When people think of dangerous or addictive medications, their minds most likely immediately go to opioids like Vicodin and OxyContin or benzodiazepines like Xanax and Ativan. And while these drugs are absolutely dangerous due to their extremely high potential for both abuse and addiction, there are, however, many over-the-counter (OTC) drugs that can be abused and even habit-forming, with potentially life-threatening consequences.
For clarity’s sake, a medication is considered “over-the-counter” when it can be found stocked on the regular self-service aisles in pharmacies and supermarkets and do not require a prescription from a physician or any doctor’s approval. This is admittedly somewhat confusing since it is prescription medications that require being passed over a counter from the pharmacist to the customer.
And then, between prescription and OTC medication there are what is known as restricted OTC drugs. These drugs are still legally classified as OTC because they do not require a prescription to be purchased, but they are kept “behind the counter” and may require someone to be at least 18 years of age, provide a valid form of ID, and can typically only be bought in a limited quantity.
According to the Consumer Healthcare Products Association (CHPA), of 2018, currently, 81 percent of adults aged 18 and older in the United States use OTC drugs as their first option for the treatment for minor illnesses. OTC medications are affordable and able to be accessed 24 hours a day depending on the store. OTC drugs can be incredibly useful when it comes to treating allergies, colds, coughs, and various other illnesses that do not merit a visit to the doctor. But when they are misused or abused, they can have a whole host of negative health consequences and the possibility of addiction or overdose.
There are two main factors that contribute to the issue of OTC drug abuse. The first is that because these medications are so commonplace and do not have the same level of warnings or negative associations of certain prescriptions such as opioids, they are perceived as safe to misuse or abuse without any major consequences.
Obviously, Vicodin and aspirin are worlds apart, but it is still possible to become addicted to and even fatally overdose on many different OTC drugs, including aspirin. Nonetheless, even people who are aware of the substance abuse issues happening across the country are still highly likely to engage in OTC drug abuse just because there are no real dangers associated with their use.
The second factor that has a significant impact on OTC drug addiction is accessibility. As previously mentioned, these drugs are available in most any pharmacy, supermarket, convenience store, or even gas station, in the case of pain-relievers like Tylenol or certain cough medicines.
And as we also mentioned, with the exception of the OTC medications that have certain restrictions, like extra-strength Sudafed, anyone can buy them. There are none of the dangers or difficulties of obtaining illicit drugs or forged prescriptions.
Instead, all someone needs to do is walk into their local Walgreens or CVS and make their purchase, which is, in part, why OTC drugs are a prime target for abuse by teenagers and young adults. According to the Drug Enforcement Administration, roughly one out of every 10 teenagers has abused an OTC drug specifically to get high at least once in their life.
4. Diet Pills
Diet pills may be available for over-the-counter purchase, but they are far from safe, especially if someone begins to abuse them. Many weight loss supplements claim to be “all-natural,” which helps to give the impression that they cannot contain anything that could be hazardous to a person’s health. However, these drugs are not regulated by the U.S. Food and Drug Administration, and, therefore, their ingredients have not been inspected by anyone and can vary widely.
The most dangerous and potentially addictive weight loss supplements are stimulant-based. They work by speeding up the user’s metabolism and suppressing their appetite as well as increasing alertness and energy by means of amphetamines or amphetamine-based ingredients, including caffeine and guarana.
Diet pills pose an extremely high risk of addiction because the body can quickly build up a tolerance to them and require a higher dose to achieve the same effects as before. People who build up a tolerance to over-the-counter supplements are also more likely to seek stronger, more dangerous substances like Adderall, or even illicit ones like cocaine.
Stimulant-based diet pills also can have a hugely negative impact on not just your heart and digestive system but also your mental health as well, with abuse leading to the following problems:
3. Pain Relievers
Many people may end up abusing OTC pain medication as a way to deal with their pain out of a sense of desperation because they cannot get prescription painkillers or because they feel that it is a safer option than abusing prescription opioids like OxyContin. While OTC pain relievers may not be in the same class as opioids, they can still in some cases be nearly as dangerous, and even more likely to result in an accidental overdose. There are two common types of OTC pain relievers are also among the most dangerous. The first, ibuprofen, is the active ingredient in medications like Advil and Motrin.
