When taken as directed, over-the-counter medications are usually safe. There is a misconception that because they are sold over the counter, they are safe to use in any amount, manner, or combination. Although OTC medications are less potent than prescription medications and carry fewer risks, many of these substances still carry a significant risk for abuse and even addiction.
The abuse of OTC products is not limited to medications. There are many different OTC products that are abused that are not medications, such as adhesives, spray paint, whipped cream canisters, and household cleaners.
Types of OTC Medications
The following are the major categories of OTC medications that are abused:
- Cough and cold medications
- Diet aids
- Motion sickness aids
- Laxatives
- Pain relievers
- Caffeine or medications to induce wakefulness
Abuse of these medications can result in potentially dangerous side effects, interactions with other substances or medications, and even the development of physical dependence.
Dextromethorphan
Dextromethorphan, or DXM, is an active ingredient in cough and cold medications like NyQuil and Robitussin. The primary people who abuse DXM are adolescents looking for an easy way to get high.
When taken in its normal recommended doses, the psychoactive effects of DXM are mild. When taken in high doses or combined with alcohol or other drugs like ecstasy (MDMA), the effects can be significant and even dangerous. High doses of DXM can produce euphoria, stimulation, and hallucinations.
DXM products are sometimes combined with soda and consumed in large amounts. The effects are dose-dependent, such that smaller amounts of DXM produce stimulation and higher doses produce hallucinations, dissociative effects (feeling as if you are leaving your body), and decreased motor coordination. High doses can induce a coma.
The following are other adverse effects associated with abuse of DXM:
- Dizziness, nausea, and/or vomiting
- Impaired judgment
- Blurred vision
- Slurred speech
- Sensory distortions
- Rapid heartbeat
- Blood pressure changes (hypertension or hypotension)
- Dangerously elevated body temperature
- Blackouts
- Seizures
There is the potential for brain damage as a result of seizures or due to chronic abuse of DXM.
Ephedrine
Ephedrine is a central nervous system stimulant that was frequently an ingredient in OTC diet medications in the past. But the drug was banned in 2004 by the Food and Drug Administration (FDA) because it led to significant cardiovascular problems, including an increased risk for heart attack.
Ephedrine is similar in structure to amphetamines. The evidence that it was actually helpful with long-term weight loss was scant.
Despite being banned by the FDA, there are herbal OTC products that may contain ephedrine. It is sold online in numerous forms as an energy enhancer, weight loss aid, or to increase concentration or cognition.
Products containing ephedrine are not legal to purchase in the United States.
Pseudoephedrine
Pseudoephedrine is a decongestant that is found in medications like Sudafed. It is intended to treat allergies or other conditions that may increase nasal congestion like the common cold.
It can be bought over the counter, but its purchase is now monitored due to pseudoephedrine being an active ingredient in the production of crystal meth (methamphetamine).
Abuse of pseudoephedrine can produce stimulant effects and euphoria. It can also trigger the following side effects:
- Stomach pain, nausea, and vomiting
- Dizziness and/or weakness
- Hypertension
- Irregular heartbeat or heart palpitations
- Irregular breathing or other respiratory issues
- Seizures
Motion Sickness Pills (Dimenhydrinate)
Dimenhydrinate is included in some medications like Dramamine to address motion sickness or vertigo (dizziness associated with many different conditions).
This drug may be abused by some individuals because it can produce feelings of relaxation, mild euphoria, and other psychoactive effects. Depending on the dose, you may also experience hallucinations that are similar to those that occur with drugs like LSD.
The following serious side effects can occur due to dimenhydrinate abuse:
- Dizziness
- Ringing in the ears
- Itchy skin
- Pain in the eyes
- Blurred vision
- Stomach pain, nausea, or vomiting
- Irritability or severe agitation
- Delirium (confusion, disorientation, and other issues)
- Heartbeat irregularities and potential heart attack
- Potential liver or kidney damage due to long-term abuse
- Mood swings, including depression
- Brain damage that can result in amnesia
- Potential coma.
Laxative Abuse
The primary abusers of laxatives are people who have eating disorders, such as anorexia or bulimia. As many as 60 percent of this group abuses laxatives at some time.
