spending within four years. Expansion of the over-the-counter (OTC) drug list could contribute to the reduction of public spending. Hence, a review was undertaken to investigate the implications of expanding their use. METHODS: Relevant published studies examining the effect of using OTC drugs were identified with search in MEDLINE, EBSCO and PUBMED. The literature search was based on the following terms: Over the counter, OTC, drugs, prescription medicine, Rx, Non Rx, benefit, economic impact, self-care. Studies were included based on the following  criteria: peer-reviewed English-language articles, published from 2000 and over, cited at least in 25 other articles. The selected studies were divided into three groups based on the stakeholder for whom the study had been conducted. RESULTS: For patients, the shift of drugs from prescription to OTC status leads to increased access, greater utilization, reduced traveling cost and physician payments, increases in productivity and drug expenditure. The switch reduces public spending on drugs and physician visits. However, the expansion of the OTC list may in certain cases be associated with risks and negative effects on health outcomes, if patients are not well informed regarding the ways of responsible self-medication. Finally, the literature review revealed that patients are more likely to prefer a, more expensive, prescription drug from a cheaper but similar in effectiveness non-prescription one if both are available. CONCLUSIONS: It is evident that the greater use of OTC drugs may improve access, convenience, service, health outcomes and patient satisfaction and may reduce the expenditures of social insurance, under certain well controlled and designed circumstances. In particular the drugs need to be carefully selected and the patients and pharmacists well informed and trained on responsible self-medication.