Over-the-Counter Drug Abuse
What Are OTC Drugs?
Over-the-counter drugs are available for purchase at pharmacies, grocery stores, and convenience stores across the country. These drugs, such as ibuprofen and acetaminophen, are regulated by the Food and Drug Administration and approved for use without a prescription in the doses recommended on each package. Most often, people use them to treat minor pain that is intermittent. However, in some cases, long-term use occurs when someone tries to treat recurring discomfort on their own.
Over time, tolerance can and does develop to OTC drugs. When drugs are used more often than they should be or without a medical reason, this is classified as misuse, and it applies to OTC drugs just as much as illicit ones. The PACT Coalition reports over 3.1 million people aged 12 and older have misused an OTC drug at some point in their lives.
Today, there are hundreds of OTC drugs on the market, and each one comes with its own set of risks. Dependency is far more common than most people realize. Despite how safe many assume OTC drugs are, merely because a prescription isn’t needed to acquire them, all of these drugs come with warnings for a reason. People experience side effects from common household pain relievers, cold medicines, and antihistamines every single day. Some are mild and some are severe, and some can even cause death. This occurs even in cases of typical, recommended use. Thus, abusing these drugs seriously increases the risk of adverse events like overdose, which can lead to death.
In recent years, the recommended doses and warning labels on the back of OTC drug bottles are often hidden from sight. Double-sided labels conceal important information, and some people don’t even realize there is anything worth reading beneath the surface label they see when they open the package. When it comes to prescription drug labels, less than 10 percent of people actually read the warning labels printed on their bottles and package inserts, Consumer Reports notes. Considering most of the population believes OTC drugs are even safer than prescription variants, it’s likely even fewer read OTC drug warnings.
Why Abuse Them?
It’s hard for some people to understand why anyone would abuse an OTC drug, but there are many reasons people abuse them. Most people will start out using these drugs as recommended. Over time, they might get lax and take more than the label suggests, especially when abusing pain relievers in light of stronger or more intense pain. For example, if someone usually takes 400 mg of ibuprofen for menstrual cramps, the person may take 800 mg or 1000 mg for a persistent migraine headache that won’t go away. Given that these headaches can last for days on end, some people end up using far more than the 3200 mg recommended daily limit.
Many people may even use more than one substance at the same time, because they assume more drugs equates to increased efficacy. It is common for individuals to alternate taking both ibuprofen and acetaminophen together in attempts to treat unruly pain.
Sometimes, individuals lack the means to buy or attain illicit substances or prescription drugs, so they opt for OTC medications. They may double or triple doses of OTC meds to intensify their effects. Often, it’s merely a need to get more sleep so someone might misuse Tylenol PM, which contains diphenhydramine – a nonprescription drug that can help induce sleep. According to the Handbook of the Medical Consequences of Alcohol and Drug Abuse, there were 3,000 reports of adverse events to American poison control centers in 2005 related to the abuse or misuse of antihistamine drugs, and half of them involved drugs containing diphenhydramine.
Furthermore, it is possible to get high off OTC drugs, too. Many people are unaware of this, and thus, they question why anyone would abuse these mild substances, but none of them are mild when larger-than-recommended doses are being used. OTC drug abuse is particularly common among teenagers since they don’t have as much access to illicit substances and alcohol as adults do. The Drug Enforcement Administration reports 12 percent of teens have used OTC cold medicines for the purpose of getting high. In a study regarding just how much teens know and understand about OTC drugs, half of the teens surveyed weren’t aware there were any risks involved in mixing OTC drugs or using them improperly, Medical Daily notes.
In some cases, certain OTC drugs may actually improve an individual’s mood. For example, Science Direct notes the ability acetaminophen has to indirectly increase forebrain serotonin levels. For this reason, individuals with imbalances or those affected by depression may be more likely to abuse this particular OTC drug.
Death may be a side effect of habitual acetaminophen use or abuse. WebMD reports the risk of early death can be increased as much as 60 percent in those who overuse acetaminophen.
One of the oldest OTC treatment drugs on the market, acetaminophen is also one of the most widely abused. It can cause some serious problems for those who don’t use it correctly. Popularly known but its brand name, Tylenol, acetaminophen contains caffeine, making it an even more likely candidate for abuse. The stimulant effects of caffeine are potent enough that it has hooked the majority of the nation. Around 80-90 percent of North Americans regularly consume caffeine in some form, Johns Hopkins Medicine reports. In many cases, the stimulant-like impact that caffeine has may increase someone’s propensity toward abusing illicit stimulants over time.
Acetaminophen-based drugs have a strong impact on several parts of the body and can cause extensive damage when used for prolonged periods of time or abused in any sense. Acetaminophen is second in line to prescription drugs when it comes to drug overdose-related suicides, per the Centers for Disease Control and Prevention.
