Abuse of Over-the-Counter Drugs

Articles on abuse of over-the-counter drugs typically center on younger demographics. Since adolescents typically have less access to street drugs and tend to learn about drugs of abuse by word of mouth among peers, they are particularly vulnerable to abuse of over-the-counter (OTC) drugs. However, it is important to keep in mind that anyone, at any age, can abuse over-the-counter drugs. Even though OTC medications are lawfully manufactured, when a person abuses these drugs, a host of side effects can emerge; some may be severe and even cause a fatal overdose. For this reason, individuals who are concerned about their own or another’s abuse of over-the-counter drugs are advised to learn about the dangers inherent in consuming a high volume of these drugs.

Certain over-the-counter drugs, if taken at high enough doses, can have psychoactive effects (the person experiences a high). OTC drug abuse occurs any time a person takes this drug with the intention to get high. To bust the myth that OTC drugs are safe, consider this simple point: Even though these medications do not require a prescription, if the multiple doses a person takes to get high were concentrated into one dose, then a prescription might be necessary. In short, the legality of these drugs is never a defense to their abuse; it’s actually a sign of abuse since denial is implicit in this rationale.

Cough Medicine Abuse

Of all over-the-counter drugs of abuse, the most commonly abused type includes those with the active ingredient dextromethorphan (DXM). This medication is indicated for the treatment of coughs and other flu symptoms. According to the National Institute on Drug Abuse, promethazine-codeine cough syrup is also a flu medication that is vulnerable to abuse, but it is only available by prescription. Per reports, taking too much of this drug induces euphoria and relaxation. In addition, the ingredient promethazine HCl, which is an antihistamine, can have a sedative effect. Even though this drug is not available over the counter, it is helpful to know that it exists, especially if a person engages in doctor shopping to receive it.

A main problem involved in DXM abuse is its widespread availability. There are more than 100 over-the-counter medications in the US that contain DXM. Formats include capsules, tablets, gel caps, liquids, and lozenges. The following are some of the most common OTC medications that include DXM:

• Vicks DayQuil/NyQuil
• Vicks Formula 44
• Alka Seltzer Plus
• Theraflu
• Triaminic
• Comtrex
• Coricidin
• Tylenol Cough & Cold
• Mucinex DM
• Pediacare
• Robitussin
• Delsym
• Dimetapp

According to one survey, one in every 10 US teenagers had abused an over-the-counter medication with DXM in it to get high at least once in their lifetime. There was a greater incidence of DXM abuse in this age group compared to (in no particular order) LSD, cocaine, meth, and ecstasy. A consideration of the potential side effects of DXM abuse would cause concern, among parents and anyone affected by abuse of this drug.

The following is a list of symptoms and signs that may emerge when a person abuses DXM:

• Hallucinations
• Euphoria
• Feeling disassociated from one’s body
• Paranoia
• Disorientation
• Seizure
• Panic attacks
• Sensation of floating
• An altered perception of time
• Poor coordination
• Dizziness
• Nausea
• Hot flashes
• Impaired brain functioning
• Fatigue
• Vomiting
• Rashes
• Sweating
• Slurred speech
• Being hyperactive
• Rapid eye movements
• An increase in blood pressure
• Pounding or racing heart

The way DXM medications are abused can directly impact the intensity of the high and the side effects. Since liquid is a common format, drinking DXM medications may be particularly inviting, especially when mixed with alcohol or soda at a party or in any other social setting. When people abuse the extra-strength variety of DXM, they may call this practice “skittling” or “robo-tripping.” Some individuals may abuse Coricidin HBP Cough & Cold capsules (called “C C C” or “triple C” on the street) because these medications lack guaifenesin, an ingredient in cold medication that can cause nausea at high doses. The concoction popularized in hip hop music known as “purple drank” contains promethazine-codeine cough syrup, which, as stated earlier, is only available by prescription.

