Over-the-counter, or OTC, medications are those that can be purchased at places like supermarkets and pharmacies without needing any kind of prescription or doctor approval. OTC drugs are generally affordable and able to be accessed 24 hours a day depending on the store these medications available in.
How Are OTC Drugs Defined?
The term can often be a little confusing since OTC drugs are typically stocked on self-service shelves, whereas prescription medications need to be passed “over the counter” from the pharmacist to the customer.
There are also medications that fall in-between prescription and over-the-counter, usually referred to as restricted over-the-counter substances.
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This means that even though they are legally classified as OTC, they are kept “behind the counter” and, while someone does not need a prescription to purchase them, they may need to be over the age of 18, provide a valid form of ID, or can only be given a limited quantity of the medication.
According to the Consumer Healthcare Products Association, as of 2015, the average American household was reported as spending roughly 338 dollars a year on OTC medication, and, as of 2018, 81 percent of adults in the United States use OTC drugs as their first line of treatment for minor illnesses.
While all OTC medications are legitimately useful for colds, allergies, coughs, and other easily treated illnesses, when misused or abused, they can have a wide range of damaging effects. Forms of over-the-counter drug misuse and abuse are typically categorized as:
- Taking a higher-than-recommended dose
- Using them more frequently than the directions call for
- Combining them with substances like alcohol or other drugs
- Doing one or more of these for an extended period of time until a dependency is formed
When it comes to the issue of OTC drug abuse, there are two major factors at work: the first is that because these drugs are so commonplace and don’t need a doctor’s permission, they are perceived as safe and therefore can be misused or abused without serious consequences. And while it’s true that an OTC decongestant is obviously a far cry from illicit drugs like heroin or even prescription medications like Xanax or Oxycontin, it is still possible to fatally overdose on many different OTC medications.
The second factor is accessibility. Like we mentioned above, these drugs are available in most any supermarket, pharmacy, convenience store, and sometimes even gas station, and for the most part, anyone can buy them.
Rather than having to jump through the necessary hoops to get a fraudulent prescription or obtain illicit drugs, anyone can just walk into their local CVS or Walgreens and buy some cough syrup. This also makes them a prime target for abuse by teens and young adults.
It’s always important to follow the labeled directions of intended use on any given medication and be aware of the side-effects and potential interactions with other medicines and substances, no matter if it’s a strictly regimented prescription or an OTC cold medication.
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What are the Most Commonly Abused OTC Drugs?
When it comes to over-the-counter drug abuse, the number of different medications with ingredients that have a potential risk of addiction and damaging effects if misused is much longer than most people might think. However, there are several OTC medications that are among the most commonly abused, as well as some of the most dangerous. The list of frequent offenders includes:
5. Diet Pills
Just because diet pills can be bought over-the-counter doesn’t mean they can’t pose a serious health risk. The danger in weight loss supplements is that they are not regulated by the FDA, which means that the ingredients in them are not subject to inspection and can vary widely. Even if they claim to be “all-natural,” this does not mean they are safe to misuse.
Many diet pills work to increase your metabolism and suppress your appetite by using amphetamines or amphetamine-derived ingredients, such as caffeine or guarana. Diet pills can pose a serious risk of addiction, and once the body is dependent on them and builds up a tolerance, it can lead people to seek out stronger, illegal substances such as cocaine.
Apart from their addictiveness, stimulant-based diet pills can also negatively affect your heart, stomach, and mental health, and when abused can lead to:
- Elevated blood pressure
- Heart palpitations
- Heart attacks
- Anal leakage
- Panic attacks
Though it may sound unlikely, laxatives are frequently abused by people in an effort to quickly lose weight. And while overdosing on laxatives might sound equally unlikely, it is very much possible and comes with a nasty list of side effects, including:
- Abdominal pain
- Muscle weakness
- Slow or shallow breathing
- Coma (although this is much more rare)
4. Motion Sickness Pills
Dimenhydrinate, the active ingredient in OTC medications such as Dramamine, is used to help treat motion sickness and vertigo and has the common side effect of drowsiness. Many teenagers and young adults will take dangerously high doses of Dramamine to experience feelings of sedation, its hallucinogenic properties, and a mild euphoric “high,” mainly because it’s much easier to access than other hallucinogenic substances.