Effects on the Brain
Acetaminophen definitely has an impact on neurological processes. In fact, CNN News reported on one study in which half of the participants were given acetaminophen and half a placebo, noting pain was reduced in the treatment group, but half of participants also showed a reduced propensity toward pleasure, too.
Tylenol PM has been shown to actually cause damage to the brain in some studies. In a study of 1,652 African American participants, those who were given anticholinergic drugs like Tylenol PM had a fourfold increased risk of cognitive impairment, per the Journal of Neurology.
Harvard Health Publications notes that although acetaminophen has long been touted as a protective factor for people with cardiac health issues, one study shows regular use of the drug increased blood pressure levels in participants.
Effects on the Renal System
Acetaminophen wreaks havoc on the kidneys and liver when it is used or abused in large amounts. Individuals who abuse more than one substance alongside acetaminophen may be looking at even greater risks.
Mercola notes those who abuse both alcohol and acetaminophen increase their risk of kidney damage by 123 percent. The liver likely pays the biggest price when it comes to acetaminophen abuse. While liver disease and subsequent failure of the organ can take years to develop and actually bring fatality when substance abuse (like alcohol and opiates) is usually concerned, acetaminophen can cause acute liver failure in a matter of just two days and often as a result of viral hepatitis, the Los Angeles Times reports. Acetaminophen poisoning is the most frequent cause of acute liver failure in the nation, per Medpage Today.
There is now evidence that points toward damage to both the intestines and the stomach with regular use or abuse of acetaminophen, especially when used in conjunction with aspirin or other nonsteroidal anti-inflammatory drugs, the University of Illinois at Chicago reports. It is thought the combined use of these two drugs increases the potential for damage to the stomach lining and the formation of ulcers. The Journal of Pharmacotherapy also notes the potential for rhabdomyolysis development in cases of acetaminophen overdose.
The abuse of ibuprofen usually stems from chronic pain that isn’t being managed well. WebMD accounts for some 100 million Americans being affected by persistent pain each year. Unfortunately, ibuprofen does not come without risks.
Mercola notes the results of a large-scale study in which nonsteroidal anti-inflammatory drugs, such as ibuprofen, were given to over 116,000 participants. The results showed the popular OTC pain reliever was associated with more than a threefold increased risk of stroke. Consumer Health Day notes that among the 14 million people with arthritis who take NSAIDS like ibuprofen regularly, up to 60 percent will incur side effects, ranging from bleeding and stomach ulcers to tissue erosion and death. Science Daily reported on a study of 43 people being treated with NSAIDS that showed 71 percent experienced damage to their small intestines when exposed to the drugs for at least three months in recommended doses.
Abuse of ibuprofen can also lead to impaired blood flow to the kidneys, which often results in acute kidney failure, per Mayo Clinic. While the drug isn’t thought to be as bothersome to the liver as acetaminophen, chronic abuse of it can inflame liver tissues and cause other problems with the blood-filtering organ. The Journal of Circulation notes the results of a large study in which 100,000 people were followed after having suffered heart attacks. Forty-four percent were prescribed NSAIDS like ibuprofen following the event, and 30 percent of that group went on to have a subsequent attack or died from coronary artery disease within the following year.
Most people are surprised to find out Imodium AD is actually an opiate-based drug. Known for their trademark constipation, opiates are actually the perfect remedy for cases of diarrhea. That being said, there are many people who are well aware of what this drug really is, and as such, they abuse it to achieve the same high they would get from abusing prescription opioid pain relievers or heroin.
The OTC drug works to flood the brain with dopamine in much the same way other opiates would. In large amounts, Imodium AD causes individuals to feel a relaxed and euphoric high. While cardiac arrest, stroke, diarrhea, constipation, and even kidney damage can result from long-term abuse, the biggest risk involved with the abuse of Imodium AD is respiratory distress. This can lead to coma and even death.
Dextromethorphan is a popular ingredient in many cold remedies, such as Delsym, which is a cough suppressant. People often abuse this drug to try and achieve a high similar to that which psychedelics supply. Side effects include a drunken-like state, slurred speech, and other cognitive impairments.
Neurologically, DXM has been known to inflict hallucinations, and abuse of the drug may lead to permanent cognitive damage. Many people who abuse drugs containing DXM have trouble breathing. Cases of self-harm have also been reported, often as a side effect that stems from hallucinations.
Many who abuse this drug snort the powdered form of it rather than consuming the oral solution. This is merely an attempt to get high faster, but the risks also increase when snorting the drug.
Abusing these drugs can cause dependence. As a result, many who later try to stop using them end up suffering from withdrawal symptoms, such as:
- Bowel issues
- Problems regulating body temperature
- Elevated blood pressure
- Nausea and vomiting
- Joint and muscle pain
Diphenhydramine is most popular among teens. The rate of abuse among this demographic doubled between 2000 and 2003 from 1,623 to 3,271 reported calls to poison control centers, per the United States Department of Justice.
