Identifying Over-the-Counter Medication Abuse: Signs and Symptoms

Most people view OTC medication as safe. After all, you do not need a prescription to get them. However, like all medications, they have the potential to be abused. Recognizing the signs and symptoms can help identify those needing help.

Key takeaways:
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    OTC medications can be used to obtain a high similar to other illicit drugs.
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    Four commonly abused medications include dextromethorphan, pseudoephedrine, diphenhydramine, and dimenhydrinate.
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    Changes in personality or behavior can be signs of OTC abuse.
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    Obtaining help early can lead to more successful treatment of abuse and addictions.

Commonly abused OTC medications

OTC medications are readily available and inexpensive making them easy to abuse. A study by the University of Cincinnati found that 1 in 10 (10%) surveyed 7th–12th graders reported abusing an OTC medication.

The most common OTC medications abused include:

  • Dextromethorphan (DXM).
  • Pseudoephedrine (PSE).
  • Diphenhydramine.
  • Dimenhydrinate.

DXM is a cough suppressant that is found in many OTC cough and cold preparations. From 1994 to 2007, the California poison control center showed a 7-fold increase in DXM abuse cases.

PSE is a decongestant that can be used to make methamphetamine. However, it can also be abused in its original form.

Diphenhydramine is the active ingredient in Benadryl. It is an anti-histamine used for allergies, cold symptoms, and as a sleep aid.

Dimenhydrinate is used to treat motion sickness. It is the active ingredient in Dramamine.

What is abuse?

Abuse of an OTC medication is considered taking the medication in a way that is not consistent with recommendations. This could include taking higher doses, more frequent doses, or when it is not necessary.

Changes that can indicate abuse

When someone is abusing an OTC medication they often begin to display changes in their personality and behavior. Losing interest in previously enjoyed activities and changes in friendships can be warning signs. In addition, changes in performance at school or work and missing important deadlines are worrisome for abuse.

It is common for people abusing medications to hide this from their friends and family. However, noticing increasing secretive or suspicious behavior can be a sign. Additionally, blaming others or becoming angry when confronted is often a sign someone is hiding something.

Typically, when someone begins to act uncharacteristically for themselves, one should look at various causes. Abuse should be considered especially when signs of OTC medication abuse are present (ie. multiple empty containers).

Symptoms of commonly abused drugs

  • Dextromethorphan — hyperexcitability, sweating, slurred speech, lethargy.
  • Pseudoephedrine — Agitation, high blood pressure, fast heartbeat, nausea/vomiting.
  • Diphenhydramine — Flushing, somnolence, problems urinating, agitated delirium.
  • Dimenhydrinate — Hallucinations, problems urinating, flushing, agitated delirium.

Abuse can lead to addiction

The chronic abuse of OTC medications can lead to a dependency on the medication. This dependency can lead to withdrawal symptoms when an absence of the drug is prolonged. The withdrawal symptoms occur due to chemical changes in the brain from long-term substance use.

However, these changes are reversible and the sooner abuse/addiction is recognized the better chances of overcoming the disorder. Obtaining help early is important. Identifying abuse and getting help can also reduce the risk of accidental overdoses.

Statistics on OTC drug abuse

  • Over 3 million persons aged 12 to 25 have misused an OTC medication at least once in their lives.
  • Approximately 82 percent of 12 to 25-year-olds who misused OTC medications are lifetime marijuana users.
  • Slightly less than 50 percent of 12 to 25-year-olds who misused OTC medications are lifetime users of hallucinogens (such as LSD, PCP, or Ecstasy) or inhalants.

OTC medications are readily available and can be found at any local drug or grocery store. In addition, they are often viewed as safe and less dangerous than illegal drugs (ie. cocaine, heroin). However, they carry significant risks of abuse and need to be monitored closely.


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