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.http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications. Updated 2013. Accessed October 10, 2013.
2. Cohen M. 10 over-the-counter medicines abused by teens. Philly.com Web site. http://www.philly.com/philly/blogs/healthcare/10-over-the-counter-medicines-abused-by-teens.html?c=r. 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.