Diphenhydramine abuse often causes heart palpitations and arrhythmias, which can lead to cardiac arrest. The drug is the base ingredient in Benadryl, a common cold medication. Drowsiness, constipation, and nausea are common as mild side effects. Outside of such, the drug has a hypnotic effect on the brain and can inflict those who abuse it with cognitive impairment, especially among the aging population, U.S. News reports. Another study notes those who take the drug for three years or longer have a 54 percent increased risk of developing dementia, according to Harvard Health Publications. It is noted by the Journal of Pharmacy & Therapeutics that medications are to blame for as many as 60 percent of cases of acute kidney injury, and diphenhydramine is one of those medications.
Pseudoephedrine is another common OTC substance of abuse, especially among teenagers. Most states now require that individuals purchasing drugs that contain this ingredient show identification that proves they are at least 18 years old, and some also require they sign forms to track their purchase of it. The reasoning behind this move was to deter people from buying multiple packages of this drug to use in the manufacturing of crystal meth and other methamphetamines.
The abuse of cold medicines is particularly common among young people. Around 3.1 million people between the ages of 12 and 25 admitted to abusing an OTC cold medicine in 2006, per the Drug Free Alliance. They purposely abuse these drugs in effort to feel a euphoric high followed by a deep state of relaxation in most cases. But the abuse of OTC cold meds can be harmful, even causing death.
Diet Pills and Herbal Stimulants
Often referred to as dietary supplements, this class of OTC drugs often causes harm to those who abuse them. Diet pills are not a new concept. Manufacturers of these drugs have been making promises of effortless weight loss that they can’t fulfill for years. One of the most popular diet aids to see store shelves was ephedrine, which was banned from the United States in 2004 after a number of cases of disability and sudden deaths following cardiac arrest were documented. While weight loss results were generally greater with accompanying diet and exercise, even those who did nothing but pop these pills every day were dropping excess pounds with ease. They did indeed work, but that came at a price.
Herbal stimulants that are marketed as “energy boosters” are also popular in America. Most of the time, people are using these drugs to try and stay awake or alert when their bodies are craving sleep. These stimulant drugs are often abused by specific groups of people known for pushing the limits of what their bodies can do in favor of staying awake, such as college students who need to stay up and cram for an exam or truck drivers who want to get a few more miles in before pulling over to rest. Dinitrophenol is one of the riskiest herbal diet remedies on the market right now. In fact, a woman from Britain died after an overdose of a diet pill that contained the ingredient, Yahoo! News reports.
These drugs generally affect the body by stimulating nervous impulses and ramping up the metabolism and heart rate.
As a side effect, there is great pressure on the heart to pump more blood than it is accustomed to, even when the body is at rest. Heart palpitations are common, and heart attack is a possible consequence. Still, the desire to be thin drives many to use the drug. Herbal stimulants that are abused for their ability to help people stay alert and awake can and do cause many of the same side effects as diet pills.
An addiction to diet pills says a lot about what is going on with an individual mentally. Obviously, those who abuse these drugs are in some desperate need to lose weight. Often, weight loss isn’t needed though. In many cases, those who are abusing these drugs are suffering from serious mental illnesses like bulimia or anorexia nervosa. According to Anorexia Nervosa and Associated Disorders, as many as 30 million Americans are suffering from an eating disorder. It isn’t uncommon for people who struggle with these illnesses to abuse diet pills in an attempt to control their appetite and shed pounds by artificially increasing their heart rate.
Signs of Addiction
If tolerance is present and a loved one is showing some or all of the following signs of addiction, it’s time to get the person help.
- Isolation from friends and family
- Persistent abuse of OTC drugs despite negative consequences
- Inability to control how much or how often the drugs are used
- Using is the top priority in life
- Effects of withdrawal are felt when use stops or lessens
- Poor grooming habits
- Moodiness or acting out of character
If someone has been abusing OTC drugs for a long time, the person may need to seek care for a long period of time, too. The course of treatment may also be more intensive and withdrawal more abrupt. Co-occurring mental health disorders affect 53 percent of people who abuse drugs, HelpGuide reports. Therefore, those individuals will also require treatment of their psychiatric issues at the same time.With the surplus of treatment centers that now accept insurance payments and offer assistance programs and grants to their clients, worries about how to pay for treatment can be alleviated. The type of treatment someone needs will be dependent upon what substances have been abused. Restorative health efforts may be made to repair damage incurred by organs like the liver and kidneys. Individuals who have abused diet pills and herbal supplements may have looming body image and nutritional deficiencies to deal with as a result of a damaged natural metabolism and low self-esteem. A quality diet and exercise plan that is enforced alongside substance abuse treatment is vital for these clients.
Comprehensive addiction treatment programs can help those who have been abusing over-the-counter medications. With medical detox and therapeutic care, individuals can leave this substance abuse in their past and move forward toward a healthier future.
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