Self Care Pharmacy Blog


The Abuse of OTC Medications in Young Adults: What Can You Do?

October 27th, 2013

 By: Ashley Peterson, Cedarville University PharmD Student 

Over-the-counter medications are the most common abused substances after marijuana, alcohol, and prescription drugs.1 According to the National Institute on Drug Abuse, medications are abused in several ways: taking a medication that has been prescribed to someone else, taking a drug at a higher quantity, or for an alternative purpose. This article from a newspaper in Philadelphia highlights the top 10 over-the-counter medicines abused by teens. Teens between the ages of 13 and 16 especially are able to easily access over-the-counter (OTC) medicines at home or in the store.2 The list includes: dextromethorphan, pain relievers, caffeine and energy drinks, diet pills, laxatives and herbal diuretics, motion sickness pills, sexual performance medicines, pseudoephedrine, herbal ecstasy, and other herbal products. The article states that adults and teens do not realize the dangers and effects of abusing OTC medications because they think that they are safer than illegal or prescription drugs which is not the case. Abuse of OTC drugs has high risks and dangers that can be overlooked oftentimes compared to the fear and risks associated with “illegal street drugs.”2 I agree with this, there is less control over OTC products so people have more access to them. It is unfortunate that people find ways to abuse medications that are supposed to help them feel better.


For example, dextromethorphan, the main ingredient in Robitussin and other cough medicines, when taken in large doses (5-10 times the normal dose) causes major side effects in acute and chronic use. A case series study (Ziahee, V et. al.) 3 noted that acute abuse of dextromethorphan caused dyskinesia (impaired movement), euphoria and trance, nausea, vomiting, sweating, speech disorder, and photophobia. Chronic abuse resulted in constipation, apathy (lack of enthusiasm), and fatigue as well. Dextromethorphan may not be an addictive substance by itself but is often used by drug users to add to his or her “high” and to decrease dependency on the addictive substance.

Over-the-counter laxatives are also widely available and are abused by people with eating disorders, those who are dependent on laxatives and certain athletes that have a set weight point.4 Normal bowel function is disrupted and electrolyte imbalance and dehydration occurs when people abuse laxatives even just once. Individuals believe that taking a laxative means that he or she can avoid calorie absorption by inducing diarrhea, however this is not the case since most calories absorbed from food occurs in the stomach and small intestine and not in the large intestine where laxatives act. Sometimes people can experience a rebound effect of acute weight gain and fluid retention when laxatives are suddenly discontinued.4 This means that careful education and treatment is important for someone abusing these laxatives.

One of the other popular OTC drugs to abuse is Benadryl (diphenhydramine), which is classified, as a first-generation, sedating antihistamine.6 Diphenhydramine is lipophilic so it crosses the Blood-Brain barrier readily. It is selective for histamine1 receptors, and activates serotonin and alpha-adrenergic receptors but block cholinergic receptors. Overdoses of these antihistamines cause cardiac symptoms (tachycardia, vasodilation), central nervous system symptoms (hallucinations, toxic psychosis, lethargy), as well as peripheral symptoms (sudden increase in temperature, pupil dilation).6 Overdoses of diphenhydramine sometimes result in hospitalization for treatment.

Although these medications and the rest of the list from the article are available over-the-counter, they can still be harmful if abused. Parents of teenagers and children should be aware of several important factors to help their kids stay away from drug abuse. These include: high levels of involvement in activities, discussing the dangers surrounding any medication or substance that can be harmful if not taking for a correct purpose, being a supportive and encouraging parent to your child and being aware and helping them find good friends.8 Oftentimes school and peer pressure cause young adults to get involved with substance abuse, as a parent, it is important to be aware of this and be proactive in helping your teenager learn to make wise decisions that do not result in serious consequences. Parents, teachers, pharmacists, and doctors should be watchful for signs of abuse (secrecy, abnormal eating or bowel habits, impaired function and activity, sedation, etc). A positive and encouraging role a person has in a young adult’s life is an important step in combatting OTC medication drug abuse at a personal level.9 Take action steps to be involved in lives of young adults in a positive way by asking questions, learning about them, and encouraging them to succeed and make wise decisions.




1. DrugFacts: Prescription and over-the-counter medications. National Institute of Health: National Institute on Drug Abuse Web site. Updated 2013. Accessed October 10, 2013.