Additional OTC Drugs of Abuse

While DXM medications are the most commonly abused over-the-counter drugs, especially among those 12-14 years old, there are numerous others. The following is a list of nine additional types of OTC drugs of abuse that are popular among youths, though anyone can develop a use disorder vis-à-vis these drugs:

• Diet pills
• Pain relievers
• Caffeine (e.g., energy drinks or caffeine pills)
• Motion sickness tablets
• Herbal diuretics and laxatives
• Pseudoephedrine
• Sexual performance enhancement medications
• Herbal ecstasy
• Other herbal substances (e.g., nutmeg)

A review of the foregoing list reveals that creativity is at work in OTC abuse, and it can have disastrous results. As noted earlier, teenagers are among the most vulnerable groups to abuse these drugs. From the perspective of neurobiology, it is critical for the teen brain, and young adults, to remain free of drug abuse because the brain is still in development. Early drug abuse can bring about structural changes in the brain that predispose the brain to drug abuse throughout adulthood. In fact, as Above the Influence notes, 90 percent of all Americans who have a substance use disorder began drinking, smoking, or using drugs before they turned 18 years old. In the past, this phenomenon may have been chalked up to a person’s character, but today, in view of the brain disease model of addiction, the neurological underpinnings of addiction are better understood.

Treatment for Over-the-Counter Drug Abuse

Much of the literature available on rehab treatment for over-the-counter drug abuse focuses on the teen population and is geared towards parents. For this reason, treatment approaches for teens will be discussed in this section. However, there is still considerable overlap in the treatment of teens and adults who are experiencing OTC medication abuse.

Speaking in broad strokes, the National Institute on Drug Abuse organizes treatment for adults (and teens) into two main types: medications and therapies. At present, there are no medications that are approved by the Food and Drug Administration for recovery from OTC drug abuse. The use of medications is usually limited to recovery from addiction to alcohol, nicotine, opioids, and benzodiazepines.

The Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide, published by the National Institute on Drug Abuse, provides helpful insights into research-based approaches that are effective in treating teenagers in recovery. The following are some highlights of the guide, which can be helpful to teenagers who are questioning their OTC drug abuse and wanting help, as well as parents who are concerned and seeking treatment for their child:

The treatment needs of teenagers can be different from those of adults. Compared to adults, Americans aged 12-17 are less likely to ask for help for drug abuse. According to research, only 10 percent of Americans in this age group who need drug addiction treatment get it. For this reason, a parent may need to organize an intervention, have a talk, or implement other strategies to motivate the affected adolescent to open up about the drug abuse. Discussing treatment is a step toward getting help at a rehab center.

There are research-based approaches to help adolescents. Scientifically evaluated therapies are available at rehab centers to help adolescents identify the thoughts, behaviors, and emotions underlying over-the-counter drug abuse. Since medications are not typically used, the delivery of effective therapies (individual and group) is an important key to recovery.

Recovery groups that focus on teen issues, concerns, and realities are recommended. In addition to therapy, a host of rehab services are available, including group recovery meetings with a teenage composition and focus on teen issues. The principle of recovering through mutual aid can be helpful, especially because teenagers are peer-focused. A peer can stand out as a good influence as much as a negative one.

A dedicated treatment center and counselors are needed. Some rehabs offer an adolescent-only program, with no adult clients on site. In other instances, a program may be mixed age, but they may separate group counseling, group recovery meetings, and other services by age. A rehab center with mixed age groups can be just as effective as one with an adolescent-only focus. The key is going to be the quality of the programming for the adolescents.

While adolescent drug abuse is distressing at a personal and societal level, the good news is that help is available. Although early drug abuse can have a negative impact on the developing brain, the damage can be reversible, especially if treatment is sought as soon as possible. From a social and personal perspective, the earlier teenagers in need of help get treatment, the more likely they will be to not experience, or further experience, health problems, trouble at home, difficulties at school, or issues with the law.

Whether the person struggling with OTC drug abuse is a teenager or an adult, comprehensive help is available. With the right care, OTC drug abuse can be left in the past for good.