Over-the-Counter Drugs: Abuse, Side Effects, and Addiction

Updated on August 7th, 2020

Did you know that 93 percent of U.S. adults prefer to treat their minor ailments with over-the-counter medicines before seeking professional care?¹ OTC medications may be affordable, accessible, and effective, but that doesn’t necessarily mean they’re harmless. Although OTC medications may not have the sinister reputation that illegal drugs like meth and heroin have, they do carry risks of their own.

What are Over-the-Counter (OTC) Medications?

Over-the-counter (OTC) medications are drugs that can be legally sold to consumers without a prescription.² These types of drugs can be used to treat a variety of symptoms and ailments such as cough, stuffy nose, or diarrhea. The active ingredient in OTC medications will vary depending on the drug and its intended purpose. However, some OTC medications are more likely to be abused recreationally if the active ingredient can produce euphoria or other pleasurable feelings when consumed in large doses. Certain ingredients in some OTC drugs may also be extracted and used to manufacture illegal drugs like crystal meth.

Despite the opportunities for misuse, many people use OTC medications for legitimate medical reasons. According to the Consumer Healthcare Products Association:

• There are a total of 2.9 billion retail trips annually to purchase OTC products.
• On average, U.S. households spend about $338 per year on OTC products.
• 81 percent of adults use OTC medicines as a first response to minor ailments.
• U.S. consumers make 26 trips a year to purchase OTC products. They only visit doctors three times a year on average.
• While there are approximately 54,000 pharmacies in the United States, there are more than 750,000 retail outlets that sell OTC products.
• 8 in 10 consumers use OTC medicines to relieve their symptoms without having to see a healthcare professional.

What Is the Difference Between Over-the-Counter and Prescription Drugs?

People trying to obtain prescription drugs need a legal prescription written by a doctor to get them. However, over-the-counter drugs are not intended for one particular individual and they are readily available without consulting with a doctor or pharmacist.

Regardless of their availability, over-the-counter drugs still come with some risks and may interact with other drugs and cause adverse effects. OTC drug users should always follow the recommended doses on the label, ask a doctor or pharmacist about any possible drug interactions, and pay attention to any side effects or allergic reactions that may occur as a result of taking the OTC drug.

How Are Over-the-Counter Drugs Abused?

Because OTC drugs are so accessible and their use is so normalized in our society, you may not think of them as a drug of abuse. However, this is far from the truth. Over-the-counter drugs can be misused in several different ways, such as:

• Taking over-the-counter medications to get high
• Taking over-the-counter medications in any other way than directed on the packaging
• Mixing over-the-counter medications or consuming them with illegal drugs or alcohol

Teens are the largest population of OTC drug abusers. According to the National Institute on Drug Abuse, 1 in 10 teens admitted to abusing cough or cold medicine to get high.³ Although illegal drug abuse among U.S. teens has declined in recent years, over-the-counter drug abuse and prescription drug abuse has continued to be a dangerous trend for teens.⁴

Teenagers may abuse OTC drugs for many reasons. They may just want to experiment and get high for fun or due to peer pressure. They may also mix over-the-counter drugs with illegal drugs to enhance the effects of the drugs or to experience a stronger high. OTC medications may also be a convenient alternative for addicted teens who can’t come up with the money to buy their drug of choice.

Regardless of the reasons why, frequent and chronic misuse of over-the-counter drugs can lead to serious physical harm, overdose, addiction, or even death.

What Are the Side Effects of Over-the-Counter Drug Abuse?

Abusing over-the-counter drugs can cause serious physical harm or overdose. Some of the common side effects of OTC drug abuse may include:

• Impaired motor functioning
• Dizziness
• Sedation
• Confusion
• Numbness
• Nausea
• Vomiting
• Increased heart rate
• Increased blood pressure
• Respiratory depression
• Impaired judgment/decision-making
• Increased risk for HIV and other sexually transmitted diseases⁵

What Are Some Commonly Abused Over-the-Counter (OTC) Medications?