2. Cohen M. 10 over-the-counter medicines abused by teens. Web site. Updated 2013. Accessed October 1, 2013.


3. Ziaee V, Akbari Hamed E, Hoshmand A, Amini H, Kebriaeizadeh A, Saman K. Side effects of dextromethorphan abuse, a case series. Addict Behav. 2005;30(8):1607-1613.


4. Laxative Abuse. Drugs [serial online]. August 2010;70(12):1487-1503. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 26, 2013.


5. Scolaro K. Disorders related to colds and allergy. In: Krinsky D, Berardi R, eds. Handbook of nonprescription drugs. 17th ed. Washington DC: American Pharmacists Association; 2012:179.


7. Lessenger J, Feinberg S. Abuse of prescription and over-the-counter medications. Journal Of The American Board Of Family Medicine [serial online]. 2008 Jan-Feb 2008;21(1):45-54. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 26, 2013.


8. Lessenger J, Feinberg S. Abuse of prescription and over-the-counter medications. Journal Of The American Board Of Family Medicine [serial online]. 2008 Jan-Feb 2008;21(1):45-54. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 26, 2013.


9. Mayberry M, Espelage D, Koenig B. Multilevel Modeling of Direct Effects and Interactions of Peers, Parents, School, and Community Influences on Adolescent Substance Use. Journal Of Youth & Adolescence [serial online]. September 2009;38(8):1038-1049. Available from: SocINDEX with Full Text, Ipswich, MA. Accessed October 26, 2013.


4 Responses to “The Abuse of OTC Medications in Young Adults: What Can You Do?”

  1. Zachary Wallace Says:

    We have already learned that OTC’s are commonly abused, but this post exposes the horrible truth in a way that calls for urgent action on the part of pharmacists. Never before did I realize that OTC-abuse was so rampant across the nation- for instance, trailing only behind marijuana, alcohol, and prescription drugs. To know how serious the threat is, this is the first step in combating the problem. In practice, this means I will need to treat all drugs as potential threats of abuse rather than just the “hot items” like pseudoephedrine. It doesn’t mean I need to have a negative mindset that treats all patients as potential abusers; rather, it means I should have a positive mindset that seeks to protect patients from becoming victims to drug abuse. Though only a subtle difference, I think keeping in mind the risk of abuse (without judging patients) is something particularly important in offering the best service to our patients in a Christ-like fashion.

  2. Yeseul Kim Says:

    Drug abuse is one of important issues that both patient and pharmacists, should be aware in the society of pharmacy. This can lead a patient to very negative side while drug was intended to improve patient’s health status and quality of daily life. As I red your blog, it reminded me the importance of people around young adult. Since, children are easy to get influenced by others around them, the behavior of people toward the children can make big difference. I think this is easier for Christian who believes and has been taught loving and caring others are major responsibilities. I also believe that the patient education about drug abuse is very important. There should be more sessions that deals with drug abuse in schools so that the students can realize why they should be careful in using drugs. Not only prevention is important but also follow up patient with drug abuse is a key point. The follow up procedure will decrease the rate of repetition in drug abuse.

  3. Jordan Long Says:

    I must agree that OTC medications are just as easily abused as prescription drugs and are considered less harmful by young adults because of that fact. I also don’t think there is enough patient education on the dangers of over-the-counter products. There are certain people that could a have a very positive impact in young adults lives when it comes to the risks of drug abuse; like parents, teachers, coaches, etc. However, the healthcare professional’s role should be preparing and equipping these people to influence the young adults that they mentor. Preparing and providing drug abuse packets, brochures, and fact sheets should be a common practice in pharmacies. This situation is becoming a even bigger problem. But we can stop it if everyone does their part in the process.

  4. Jeniffer George Says:

    I agree that drug abuse among OTC products is an important issue to deal with. As of now many pharmacists focus solely on the abuse of prescription products but after reading this post I can see why it is important to have a strong pharmacist-patient communication to explain the importance on adverse effects of OTC medications. Young adults can reduce the chance of OTC medication abuse by surrounding themselves around people that have a positive influence on their lives rather than those that negatively bring them down, such as family, church group, etc. Another solution is instilling education in schools about prescription and OTC abuse. Although, education has been placed in schools many schools focus mainly on the abuse of illegal drugs rather than OTC medications. By incorporating abuse on OTC medications young adults and children will be able to learn more about the issue.

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