However, the abuse of laxatives does not occur exclusively in people with psychiatric disorders. The stimulants that are present in laxatives are designed to increase the movement of food through your gastrointestinal system. They do not have the same effects as other stimulants, like amphetamines, that are often abused.
Long-term use of laxatives does not promote long-term weight loss. Continued abuse of laxatives can lead to the following:
- Dehydration, which can lead to organ damage (kidney or liver damage)
- Other organ damage, especially damage to the heart
- Anemia
- Diseases of the colon or colon cancer
- Dependency on laxatives, which often presents as being unable to function and defecate without laxatives, leading to chronic problems with constipation
Caffeine
Caffeine is a legal central nervous system stimulant. It is one of the most commonly used substances in the world.
You may think that caffeine is safe to use in high amounts, but it can lead to significant problems with your health and to the development of physical dependence (withdrawal symptoms).
Caffeine pills contain high amounts of caffeine that are typically designed to help keep you awake or give you energy. This includes products like NoDoze. In addition, a large proportion of energy drinks and products sold over the counter contain high amounts of caffeine.
It is possible to overdose on caffeine. The following are symptoms of caffeine overdose:
- Rapid or abnormal heartbeat
- Nausea and/or vomiting
- Fever
- Dizziness
- Increased thirst
- Dehydration
- Convulsions
- Hallucinations
- Confusion
- Significant breathing problems
OTC Analgesics
The abuse of OTC analgesics like aspirin, acetaminophen, ibuprofen, and naproxen is a real issue. Many people take too much of these medications in order to deal with pain, or they combine them with potentially dangerous substances like alcohol.
Long-term use of these substances has been shown to produce problems with cardiovascular functioning and liver damage. Even so, taking them in high amounts on a daily basis is considered by many to be acceptable because they are sold over the counter and safer than prescription pain relievers. This conceptualization is only accurate if the drugs are used according to their prescribed instructions, and you do not exceed the maximum daily dose listed on the instructions of the container.
Taking too much of these medications can lead to the following issues:
- Pain or cramps in the stomach, nausea, vomiting, and/or diarrhea
- Convulsions
- The accumulation of too much acid in the body (metabolic acidosis)
- Jaundice
- Liver failure
- Ulcers or abscesses in the intestine
- Coma
- Dehydration
- Respiratory problems
Self-Assessment: Am I Addicted?
Some Dangerous Combinations
There are some potentially dangerous combinations of OTC medications and other substances.
- Combining OTC analgesics like acetaminophen and alcohol can lead to an even greater risk for liver failure or liver damage.
- The combination of DXM and alcohol results in enhanced effects of DXM, leading to an increased potential for overdose and other dangerous side effects.
- Mixing caffeine and ephedrine or pseudoephedrine enhances the stimulant effects of both drugs. This can lead to potentially dangerous spikes in body temperature that can cause organ damage.
- Combining alcohol with any of the above drugs can be a serious issue.
Who Abuses OTC Medications?
Reliable statistics regarding the abuse of specific OTC medications are hard to come by. Because these medications are sold over the counter, their use is not monitored.
Misuse of these medications is probably extensive. Outright abuse of these medications may vary depending on the medication. For example, DXM is more likely to be abused by younger people, whereas caffeine abuse most likely occurs across all age groups.
Do I Need Treatment?
Since some over-the-counter medications can lead to addiction, treatment programs can address this type of substance abuse in much the same way other forms of substance abuse are treated.
You may require medical detox, depending on the type of medication you are abusing. The level of care for withdrawal will vary greatly, depending on the substance of abuse. Although caffeine can produce withdrawal symptoms, they are relatively mild and require minor treatment, whereas the abuse of laxatives or DXM might require more intensive treatment.
Therapy is where the bulk of addiction recovery takes place. You’ll spend a good amount of time in therapy, including both individual and group therapy. You’ll also likely participate in support groups and other activities that support a healthy lifestyle.
Because there is a tendency to combine alcohol with many OTC medications, it’s important to be evaluated for alcohol abuse. Alcohol use disorders can produce severe withdrawal symptoms that can be potentially fatal. If it is suspected that you have an alcohol use disorder, close monitoring and medical detox may be required.
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