Codeine

Codeine is a common ingredient found in cough syrup. It is an opiate that is similar to morphine, but it is much less powerful. Codeine works as a cough suppressant, but it can also produce feelings of relaxation and euphoria when it is consumed in high doses.⁶ Codeine misuse gained popularity among drug abusers in the 1990s and it was frequently used to make a cocktail called “purple drank,” “lean,” or “sizzurp,” which is a combination of cough syrup, soda, and a hard piece of candy.

Codeine is found in OTC cough syrup as well as with prescription-strength cough syrup, but combining either type with alcohol is dangerous and life-threatening. When it is consumed in very high doses, codeine can cause dependence and addiction.

Dextromethorphan (DXM)

Dextromethorphan, or DXM for short, is another cough suppressant and expectorant that is an ingredient in many different brands of OTC cough and cold medicines.⁷ When it is consumed in extremely large doses, DXM can produce out-of-body feelings, hallucinations, and euphoria. Most DXM users consume the drug orally, but some inject it, which can cause serious bodily harm and has been linked to brain damage.

When DXM is abused recreationally with other drugs such as alcohol, acetaminophen, MDMA, other cough suppressants, or marijuana, its negative side effects like dizziness, nausea, and vomiting can also be exacerbated or it may lead to liver damage, heart attack, stroke, or death.⁷

Loperamide

Loperamide (Imodium) is a Schedule V drug and an anti-diarrhea drug.⁸ It’s available in tablet, capsule, and liquid form and it contains a small amount of codeine. People may abuse loperamide to get high or in an attempt to self-treat opioid withdrawal symptoms. When loperamide is consumed in very large doses, it can cause a mild euphoria. However, misuse of this drug can also cause fainting, constipation, stomach pain, loss of consciousness, kidney problems, ulcers, heart damage, or cardiac arrest.^9,10

Although pseudoephedrine is technically an over-the-counter drug too, the Combat Methamphetamine Epidemic Act of 2005 mandated that all cold medicines containing pseudoephedrine be sold behind the counter. Pseudoephedrine is a drug that is found in many cold and flu medicines that can be chemically altered to make methamphetamine. Under the Combat Methamphetamine Epidemic Act of 2005, a person can only purchase pseudoephedrine from a pharmacist with a valid prescription and a form of identification. They must also sign a log that tracks all buyer purchases.¹¹

Motion Sickness Pills (Dramamine or dimenhydrinate)

Dramamine (dimenhydrinate) is an over-the-counter medication that gives people relief from nausea and vomiting, usually while traveling via car or plane. Sometimes, other over-the-counter sleep aid drugs also contain dimenhydrinate. It is considered very safe when it’s used as directed and it is available in tablet, chewable tablet, or liquid form.

Some people misuse dramamine by taking it in very large doses, which can cause hallucinations or euphoria. This behavior is common with teens but sometimes psychiatric patients with mental health problems will also misuse this drug to get relief from their symptoms. Due to its availability, dimenhydrinate is one of the most common over-the-counter drugs that is likely to be abused. In some states, dramamine is sold behind the counter due to its high potential for abuse, but it is still sold over-the-counter in many places.

Caffeine Pills

Caffeine is a naturally-occurring stimulant, which is why many people think it’s safe to abuse. However, although caffeine may not be addictive, it can still cause physical dependence and harmful side effects if it is misused. Abusing caffeine pills can increase blood pressure and cause rapid or abnormal heartbeat, jitters, insomnia, headaches, dizziness, dehydration, and anxiety.

According to the FDA, 400 mg of caffeine per day is considered safe for healthy adults. Certain people may be more sensitive to the effects of caffeine, depending on how quickly they metabolize it. A toxic dose of caffeine (5 grams or more) can cause an overdose, although it is rare.

