Over-the-counter medications are drugs that one can buy without a prescription from a doctor. According to the U.S. Food & Drug Administration (FDA), these drugs, also known as OTC drugs, are safe and effective when users follow directions on the label or as their health care professional has directed.
Walk into just about any grocery store, pharmacy, large discount retailer, or convenience store, and you can find these medications lined up on the shelves. It is estimated that there are more than 80 classes of OTC drugs available. They range from weight-loss products to pain relievers to allergy medications. The most widely used ones treat colds and the flu, minor body aches and pains, allergies, and other ailments. They are available as capsules, tablets, eye drops, sprays, ointments, and other forms. The FDA reviews the ingredients in these medications as well as the labels put on them.
According to the Consumer Healthcare Products Association, as of 2015, the average American household reportedly spent roughly $338 a year on over-the-counter medication. And, as of 2018, 81 percent of U.S. adults use OTC drugs as their first line of treatment for minor illnesses.
Acknowledging OTC Drug Addiction
As with prescription drugs as well as illicit ones, OTC drugs are still drugs despite their easy access and widespread availability. Users can still experience side effects and risks after taking them, especially if they are taken at higher-than-recommended doses. There can still be unfavorable drug or food interactions, and these medications can be harmful when misused or abused. Misusing and abusing over-the-counter medications can lead to drug addiction. Abuse includes:
- Taking more of the medication than recommended
- Using the drug in ways that are inconsistent with its purpose or design
- Combining the OTC drug with other drugs, legal or illegal, and/or alcohol (polysubstance abuse)
- Using the drugs for a length of time that one is now dependent upon them, either physically, psychologically, or both.
Many people think because they can buy medications off the shelves, and not from the streets, that it means the drugs are safe and can be used without following the directions that came with them. However, that’s generally not true. As the Poison Center advises, the most important part of taking or giving medicine is reading and understanding the label. Despite the drugs being sold over-the-counter, these substances can contain mind-altering and mood-altering effects than can result in health problems and overdoses that can prove fatal. Irresponsible OTC drug use can cause memory loss, kidney failure, heart problems, and more.
Commonly Abused OTC Drugs
Some kinds of over-the-counter drugs are abused more than others. Below are a few of the most commonly abused ones.
Dextromethorphan (DXM, DM) is the active ingredient in cough suppressants such as Delsym, Nyquil, Robitussin, and Theraflu. DXM, which is also found in the store-brand version of cough medicines, is an opioid although it acts differently from most opioids in that it does not provide pain relief or affect the brain’s opioid receptors. However, it blocks nerve signals to the brain that sends a reflex signal to the muscles responsible for producing a cough.
In addition to syrup, DXM also can come in the form of a tablet or gel capsule. When used as directed, the drug is safe. However, when recreational users take it in excessive amounts, it can be addictive. DXM has been taken in larger-than-recommended doses, snorted, or injected. Users usually use cough and cold tablets containing in the ingredient for this purpose. Street names for dextromethorphan include Skittles, Triple C, and Robo. Chronic users, who may be known as “syrup heads” will take the abuse an extra step and mix dextromethorphan with alcohol.
In Addition to the Effects that Make DSM Appeal to Users, Short-Term DXM Effects Include:
- Increased sweating
- High blood pressure
- Dangerous elevated heart rate
- Stomach pain
- Anxiety or panic attacks
- Impaired motor skills
- Slurred speech
- Vision loss
Long-Term DXM Abuse Can Cause:
- Memory loss
- Intense and rapid mood swings
- Severe liver damage
Abusing DXM can lead to overdose. In extreme cases, users can exhibit chemical psychosis, a condition described as a when a person is too impaired to recognize reality or communicate with or relate to others.
Medications that contain DXM and other active ingredients in cough medications, such as acetaminophen (Tylenol) and the decongestant pseudoephedrine can cause unfavorable health conditions. Among them are:
- Liver failure
- Respiratory failure
Allergy Medications, Decongestants
Many cold medicines, such as Sudafed, contain the active ingredient pseudoephedrine, a stimulant used in decongestants that is used to relieve symptoms associated with allergies and colds. The drug shrinks swollen nasal passages, which is how it provides relief. When abused; however, users experience rushes of intense energy or excitement. Some users also have used pseudoephedrine to lose weight. The medication is now federally regulated on pharmacy shelves as it has been used in the production of the illegal drug methamphetamine in also-illegal meth labs.
Pseudoephedrine Abuse Can Cause:
- Irregular and elevated heart rate
- High blood pressure
- Shortness of breath
- Chronic abdominal pain
Even allergy medications that have non-drowsy effects are not off limits to abuse.
Some antihistamines contain diphenhydramine, an ingredient similar to dimenhydrinate, which is the active ingredient in over-the-counter motion sickness medication. Both produce the same sedative effects. Benadryl and similar medications that contain diphenhydramine have been abused along with benzodiazepines Xanax or Ativan, which are prescription medications.