However, abusing dimenhydrinate comes at a high price. Along with the sought-after hallucinatory effects, taking large amounts of dimenhydrinate can cause:
- Irregular or elevated heart rate
- Stomach ulcers
And in the case of overdose, taking too much dimenhydrinate can even prove fatal.
3. Pain Relievers
Ibuprofen is the active ingredient in anti-inflammatory pain medication such as Motrin and Advil. While not necessarily addictive, ibuprofen is generally abused to help people with chronic pain, arthritis, or other joint issues who are unable obtain prescription painkillers or illicit drugs. The side effects of long-term ibuprofen abuse include:
- Stomach bleeding
- Major cardiac issues
- Kidney damage
The active ingredient in OTC pain relief medications like Tylenol, Excedrin, and Midol, acetaminophen is also frequently abused as a means to manage chronic pain. Because Tylenol, for example, is one of the most commonly used medications in the world, people assume that it is safe to misuse. Unfortunately, this is not the case. Long-term use of higher-than-recommended doses of acetaminophen can cause:
- Stomach pain
- Excessive sweating
And has been linked to serious health problems such as:
- High-blood pressure
- Higher risk of stroke
- Digestive tract bleeding
- Kidney disease
- Major liver damage
In fact, acetaminophen is considered by many doctors to be the most dangerous OTC pain relief drug due to the fact that the effective dosage is extremely close to the amount it would take to overdose, making it all-too-easy to accidentally overdose.
Acetaminophen overdose is actually one of the most common reported poisonings and can cause kidney and liver failure, which can be fatal.
Most commonly sold under the brand name Bayer, aspirin is an anti-inflammatory pain medication that works similarly to ibuprofen. It also acts as a blood-thinner, which is why many people also use it to prevent blood clots, which lowers the risk of heart attacks and strokes.
Aspirin has the association of a benign and harmless OTC medication, but it is extremely dangerous for hemophiliacs due to its blood-thinning effects and is not recommended for use by children. While not as commonly abused as the other two medications, like aspirin, it is extremely easy to accidentally overdose on if too much is taken, and is among the most common cause of poisoning in children. Aspirin overdose symptoms can include:
- Dangerously rapid heart rate
While many people may abuse OTC pain relievers to try to deal with their pain out of either desperation or because they are under the mistaken impression that it is safer than abusing prescription painkillers, they can be nearly as dangerous, and in most cases, much more likely to cause an accidental overdose.
2. Allergy Medication and Decongestants
OTC allergy medication is definitely among the most popular choices for a legal high, partially because, depending on what kind of medication you buy, you can experience very different effects.
Today, it is more common to see allergy medications promoting their non-drowsy effects, but some antihistamines such as Benadryl contain diphenhydramine, which is similar to dimenhydrinate, the active ingredient in OTC motion sickness medication, and produces the same sedative effects.
Benadryl and medications similar to it are also often abused in conjunction with prescription benzodiazepine medications like Xanax or Ativan, which can lead to nausea, double vision, and dangerously shallow breathing. The side effects of long-term antihistamine abuse include:
- Liver dysfunction
- Kidney damage
- Major heart problems
Unfortunately, non-drowsy OTC allergy and cold medicine have their own risks, namely, the presence of the decongestant pseudoephedrine.
OTC medications like Sudafed that promise to provide non-drowsy congestion relief do so with pseudoephedrine, a stimulant that shrinks swollen nasal membranes. However, when taken at high doses, it can create feelings of intense excitement and energy, making it a widespread target for recreational misuse. Regular abuse of pseudoephedrine can cause:
- Irregular and elevated heart rate
- High blood pressure
- Shortness of breath
- Chronic abdominal pain
Pseudoephedrine is also a key ingredient in the illicit substance methamphetamine, and was, in previous years, often purchased in bulk in order to manufacture the drug in meth labs.
