Are Over-the-Counter Medications Safer Because You Don’t Need a Prescription?
Though over-the-counter medicines usually offer the perception of safety because they are so readily available, certain dangers present, particularly when someone misuses these substances. When a person takes large doses or mixes certain over-the-counter medications with prescription drugs, illicit drugs, or alcohol, the risk of harmful effects increases.
Many people develop a problematic pattern of misuse known as addiction. Fortunately, professional addiction interventions including detoxification, rehabilitation, and aftercare are available to help you quit misusing over-the-counter medications.
What Are Over-the-Counter Drugs?
Over-the-counter (OTC) drugs are everywhere. You may frequently encounter some of these medicines on store shelves and home medicine cabinets. If you can walk into a grocery store, pharmacy, or gas station and buy a drug that promises to treat the symptoms of an illness or problem, it is likely an OTC medicine.1
Available OTC medications are too numerous to name individually. Many are designed to treat what ails you—easing the impact of a common health conditions by managing unwanted symptoms, such as:1
- Pain.
- Headaches.
- Cough and colds.
- Diarrhea.
- Constipation.
- Allergies.
Some OTC medications promise a way to improve certain traits or abilities as a way to achieve your personal goals. People seeking these benefits may take OTC drugs for the purpose of boosting concentration, accelerating weight loss, or increasing energy.
Recently, as some states have added restrictions for certain medications that were previously available over-the-counter, another group of medicines emerged that exists between prescription and over-the-counter drugs. Called “behind-the-counter,” these drugs may be found in a different location of the pharmacy and require identification in order to purchase limited amounts.1 Still, no prescription is needed.
Are They Safe?
In the U.S., the Food and Drug Administration (FDA) tests and reviews all drugs. Only the safest medicines are allowed to be designated as OTC.2
Generally, OTC medicines are safe and effective when used to treat the intended condition or set of symptoms. When taking a new OTC medicine, always read the label to understand what the medication is, what it does, and how to use it. Consult your doctor to identify any special risks or dangers you may encounter by using the medication or giving the drug to someone else, especially children.
Despite the overall safety of OTC medications, not all of them are safe in all situations.2 Some OTC drugs produce unpredictable side effects or allergic reactions resulting in trouble breathing. OTC drugs may be contraindicated for use in people with certain medical conditions and can also interact negatively with foods, drinks, supplements, and other medicines to produce a variety of dangerous effects.2
The associated risks from OTC medicines increase dramatically when a person misuses them. OTC drug misuse happens when someone:1
Takes the drug in ways other than directed on the package by:
- Using too much.
- Using too often.
- Using in a different method than directed, such as crushing and snorting or dissolving in water and injecting.
- Intentionally mixes the drug with other substances to amplify the effects.
- Takes the drug only to get high from it.
It may seem odd for a person to misuse a simple OTC medicine, but some drugs contain active ingredients that cause psychoactive effects and thus, have a serious potential for misuse.1
Some may mistakenly believe this practice is safer than using illicit or prescription drugs, but all substance use carries severe risks to your mental and physical health.1 You should only take medicines to treat your symptoms and only as directed by your doctor.
The challenge for parents or other loved ones of someone who could be misusing OTC drugs is understanding how misuse can be dangerous, knowing the warning signs, and helping the user get treatment. With this information, you can react in educated and purposeful ways to prevent and reduce harm.
Common OTC Medications of Misuse
People misuse many OTC medications either alone or in combination with alcohol and other drugs. Some of the most commonly misused OTC drugs are:1,3,4,5,6,7
- Dextromethorphan (DXM) — A cough suppressant ingredient in various OTC cough and cold syrups, tablets, and gel capsules. To use DXM, people will take large amounts orally, inject the drug, or mix it with alcohol or marijuana.
- Loperamide — An anti-diarrhea medicine available in tablet, capsule, or liquid formulations. Most people misusing this OTC drug will simply consume large amounts orally.
- Ephedrine — A dietary supplement derived from the ephedra plant, native to parts of Asia. People in China have used this substance for centuries to treat colds, congestion, headaches, and asthma. Those misusing the substance will use higher doses or combine with caffeine. It is often included in weight loss or athletic performance products.
- Pseudoephedrine — A nasal decongestant used in many OTC cold medicines. Rather than simply taking a high dose of this substance, pseudoephedrine is more often misused as an ingredient in homemade methamphetamine (crystal meth) recipes. It is now available behind-the-counter and requires a signature to obtain.
- Laxatives — A group of OTC medicines used to treat constipation and encourage bowel movements by softening stools or stimulating the intestines to function. People misuse laxatives by using higher or more frequent doses than directed, usually in an effort to lose weight.