While necessarily addictive, it is still frequently abused by people struggling with joint issues, arthritis, or other forms of chronic pain who are unable to obtain stronger painkillers, either prescription or illicit. The side effects of long-term ibuprofen abuse include:
The other common pain reliever is acetaminophen, the active ingredient in OTC drugs like Midol, Tylenol, and Excedrin, which are all also often abused as a means of managing people’s chronic pain issues. As one of the most commonly used medications in the world, Tylenol, in particular, is assumed by the vast majority of people to be safe to misuse without any negative effects. Unfortunately, quite the opposite is true.
In truth, acetaminophen is probably one of the most dangerous OTC pain medications, with long-term abuse resulting in:
Lastly, what is perhaps the greatest danger of acetaminophen misuse is the fact that the regular effective dosage is incredibly close to the amount needed to overdose, which makes those who misuse or abuse acetaminophen extremely likely to accidentally overdose. This is largely why acetaminophen is one of the most common reported poisonings in the United States and can even be fatal as a result of liver or kidney failure.
2. Allergy Medication and Decongestants
One of the more popular choices for obtaining a legal high, OTC allergy medications pose a variety of risks and negative effects. The two most potentially dangerous forms of over-the-counter allergy medicine and decongestants are antihistamines and pseudoephedrine.
In recent years, it has become much more common for allergy medications to be formulated to be non-drowsy, but many antihistamines, including Benadryl, still contain an ingredient called diphenhydramine, which produces effects of sedation, mild euphoria, and, depending on the amount taken, hallucinations.
The side effects of ongoing antihistamine abuse can wreak havoc all across the body and include:
Unfortunately, non-drowsy OTC decongestants and allergy medication are not without their own problems, which are mostly caused by the decongestant agent pseudoephedrine. When allergy medications make that promise of a non-drowsy experience, they do so with pseudoephedrine, a stimulant that provides congestion relief by shrinking down swollen nasal membranes.
However, like all stimulants, when taken at a high enough dosage, it can create intense feelings of energy, alertness, and euphoria, which has lead to its widespread abuse and, in part, its subsequent move to behind the counter for semi-restricted access.
The other reason allergy medications with pseudoephedrine in them require someone to provide identification and be over the age of 18 is due to the fact that pseudoephedrine is also a key ingredient in the illicit manufacturing of methamphetamine and was, prior to these changes, purchased in bulk to be used in meth labs.
But pseudoephedrine does not need to be taken in the form of methamphetamine to be dangerous. Regularly abusing pseudoephedrine can lead to:
1. Cough Medicine
Not only is cough medicine one of the most commonly abused OTC drugs in America, it is also perhaps the most dangerous. Major cough suppressants such as Delsym, Nyquil, and Robitussin are not only available in almost any store but can also be found in nearly every medicine cabinet in the country.
Cough medicine can be taken in the form of a tablet, gel capsule or syrup, and can have intense sedative and hallucinatory effects, especially when abused at high doses. These effects and the ease through which these OTC medications can be obtained has made them the drug of choice for children and teens.
The active ingredient behind these effects is dextromethorphan (DXM). DXM is actually classified as an opioid, although it does not have any of the pain-relieving effects typically associated with opioids, nor does it have any effect on someone’s opioid receptors. However, like other opioids, it works by blocking nerve signals to the brain that would then send a reflex signal to your muscles causing you to cough.
When someone takes enough DXM, the effects can be comparable to those caused by ketamine or even PCP, but even so, these medications do not even have the same restrictions as OTC drugs containing pseudoephedrine. This is in part because DXM is not supposed to be addictive, but repeatedly abusing DXM in large doses to keep experiencing the high can indeed lead to an inability to stop using it despite the negative consequences, which certainly qualifies as an addiction.
Apart from the high users get when abusing DXM, other short-term effects include:
It is also not just possible but dangerously easy to overdose on DXM to the point of requiring medical detoxification, and when it is chronically abused, DXM can cause:
If you or a loved one is struggling with a dependence on over-the-counter medication or any kind of substance abuse, there’s no need to be afraid. Call the addiction specialists immediately at 844-899-5777 to be pointed toward the right treatment program for you, or contact us online for more information.
Millar, A. (2018, February). Defining OTC Drugs. from http://www.nridigital.com/pharma-technology-magazine/february-2018.html
National Institute on Drug Abuse. (2017, December). Over-the-Counter Medicines. from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines
Thompson, D. (2015, March 02). Long-Term Acetaminophen Use and Health Risks. from https://www.webmd.com/drug-medication/news/20150302/does-long-term-acetaminophen-use-raise-health-risks#1