In order to combat this issue, pharmacies now keep most allergy and cold medications containing pseudoephedrine behind the counter and, while they still do not need a prescription to be purchased, they fall into the restricted OTC category and require a driver’s license or valid ID and signature to buy them, and are usually not sold to anyone under the age of 18.
1. Cough Medicine
Cough medicine is not only one of the most commonly abused OTC medication in the United States, but also perhaps the most dangerous.
Cough suppressants like Robitussin, Theraflu, Delsym, and Nyquil are widely accessible both in stores and in the medicine cabinets of most homes, can be taken as a syrup, tablet, and gel capsule, and when abused can have intense sedative and hallucinatory effects, making them the drug of choice for young people.
The active ingredient in OTC cough medicine that creates these effects is dextromethorphan, or DXM.
DXM is actually an opioid, although it does not provide pain relief or act on the opioid receptors. It does work in a similar way as other opioids in that it blocks the nerve signals to the brain that sends a reflex signal to your muscles that results in a cough.
When misused at large doses it can cause effects comparable to taking ketamine or PCP but is much easier to get ahold of, not even possessing the same restrictions as OTC medications with pseudoephedrine.
While part of the reason that cough medicine with DXM in it is still sold over-the-counter is that it is not supposed to be addictive, repeatedly abusing DXM in large doses to keep experiencing the high can indeed lead to an inability to stop using it despite its damaging consequences, which is the very definition of addiction.
Apart from the sought-after effects of DXM, other short-term effects include:
- Increased sweating
- High blood pressure
- Dangerous elevated heart rate
- Stomach pain
- Anxiety or panic attacks
- Slurred speech
- Impaired motor skills
- Loss of vision
- Full-on blackouts
It is possible to overdose on DXM to the point of requiring medical detoxification, and when it is abused long-term, DXM can cause:
- Severe liver damage
- Memory loss
- Intense and rapid mood swings
And in some extreme cases, a condition known as chemical psychosis, which is described as a total break from reality coupled with an inability to communicate to anyone around you.
What Is Dangerous to Mix with OTC Medication?
OTC medications, especially ones like cough medicine with DXM, can be plenty dangerous enough on their own. However, things can quickly escalate to life-threatening when they are mixed with other substances. Many times it’s not even for the purpose of trying to get high or experience stronger effects, but people do not realize how dangerous OTC drugs can be.
In this case, alcohol is the most frequent culprit. Alcohol already puts a significant strain on the liver, especially when consumed in excess, and acetaminophen, as previously mentioned, can also be responsible for liver problems. Drinking alcohol while also taking OTC medications that contain acetaminophen can cause catastrophic, permanent damage to the liver.
It can be as simple as drinking to excess while taking OTC medication for a cold or even popping some Tylenol the morning after to help with a hangover, but if the alcohol is still in your system, the combination can still do serious damage.
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Common OTC medications that include enough acetaminophen to interact with alcohol and potentially cause liver damage include:
- Alka-Seltzer Plus
You might have noticed something about quite a few of the medications on this list: they’re also cough and cold medicines that contain DXM. DXM is also frequently mixed with alcohol, although this is more often done on purpose with the intent of increasing the effects of both.
Alcohol and DXM are perhaps even more dangerous a combination than acetaminophen and alcohol due to the fact that both DXM and alcohol act as central nervous system depressants, which, when used together in excess, can cause respiratory depression or dangerously slow and shallow breathing. Couple that with increased drowsiness and there is a high risk of death from lack of oxygen.
Who Is Most Vulnerable to Over-the-Counter Drug Addiction?
People who are already suffering from a substance misuse disorder are the most vulnerable to OTC drug abuse.
While anyone is capable of abusing or becoming addicted to OTC medications because they are available to anyone, there are still several key groups who are most vulnerable to the dangers of OTC drug abuse.