People who take over-the-counter antihistamines with prescriptions medications may experience nausea, double vision, and breathing that is dangerously shallow. Long-term antihistamine abuse side effects include:
- Serious heart problems
- Liver dysfunction
- Kidney damage
Motion Sickness Medication
People who experience motion sickness, vertigo, and nausea will take over-the-counter medications such as Dramamine and Gravol, which contains dimenhydrinate, to ease their symptoms. Drowsiness is a side effect of these medications, but large doses bring on a range of effects. High doses that are close to 800 milligrams can bring on euphoria, hallucinations, and visual sensations. Doses that are far larger than that, like those that are close to 1250 milligrams can cause confusion and violence.
“The higher the dose taken, the worse and more realistic the hallucinations become. It is common among abusers to hear their name being called and see creatures that invoke fear, or to have conversations with someone who is not present,” according to BrightHub.com.
Large Doses of Dimenhydrinate Also Can Cause:
- Irregular or elevated heart rate
- Stomach ulcers
It is possible to overdose on dimenhydrinate, which can cause heart attacks, pupil dilation, urinary retention, dry red skin, heaviness of the legs, and even death.
Acetaminophen is the active ingredient found in over-the-counter pain relievers such as Tylenol, Excedrin, Dayquil, Mucinex, and many others as well as some prescription opioid pain medications such as Percocet and oxycodone. It is advised that acetaminophen should be taken with care. It is generally not considered safe for users to take this drug consistently during long periods. Health hazards of prolonged use include damage to the liver, stomach, and intestines. Prolonged use or higher-than-recommended doses of acetaminophen can also cause:
- Stomach pain
- Excessive sweating
That’s not all. Other serious health problems include high blood pressure, increased risk of stroke, bleeding in the digestive tract, and kidney disease. Many health care professionals consider OTC acetaminophen to be among the most dangerous to use of all over-the-counter pain medications, because the dose that is considered effective is too close to the dose one would need to accidentally overdose.
Acetaminophen’s easy access is also cause for concern. According to the Journal of Adolescent Health, during a 10-year period of suicide by adolescents most commonly involved the overdose of medications such as acetaminophen and ibuprofen among other medications.
Ibuprofen, a mild-to-moderate pain medication is taken for minor aches and pains, such as a headache, toothache, and menstrual pain among other conditions. It is the active ingredient in anti-inflammatory pain medication such as Advil and Motrin. Ibuprofen is unlike other prescription pain relievers, because it does not cause addiction and it does not bind to the brain’s opioid receptors.
Common ibuprofen users are people who live in chronic pain who are not using illegal drugs or are unable to get prescription pain pain relievers. To get high off ibuprofen involves using medicines in which the ingredient is combined with others that cause sensations of some kind, usually euphoria or stimulation.
Long-Term Ibuprofen Abuse Can Cause:
- Cardiac issues
- Kidney damage
- Stomach bleeding
Popping an aspirin is so common that it raises few eyebrows when people do it. It really is as common as taking ibuprofen or other OTC medications. But you have to be careful, too, with taking this anti-inflammatory pain medication that works similarly to ibuprofen. Aspirin is a blood thinner and is used to prevent blood clots, which can reduce the risks of getting a heart attack or stroke. In some people’s cases, taking aspirin daily is recommended, particularly if they already have had a heart attack or stroke or if you have diabetes.
Dietary Supplements, Laxatives
Despite claims to be “all natural,” over-the-counter weight-loss supplements can be just as dangerous as any other drug. Users who are considering taking capsules, tablets, liquids, and other forms of dietary supplements should do their research and read labels carefully.
The FDA does not regulate weight-loss supplements, which means the content of these ingredients have not been inspected. Even without misusing or abusing them, some do come with unwanted side effects and health risks.
Stimulant-based dietary supplements containing amphetamines or amphetamine-derived ingredients, such as caffeine or guarana, are designed to increase the metabolism and suppress the appetite. Diet pills of this kind can lead to addiction as a person builds up tolerance for then. In some cases, dependence on over-the-counter dietary supplements can make some users move on to stronger addictive substances, such as cocaine and methamphetamine.
These products can affect heart and stomach health, and affect one’s mental health as well. Other health hazards include:
- Elevated blood pressure
- Heart attacks
- Heart palpitations
- Anal leakage
- Panic attacks
Many people abuse laxatives because they want to lose weight or look and feel thin. They are often misused and abused after eating binges. Users who engage in this practice mistakenly think the laxatives will move food and calories out of them before the body absorbs them. But that is false. Excessive use of laxatives can lead to overdose and other side effects, such as:
- Abdominal pain
- Muscle weakness
- Slow or shallow breathing
- Coma (in rare instances)
Who is Most Vulnerable to OTC Drug Addiction?
People Who Have a History of Substance Abuse
People who have substance use disorders are at high risk of abusing over-the-counter medications. The recent trend of recovering opioid users abusing loperamide, or an OTC anti-diarrheal medication, to manage bowel discomfort during opiate withdrawal, is an example of this.
The over-the-counter medication, sold under the brand name Imodium A-D, is low in cost, has over-the-counter legal status, and has widespread access, making it an easy drug to abuse. Recreational users achieve a euphoric high when abusing it, but using it in higher amounts than recommended can lead to death.
