Key takeaways:

  • Pseudoephedrine is a stimulant used in most cold medicines. If used appropriately, it can relieve symptoms of cold or allergies such as nasal, sinus, and chest congestion. Those who abuse cold medicines often do so to achieve hallucinations or an intense high
  • There are a growing number of supplements that are unregulated by the FDA but are commonly sold online, in head shops, vape stores, and other retail stores. Kratom is one of the most commonly abused supplements, and has effects very similar to opioid drugs like Oxycodone and heroin, with similar addictive properties
  • As with abuse of illicit and prescription drugs, continued misuse of OTC drugs rewires brain chemistry over time. If an OTC drug is abused regularly the brain will eventually develop a tolerance to it, meaning higher doses will be needed to feel the effects

Over-the-counter (OTC) drugs are medications that can be obtained without a prescription from most drug stores and supermarkets. OTC drugs are less potent than illicit drugs and prescription medications, meaning they are generally safer to use. However, they can also be abused if taken above the recommended dosage, and it is still possible to develop an addiction to OTC drugs.

OTC drug abuse

OTC medication is used to treat a wide range of ailments, from mild pain and inflammation to motion sickness and muscle aches. There are many reasons someone may start to abuse OTC drugs. Some abuse them to self-medicate mental health problems such as depression or anxiety. Others do so in order to feel a sense of euphoria or hallucinations that can occur when taking more than the recommended dose.

In any case, consuming OTC medications in higher doses than the recommended guidelines state is considered abuse. Abusing OTC drugs can often lead to users trying illicit or stronger drugs in order to get a better high. 

Continuous abuse of OTC drugs or taking them in high doses can result in memory loss, heart problems, respiratory failure, kidney failure, and even death. 

The most commonly abused OTC drugs include: [1,2]

  • Cough medicines (Dextromethorphan, or DXM)

  • Cold medicines (Pseudoephedrine)

  • Motion sickness pills (Dimenhydrinate)

  • Sedatives like sleep aids (i.e. ZQuil)

  • Caffeine pills or weight loss supplements (i.e. Ephedrine)

  • Nutritional supplements not regulated by the FDA (i.e. Kratom)

  • Laxative medications

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Common OTC drugs

Over-the-counter drugs come in many forms for treating a wide range of ailments. While most are harmless when taken in the correct dose, many can be harmful when abused. Some of the most common OTC drugs that are abused include:

Cough medicines (Dextromethorphan, or DXM)

Cough medicines are widely available in most homes, making them the target of teen drug abusers. Abusing cough medicine can cause mild stimulation and a sense of euphoria, or hallucinations if taken in higher doses. The Drug Enforcement Administration (DEA) outlines different levels of high or symptoms depending on the dose. The maximum recommended daily dose of DXM is 120 mg; beyond that, intoxication and dangerous side effects begin to appear. [1,2]

120-200 mg induces mild stimulation and euphoria

200-400 mg leads to stronger euphoria and hallucinations

300-600 mg causes loss of motor coordination and visual distortions

500-1500 mg leads to out-of-body sensations

High doses of DXM can cause adverse side effects that can be extremely harmful to health, such as: [1,2]

  • Breathing problems-irregular or slow breathing

  • Blacking out

  • Muscle twitching

  • Extreme drowsiness

  • Heart palpitations

  • Changes in blood pressure, either too high or too low

  • Elevated body temperature

  • Vomiting

  • Rapid heart rate

  • Blurred vision

  • Muscle twitching

  • Brain damage

Cold medicines (Pseudoephedrine)

Pseudoephedrine is a stimulant used in most cold medicines. If used appropriately, it can relieve symptoms of cold or allergies such as nasal, sinus, and chest congestion. Those who abuse cold medicines often do so to achieve hallucinations or an intense high. 

Pseudoephedrine is also one of the key components used in processing illicit drugs such as methamphetamine. Those who abuse pseudoephedrine regularly in large doses may experience shortness of breath, high blood pressure, irregular heartbeat, and seizures.

Motion sickness pills (Dimenhydrinate)

Dimenhydrinate is used to treat the discombobulation and nausea felt during motion sickness and from vertigo. In larger than recommended doses (around 200-1200 mg, depending on body mass) it can cause hallucinations, making it a popular alternative to other hallucinogens for its psychedelic properties. If abused in large doses it can cause ringing in the ears, nausea, seizures, coma, and death. 

Sedatives & sleep aids

Sedatives and sleep aids are also sometimes abused by people, especially those who struggle with insomnia. With regular use, it’s possible to develop either a psychological or physical dependence on these sleep aids, with people being unable to sleep without them. Taking these too often or in higher doses than recommended, or taking them with other sedatives (including alcohol) increases the likelihood of addiction.

Caffeine pills and energy pills

Pills or supplements that contain caffeine or other stimulants can also be addictive and are commonly abused by people who rely on them for their mood and energy-enhancing effects. Taking these supplements often, regularly, or relying on them to be awake or focused can increase the likelihood of becoming dependent on them. Similar to illicit stimulants, these medications can place strain on the heart, increase blood pressure, and cause other negative health and mental health effects. [2]

Laxatives

Laxatives are sometimes abused, especially by people who are trying to lose weight or have a diagnosable eating disorder. People who abuse laxatives often taken OTC laxatives often and in higher doses than recommended, leading to diarrhea and GI problems. [2]

Unregulated supplements

There are a growing number of supplements that are unregulated by the FDA but are commonly sold online, in head shops, vape stores, and other retail stores. Kratom is one of the most commonly abused supplements, and has effects very similar to opioid drugs like Oxycodone and heroin, with similar addictive properties. [3] Taking any unregulated supplement is unadvised, as these supplements are not tested for purity or dosage, and cannot be verified as safe for consumption.

OTC drug addiction

As with abuse of illicit and prescription drugs, continued misuse of OTC drugs rewires brain chemistry over time. If an OTC drug is abused regularly the brain will eventually develop a tolerance to it, meaning higher doses will be needed to feel the effects. This can lead to a dependence on the substance forming, which if left unchecked can lead to addiction. 

As with all forms of recognized addiction, a diagnosis is based on the negative impact the abuse of a substance is having on a person's life, using 11 criteria overall to measure them. One criterion is withdrawal symptoms being felt when a person stops or reduces their substance abuse. With OTC drugs, these withdrawal symptoms will often present themselves as the following:

  • Confusion

  • Irritability

  • Agitation

  • Anxiety

  • Mood changes

Other criteria of OTC addiction include a person's inability to stop using the drug despite knowing the consequences, the length of time and expenditure spent abusing the substance, and putting off regular life activities such as work or relationships in order to abuse the drug.

OTC drug addiction treatment

There are many effective methods of treatment for OTC addiction. Group therapies such as Narcotics Anonymous (NA) can introduce support networks, and mental health counseling and psychotherapies such as cognitive-behavioral therapy (CBT) can all help to combat OTC addiction and begin recovery. 

There are also many inpatient and outpatient rehab centers that can help with OTC addiction. These treatment centers offer a safe space to detox, with medical supervision to manage withdrawal symptoms, and can introduce therapies and coping mechanisms to help manage cravings and reduce the risk of relapse. 

Inpatient and outpatient rehab programs allow those recovering from OTC drug addiction the resources to get and stay sober. Enrolling in a drug rehab program can significantly reduce the odds of relapse.

Whatever type of OTC addiction you or a loved one has, help is available. Contact a treatment center today to begin the road to recovery.