If someone is already suffering from an addiction to opioids or other substances that are difficult or dangerous to get ahold of, they are likely to turn to OTC drugs, which are cheap, legal, and easy to obtain, to provide some level of relief for their withdrawal cravings.
This can be especially dangerous because they will already, due to their dependence, have built up a tolerance to whatever stronger substance they were using before, and may not get a strong enough high or pain relief from an OTC medication.
In order to get that same experience that the other drugs were able to provide, they are far more likely to take too much, most likely seeing it as much safer than taking a large dose of an opioid or other substance, and overdosing, potentially fatally.
Seniors are also a group prone to OTC medication misuse that often becomes an addiction. The statistics of substance abuse among older adults are at an all-time high.
While many older adults will abuse prescription medications to treat the physical pain common in senior citizens as well as feelings of loneliness and stress at major lifestyle changes. OTC medications provide an easier route of access and has been seen as safer than abusing prescription drugs.
A danger unique to older adults struggling with over-the-counter drug abuse is that even these seemingly-harmless medications can become deadly when mixed with other medicines that many seniors might already be taking, or if they’re mixed with alcohol, as alcoholism and binge drinking are also becoming far more common among older adults.
Young people are perhaps the most at-risk when it comes to OTC drug abuse. According to the DEA, about one out of every 10 teenagers has abused an OTC medication for the specific purpose of getting at least once in their lifetime.
Over-the-counter medications can provide the same highs of prescription drugs or illicit substances without any of the dangers in having to try and obtain them while also having the misconception of being “safe” to misuse recreationally.
While children and young adults would have a harder time hiding marijuana or other drugs from their parents, most won’t think twice about their child keeping acetaminophen or Nyquil close at hand in their bathroom or bedroom. They might not even notice if the amount of cold medicine or other OTC drugs in the house begins to rapidly diminish. And even if they do notice, parents may not express the same level of concern as if their child was abusing alcohol or hard drugs.
However, their child’s over-the-counter drug addiction should be taken as seriously as if they were abusing other drugs or alcohol because OTC drug abuse can be just as dangerous. Teenagers have and continue to die as a result of DXM overdose, and nearly 80,000 people are sent to the emergency room due to acetaminophen abuse every year, with just under 1,000 people dying from it.
The responsibility to act doesn’t fall only on parents. If you discover that a family member or someone you care about is struggling with OTC drug abuse, take action before it’s too late and, if necessary, seek out professional treatment or an addiction recovery program.
What Are the Signs of Over-The-Counter Drug Addiction?
Being able to spot the signs of an OTC drug addiction before it’s too late can be potentially lifesaving and help to prevent the possibility of a deadly overdose.
While recognizing the hallmarks of OTC medication abuse might be slightly more difficult than other substances because these signs are often more subtle, they are still very similar to the common markers of substance dependency problems among both adults and teens, including:
- Multiple empty medicine bottles in their trash
- Regularly purchasing large amounts of OTC drugs when not medically needed
- Ordering bulk OTC medications online
- Noticeable collections of medicine bottles, packs, or sprays in easy-to-reach locations
- Cold and allergy drugs or pain relievers disappearing from your medicine cabinet
- Medicinal scents or odors on their breath or clothing
- Withdrawal from social situations
- Decline in school or work performance
- Secretive behavior
- Significant changes in appetite
- Disrupted sleep or altered sleep pattern
- A lack of interest in hobbies and activities they previously enjoyed
- Noticeable mood swings and changes in personality
- Impaired motor skills
- Difficulty remembering important things
- Money or valuables suddenly going missing
If you notice these signs in someone, it is highly likely that they are currently abusing OTC medications and may require professional addiction treatment and medical detoxification to mitigate the damaging effects of abuse on their body and mind.
How Can OTC Drug Abuse be Treated and Prevented?