The medicine has been said to be more fatal than opioids and linked to deaths that occurred after the drug disrupted the heart’s rhythm. Loperamide became an over-the-counter drug in 1988; before that, it was a prescription controlled substance in 1976.
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.
Populations that are in active addiction to substances, including opioids, are vulnerable to misuse or abuse over-the-counter medications. In addition to their low cost and widespread availability and access, the drugs provide some relief from an uncomfortable withdrawal period that often follows prolonged drug or alcohol use.
Drug tolerance builds up over time as people use addictive substances. They come to a point where it becomes hard to satisfy strong drug or alcohol cravings, no matter what they do. OTC medications may not be enough to relieve pains or create the highs these users are used to. That, unfortunately, means they can overdose from taking too much of an over-the-counter drug, which they likely view as safer to take than prescription drugs or street drugs.
Substance abuse among older adults often goes unrecognized or undetected. There are a few reasons for this.
Older people are more susceptible to misusing or abusing their medications or developing addiction to medications such as opioids and benzodiazepines because they typically buy more prescription medications than other groups. While people age 65 and older are only 13 percent of the population in the United States, they account for more than one-third of total outpatient spending on prescription drugs in the US, according to the National Institute on Drug Abuse (NIDA).
Senior adults also take medications more than other age groups. As age sets in, so do chronic ailments such as arthritis, diabetes, high blood pressure, cancer, and heart disease. Health care professionals commonly prescribed medications for these conditions. But some people will still seek out over-the-counter medications to feel better because they are easier to access. They’re also easier to misuse.
Some in this group may still drink alcohol as they take prescription and OTC medications, making it more likely that they will mistakenly mix drugs and alcohol, which is dangerous and possibly deadly.
Teenagers and Young Adults
Prescription drug misuse among teenagerss has been called a national public health problem. But over-the-counter medications are also a problem in this population. According to the Drug Enforcement Association (DEA), about one out of every 10 teenagers has abused an OTC medication for the specific purpose of getting high at least once in their lifetime.
One reason over-the-counter medications appeal to this group is because they are generally seen as medicines they can get from medical professionals or friends or family. It’s also not necessary to buy OTC medications from a drug dealer on the streets. But as the DEA says, over-the-counter medications are just as dangerous as street drugs.
They can provide the same highs that prescription drugs or illegal drugs do. Some young people are likely to abuse OTC drugs because there’s little difficulty or danger in trying to obtain them. The view that the medications are safe to use, because they come from a pharmacy also prompts people in this population to use them recreationally.
Signs of OTC Drug Addiction
There are ways to tell if someone is struggling with over-the-counter drug addiction.
Behavioral and Environmental Signs
- 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
Personal Mental and Physical Signs
- Medicinal scents or odors on their breath, 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
- Sudden outbursts of anger
- Appearing depressed or withdrawn
- Impaired motor skills
- Difficulty remembering important things
- Money or valuables suddenly going missing
Over-the-counter drug addiction is a substance abuse problem that can impair one’s physical and mental health. It should be taken just as seriously as if prescription drugs or street drugs were involved. If you recognize any of these signs of over-the-counter abuse, it may be time to take a step back and evaluate whether you need outside help for your problem. Professional addiction treatment can get you back on track to an addiction-free life.
In major situations in which an overdose has occurred, seek immediate medical attention at a hospital or urgent care center, even if the person has overdosed on seemingly harmless Tylenol or aspirin. As mentioned above, toxicity of these drugs can happen and negatively affect one’s health.
OTC Drug Addiction Treatment
Getting treatment at a center for over-the-counter drug addiction involves several steps. Each person’s post-addiction recovery plan will look different depending on who it is for.
Factors such as the age, medical history, the type of over-the-counter medication that was abused, how long was it abused and if it was abused along with other drugs, are just a few factors that will be considered before a plan is created. A person’s mental health history also may be evaluated to determine if there are any co-occurring disorders present and if those also need to be addressed as part of the recovery plan.
Some Therapies and Programs Offered During OTC Addiction Treatment Are:
- Behavior therapy
- 12-Step Facilitation Therapy
- Family therapy
- Relapse prevention education
- Aftercare services
Depending on the program, addiction therapies that address trauma as well as holistic therapy may be offered.
Six Ways to Avoid Over-The-Counter Drug Abuse, Addiction
The OTC Medicine Safety Program offers six tips that can help keep users safe as well as adults who are teaching children, tweens, and teenagers how to take medicines. They are:
- Be sure to read and follow the medicine label every time.
- Be sure never to share your medicine with someone else or use someone else’s medicine.
- Remember to always use the dosing device that comes with the medicine.
- Take only one medicine at a time with the same active ingredient.
- Store all medicines up & away and out of reach and sight.
- Be sure to only take medicines with the permission and guidance from a parent or trusted adult
OTC Drug Addiction Statistics
- 12% of teenagers have reported abusing cough syrup
- There are over 750,000 retail outlets that sell OTC drugs in the U.S.
- 93% of people in the U.S. try to use OTC drugs before going to a doctor.