- Antihistamines — A large group of OTC drugs available to treat allergies, as well as fevers and colds. Since these medicines are cheap and readily obtainable in most homes, people will misuse them by taking high doses or using for “off-label” purposes.
- Caffeine — A stimulant drug available OTC and across stores as pills and drinks. Some will consume the substance in large amounts at once or in combination with other substances, such as alcohol (e.g. Red Bull and vodka, Four Loko, etc.) for its stimulating or appetite-suppressing effect.
Since OTC drug abuse is always changing and evolving, this list may vary in your particular community. Continue seeking local information about the drug trends and effects of the abused substances from trusted sources like physicians and drug abuse experts.
What Are the Effects of These Drugs?
Every drug of abuse is consumed with a specific goal or intention in mind. Whether the individual is seeking an opportunity to feel pleasure, the chance to perform at a higher level, or simply the thrill of experimentation, they believe the substance will help them achieve that goal.
In reality, despite the perceived safety of OTC drugs, putting too much of any drug into your body can be extremely detrimental. The often-misperceived benefits are easily outweighed by the risks of hazardous outcomes.
The Danger of Mixing Drugs
By now, the dangers that will likely arise from you or your loved ones misusing OTC drugs are evident. The risks are compounded when people:
- Mix multiple OTC drugs.
- Mix OTC drugs with prescription medications.
- Mix OTC drugs with alcohol or illicit substances.
Some people will engage in this practice accidentally without realizing the risks of mixing substances. Others will intentionally combine these substances as a way to modify the effects or increase the high from either substance alone.
Combining drugs that work differently in the brain (mixing a stimulant with a depressant) can somewhat mask the effects of either drug. In the case of combined caffeine and alcohol use, using large amounts of caffeine serves to minimize some of the subjective intoxication from the alcohol, which interferes with the ability to accurately recognize how drunk you are.6 This combination may lead to overconsumption, bad decisions, and alcohol poisoning.
By mixing multiple stimulants or multiple depressants, the person will experience results that are amplified. Ephedrine and caffeine both cause increased heart rate and blood pressure, which can prove dangerous, especially in an individual with pre-existing cardiovascular issues.8 Similarly, using loperamide with alcohol can cause profound respiratory depression, which could result in overdose and death.1
Codeine cough syrups are frequently combined with alcohol or caffeinated drinks.7 Although these syrups are not available over-the-counter, these drinks remain popular, especially among teens and young adults. These drinks are known by many names including:7
- Syrup.
- Sizzurp.
- Purple drank.
- Lean.
- Barre.
Young adults also commonly combine DXM-containing cough syrups with alcohol. In relatively recent years, this may have become an increasingly common practice due to the difficulty of obtaining codeine-containing cough syrups since some products, such as Phenergan w/ codeine, have been discontinued. The act of mixing DXM with alcohol or soda is called robo-tripping or skittling.1
One of the most widely-used OTC substances, acetaminophen, has a perception of safety, but over-the-counter drug misuse can make this substance extremely dangerous. Found in Tylenol, prescription opioid drugs like Percocet, and various cold medicines, too much acetaminophen can lead to overdose, liver failure, and even death.11
Acetaminophen overdose is a very common reason for calls to poison control hotlines and visits to emergency rooms.11 Like other OTC drugs, mixing acetaminophen with alcohol and other drugs will increase the risks of unwanted outcomes, particularly liver damage.
Mixing OTC medicines with illicit substances, prescription drugs, alcohol, and other substances can lead to unpredictable and deadly outcomes. Even when not combined with other drugs or alcohol, the misuse of some substances can still lead to significant health issues, including the development of compulsive drug use behaviors.
Chronic Misuse & Addiction
One of the most impactful results of chronic substance use is addiction. Addiction is a condition characterized by intense drug cravings and compulsive use regardless of negative consequences.12 Once someone develops a substance addiction, it can be extremely difficult for them to quit using on their own.
The American Psychiatric Association (APA) has outlined several criteria which are used to help make a diagnosis of a substance use disorder—or, what is more commonly referred to in lay circles as addiction.9
OTC Withdrawal Symptoms & Dangers
Some OTC drugs may have withdrawal symptoms when someone quits or reduces their intake after prolonged chronic use.
Get Help for OTC Medicine Addiction
It’s never too late to make a positive change in your life. If you are struggling with an addiction to OTC drugs or any other substance, professional addiction treatment can help you get sober and remain in recovery.
Call to learn about addiction treatment options and begin the admissions process. You can also confidentially verify your insurance online.