There are several steps involved in the process of treating someone suffering from a dependency on OTC medication. If they are overdosing, then it is imperative that they get immediate medical attention, even if they are overdosing on something that doesn’t seem life-threatening, like Tylenol.
If someone is overdosing on DXM, because it is still technically an opioid, it can be treated with a different OTC medication, the opioid overdose reversal drug Naloxone, generally sold under the brand name Narcan. Narcan can be purchased with about the same ease as an OTC medication with DXM, making it an incredibly useful life-saving tool if someone is overdosing on DXM.
The next step, if someone is not overdosing or if the danger of an overdose has passed, is to undergo medical detoxification and flush the drug from their system. This might not be necessary in the case of every OTC medication, but some, including DXM and diet pills, can have an uncomfortable withdrawal process with symptoms that are difficult to manage without the assistance of professional medical intervention.
Finally, in order to avoid a relapse and make any kind of progress in recovering from addiction, the individual suffering from OTC drug dependency should be enrolled in an addiction rehabilitation program. Once there, through counseling, therapy, and other programs, they will learn to understand and manage their addiction and be given the tools they need to maintain long-term sobriety.
In recent years, there are several things that have been done in an effort to curb and prevent OTC drug abuse. One that we mentioned earlier was to restrict access to certain OTC medications, like nasal decongestants containing pseudoephedrine, making them more difficult to obtain, unable to be purchased by children under the age of 18, and making only a limited amount available per person per month.
Similarly, OTC dietary supplements used to be even more dangerous due to the inclusion of a stimulant known as ephedrine. Ephedrine is a methamphetamine analog that is extremely addictive and known to cause strokes and severe cardiovascular problems, as well as mental issues like anxiety, insomnia, and hallucinations.
In 2006, the United States government banned the use of ephedrine both as an over-the-counter dietary supplement or as an ingredient in one.
Outside of the legal system, there are many things people can do on their own to prevent the misuse and abuse of OTC drugs.
Education is always a good first step, becoming more aware of which medications are abused the most frequently and the dangers and risks that come from doing so. The main point of this guide is to provide people with this information as a go-to for learning about the very real dangers of OTC drug abuse.
Once educated, communication is key to preventing OTC drug abuse, specifically between parent and child. Teenagers might not understand the health risks involved in recreationally abusing OTC medication, and so parents have the responsibility to make sure their child is aware that there is no “safe” way to abuse any kind of substance, even ones they can buy at the supermarket.
Medications can also be safeguarded in the home by limiting access to the ones that can be abused as well as keeping careful and regular track of their quantities. In the case of very young children, childproof caps are a necessity.
Finally, don’t even put yourself in a position for accidental misuse: Follow the warnings and directions provided on the labels of OTC drugs, which also provide information on ingredients and what they can and cannot be taken with.
Drug labels, even OTC ones, are subject to change if new interactions or information become known, so always check when purchasing them, even if you already have before.
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Over-the-counter medications provide a cheap and accessible alternative to prescription drugs, especially if someone is only suffering from a minor illness. But just because they can be purchased legally without a prescription does not mean that misusing them won’t have dire, even life-threatening consequences.
If you or someone you care about is struggling with a dependency on an OTC drug, The Palm Beach Institute is here to provide help and healing with our time-tested recovery treatment program.
Our addiction specialists and medical staff will be there providing guidance and support through every step of the recovery process. Call us now 855-960-5456 or contact us online for more information.
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Unknown Author (December, 2017).What are over-the-counter (OTC) medicines?. National Institute on Drug Abuse. Retrieved May, 2018 from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines
Unknown Author (August, 2017).Commonly Abused Prescription and OTC Drugs. WebMD. Retrieved May, 2018 from https://www.webmd.com/mental-health/addiction/ss/slideshow-commonly-abused-drugs
Thompson, D, (n,d).Long-Term Acetaminophen Use and Health Risks. WebMD. Retrieved May, 2018 from https://www.webmd.com/drug-medication/news/20150302/does-long-term-acetaminophen-use-raise-health-risks#1