Over-the-counter (OTC) medications are widely available without a prescription, often perceived as safe due to their accessibility. Designed to treat common ailments like pain, allergies, and colds, these drugs can still be misused or abused despite their generally low risk when taken as directed. This public health concern can lead to significant health risks and complications.
Understanding Commonly Abused OTC Medications
Dextromethorphan (DXM), a cough suppressant found in many cold and cough medicines, is one commonly abused OTC substance. When taken in significantly higher doses than recommended, DXM can produce dissociative effects, including euphoria, hallucinations, and altered perceptions, similar to illicit drugs like ketamine or PCP. These products often come in syrup, capsule, or pill forms.
Loperamide, an anti-diarrheal medication, is another OTC drug that has seen increasing abuse. While it acts on opioid receptors in the gut at therapeutic doses, very high quantities can allow it to cross the blood-brain barrier, leading to opioid-like effects and euphoria. This misuse is particularly noted among individuals seeking to self-manage opioid withdrawal symptoms or achieve a high. The maximum daily over-the-counter dosage for loperamide is typically 8 milligrams, but abuse involves doses ranging from 60 milligrams to several hundred milligrams.
Pseudoephedrine and ephedrine, decongestants in cold and allergy medications, are also abused. They are primarily misused for their stimulant effects, providing increased energy or alertness. Pseudoephedrine is also a precursor chemical for illicit methamphetamine manufacturing, leading to stricter sales regulations.
Diphenhydramine, an antihistamine used for allergies and as a sleep aid, can induce hypnotic or hallucinogenic effects at high doses. It is found in various allergy medications and motion sickness pills.
Other OTC products like laxatives and diet pills are sometimes abused, often linked to disordered eating patterns. Laxatives are misused for perceived weight loss, while diet pills and caffeine pills can be abused for stimulant effects.
Why OTC Medications Are Abused
The widespread availability of OTC medications significantly contributes to their abuse potential. Unlike prescription drugs, they are easily purchased without a doctor’s authorization, making them a convenient option for individuals seeking mind-altering effects.
Many mistakenly believe OTC drugs are inherently safe because they are legal and non-prescription. This misconception can lead to a false sense of security, encouraging higher doses. Their lower cost compared to illicit drugs also makes them an attractive alternative for those seeking psychoactive effects.
Individuals may abuse OTC drugs to self-medicate underlying issues like anxiety, depression, or sleep disturbances, without professional guidance. They might seek specific effects such as euphoria, sedation, increased energy, or hallucinations. For some, OTC drug abuse serves as a way to avoid illegal substances, as these drugs may not be detected in routine drug screenings.
Potential Health Consequences of OTC Abuse
Abusing OTC medications can lead to severe health consequences, affecting both physical and mental well-being. DXM abuse can result in dangerously slowed breathing, increased heart rate and blood pressure, and central nervous system toxicity. Neurological effects may include seizures, psychosis, coma, or brain damage. Combining DXM with other substances like acetaminophen can cause liver damage.
Loperamide abuse primarily impacts the cardiovascular system. It can lead to serious heart problems, including irregular heartbeats, QT prolongation, torsades de pointes, and cardiac arrest. Overdoses can also cause central nervous system depression, respiratory depression, and impaired intestinal function.
Pseudoephedrine and ephedrine misuse can result in elevated heart rate, high blood pressure, and an increased risk of heart attack or stroke. Diphenhydramine abuse can cause significant cognitive impairment, including memory loss and difficulty concentrating. It may also lead to heart problems, extreme drowsiness, and delirium. Long-term use of diphenhydramine has been associated with an increased risk of dementia.
Abuse of laxatives and diet pills can cause severe gastrointestinal issues, dehydration, electrolyte imbalances, and potential damage to the heart or kidneys. All abused OTC medications carry a risk of addiction, psychological dependence, and life-threatening overdose.
Identifying OTC Drug Abuse
Recognizing the signs of OTC drug abuse involves observing changes in behavior, physical appearance, and psychological state. Individuals abusing these medications may become secretive or exhibit unusual behaviors, such as isolating themselves from family and friends. They might neglect responsibilities at school, work, or home, leading to a decline in performance. Financial difficulties or an unexplained need to borrow money can also be an indicator.
Physical signs can include bloodshot eyes, changes in pupil size, and altered sleep patterns or appetite. Unusual smells on the breath or clothing, impaired coordination, slurred speech, or unexplained weight changes may also be present. Deterioration in personal hygiene and appearance can be another observable sign.
Psychological indicators often involve sudden mood swings, irritability, or angry outbursts. A person might appear unusually anxious, paranoid, or fearful without clear reason. Loss of interest in previously enjoyed hobbies or activities, along with a general lack of motivation, can also signal a problem. Finding empty medication containers or drug paraphernalia may directly point to abuse.