Caffeine pills usually contain anywhere from 100 to 200 mg of caffeine per tablet and are generally used by people who are trying to combat fatigue. For comparison, a typical cup of coffee contains 95 mg of caffeine. If a person misuses caffeine pills by taking too many, he or she may experience toxic or fatal side effects due to caffeine overdose.

Laxatives

Laxatives are medications that are used to treat constipation. They work by softening the stool or stimulating the lower intestine. Most often, laxatives are misused by people with eating disorders. These individuals may use laxatives very frequently, or even daily, to combat binge behaviors or in an attempt to quickly pass the food through their system before the calories can be absorbed. This type of thinking is very common, although not accurate. Some people will take high doses of laxatives or even smaller, recommended doses, but for a much longer time than would be recommended by a doctor.

However, laxatives don’t help people lose weight. Instead, they eliminate water and waste sitting in the bottom of the lower intestine, which may make people feel like they have a flatter stomach or cause their weight to drop slightly for a short time.

Regardless, laxative abuse can worsen constipation. Misusing these over-the-counter drugs can also damage the nerves of the large intestine, weaken the colon muscles, and cause bloating, abdominal pain, and extreme discomfort. Dehydration, electrolyte imbalances, infections, irritable bowel syndrome (IBS), and impaired intestinal function are also common side effects of long-term laxative abuse.

Diet pills

Diet pills include many different types of over-the-counter supplements that help people lose weight or control their weight by suppressing their appetite, increasing their metabolism, or blocking fat absorption. Some diet pills are only legally available with a valid prescription, but others are easily accessible and available over-the-counter.

Over-the-counter diet pills are often abused by people with eating disorders and other mental health disorders. These types of pills can increase a person’s energy levels and may also produce feelings of euphoria, which can contribute to dependence and addiction.

Abusing diet pills can cause other harmful side effects including insomnia, chest pain, rash or itchiness, vomiting, yellow skin or eyes, dark-colored urine, swollen ankles or legs, hallucinations, or dizziness.

What Are the Signs that Someone is Abusing Over-the-Counter Medications?

Prescription and over-the-counter medications are the most commonly abused drugs in the U.S., after alcohol and marijuana. If you’re concerned that someone you love is abusing over-the-counter drugs, he or she may display some of the following signs of OTC drug abuse:

• Mood swings
• Problems at school or work
• Pinpoint pupils
• Bloodshot eyes
• Constant scratching
• Changing friends or social circles
• Isolation from family or friends
• Money problems
• Stealing valuables or cash from friends or family
• Requesting money frequently
• Finding drug paraphernalia³

Over-the-Counter Drug Addiction Treatment Program

Chronic and long-term abuse of OTC drugs can cause physical dependence and addiction, which are life-altering issues that can cause personal and physical harm or even death. If you or a loved one is ready to start over, the professional staff at Briarwood Detox Center can help.

Our detox centers in Houston and Austin provide medical detox programs for all addictive substances, including prescription drugs and over-the-counter drugs. We will design a personalized medical detox program to address your physical and emotional needs so you can experience a full and lasting recovery.

References:

1. https://www.chpa.org/MarketStats.aspx
2. https://www.drugabuse.gov/drugs-abuse/over-counter-medicines
3. https://www.dea.gov/sites/default/files/2018-11/DEA_PrescriptionForDisaster-2018ed_508.pdf
4. https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs
5. https://www.ctclearinghouse.org/Customer-Content/www/topics/Facts_On_Prescription_And_Over_The_Counter_Drugs.pdf
6. https://teens.drugabuse.gov/sites/default/files/drugfacts_coughandcoldmed.pdf
7. http://www.cesar.umd.edu/cesar/drugs/dxm.asp
8. https://www.deadiversion.usdoj.gov/schedules/orangebook/orangebook.pdf
9. https://www.aafp.org/news/health-of-the-public/20190109loperamideabuse.html
10. https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines
11. https://www.fda.gov/drugs/information-drug-class/legal-requirements-sale-and-purchase-drug-products-containing-pseudoephedrine-ephedrine-and