Easy, legal access to inexpensive over-the-counter (OTC) medicines has contributed to widespread abuse of them. And because a doctor’s prescription is not needed, many mistakenly believe that OTC medicines are safer than prescription medicines and illegal street drugs. But even OTC medicines—including herbals—can cause serious and potentially fatal side effects when abused.
Abuse of OTC medicines is most common among teens between the ages of 13 and 16.1 They know they can find a cheap “high” right in their family’s or friend’s medicine cabinet. Young adults have also abused OTC medicines, particularly in combination with other medicines, alcohol, and illegal drugs, which increases the risks of serious side effects. The list that follows includes the top 10 OTC medicines and herbals that are currently abused in the US by teens and young adults.
- Dextromethorphan: This is an active ingredient in more than 100 OTC cough and cold medicines such as Robitussin and NyQuil. One in every 10 teens has reported abuse of cough medicine to get high.2 Large doses can cause euphoria, distortions of color and sound, and out-of-body hallucinations that last up to 6 hours.3Some other dangerous side effects include impaired judgment, vomiting, loss of muscle movement, seizures, blurred vision, drowsiness, shallow breathing, and a fast heart rate. Dextromethorphan is also addictive and can cause withdrawal symptoms, including depression and difficulty processing thoughts, when the drug is stopped. When combined with alcohol or other drugs, a large dose can lead to death. For example, Coricidin HBP Cough and Cold includes both dextromethorphan to treat a cough and chlorpheniramine to treat a runny nose. Because of the chlorpheniramine, Coricidin abuse has led to numerous deaths and hospitalizations. Not much is known about long-term abuse of dextromethorphan, but cases of bone marrow suppression, nerve cell damage, high blood pressure, heart damage, and permanent brain damage have been reported.4
- Caffeine medicines: OTC caffeine pills such as NoDoz or pain relievers with caffeine have been abused for the buzz or jolt of energy they seem to provide.5 If these pills are taken with high caffeine energy drinks, the effects are felt even quicker. Large doses of caffeine can cause serious dehydration, gastric reflux disease, panic attacks, and heart irregularities that have occasionally been linked to accidental deaths, particularly in those with an underlying heart condition. Taking too much of a pain reliever can also cause serious side effects (see #10).
- Diet pills: In large doses, diet pills can create a mild buzz. But misuse of diet pills can also signal a serious eating disorder. Abuse of diet pills often starts with trying just a few in order to lose weight. But these OTC medicines can be highly addictive.6 Although the US Food and Drug Administration (FDA) has banned several of the most dangerous stimulants commonly found in OTC diet pills—phenylpropanolamine, ephedrine, and ephedra—other ingredients in these OTC products can also be dangerous. To cite an example, bitter orange is a common ingredient that acts much like ephedrine in the body.7 It can cause nervousness and tremor, rapid and irregular heartbeat, high blood pressure, stroke, heart failure, and death. Many other diet pill ingredients cause digestive problems, hair loss, insomnia, anxiety, irritability, extreme paranoia, blurred vision, kidney problems, and dehydration. Furthermore, even the most “natural” diet preparations can have serious side effects when misused, particularly those containing ma huang (ephedra). The FDA ban on ephedra pertained only to diet pills considered dietary supplements, not herbal remedies such as teas and Chinese preparations.
- Laxatives and herbal diuretics: Like diet pills, some teens and young adults also abuse OTC laxatives (e.g., Dulcolax, Senokot) and herbal diuretics (water pills), including uva ursi, goldenseal, dandelion root, rose hips, and others, to lose weight.6 Laxatives and herbal diuretics can cause serious dehydration and life-threatening loss of important minerals and salts that regulate the amount of water in the body, acidity of the blood, and muscle function.
- Motion sickness pills: Motion sickness pills that contain dimenhydrinate (Dramamine Original Formula) or diphenhydramine (Benadryl) taken in large doses can cause one to feel high and have hallucinations similar to street drugs.6,8 The dose needed to cause these symptoms varies widely according to body weight and tolerance. Some teens and adults may take as many as 40 tablets of Dramamine, for example, to experience the desired high.8 Extremely high doses of Dramamine have caused dangerous irregular heartbeats, coma, heart attacks, and death. Long-term abuse can cause depression, liver and kidney damage, memory loss, eye pain, itchy skin, urine retention, and abdominal pain.
- Sexual performance medicines: OTC sexual performance medicines (e.g., Kaboom Action Strips, EreXite), often purchased via the Internet or at gas stations and truck stops, are sometimes abused by teens and adults to counteract the negative effects of alcohol on sexual performance.9,6 These medicines can cause heart problems, especially when combined with alcohol or when taken in large doses.
- Pseudoephedrine: This nasal decongestant and stimulant is found in many cold medicines. Its similarity to amphetamines has made it sought out to make the illegal drug methamphetamine. The medicine has also been taken as a stimulant to cause an excitable, hyperactive feeling.10 Abuse may be less common with pseudoephedrine than with other OTC medicines due to a federal law requiring it to be kept behind the pharmacy counter, limiting the purchase quantity, and requiring photo identification prior to purchase. However, people have taken pseudoephedrine to lose weight, and athletes have misused the medicine to increase their state of awareness and to get them “pumped up” before a competition. Dangerous side effects include heart palpitations, irregular heartbeats, and heart attacks. When combined with other drugs, such as narcotics, pseudoephedrine may trigger episodes of paranoid psychosis.
- Herbal ecstasy: This is a combination of inexpensive herbs that are legally sold in pill form and swallowed, snorted, or smoked to produce euphoria, increased awareness, and enhanced sexual sensations.11 Marketed as a “natural” high, the main ingredient is ma huang (ephedra), an herb banned in the US but only in dietary supplements. The product can be purchased in gas stations, health food stores, drug stores, music stores, nightclubs, and online. It is easy to overdose on the product because the dose needed for desirable effects varies widely. The adverse effects can be severe, including muscle spasms, increased blood pressure, seizures, heart attacks, strokes, and death.
- Other herbals: Other herbal products are increasingly being abused for their stimulant, hallucinogenic, and euphoric effects.12 One example is salvia, which is ingested or smoked to experience a short-lived distortion of reality and hallucinations.12 Users can experience severe anxiety, loss of body control, extreme psychosis, and violent behavior. They are also at risk for accidents and injuries that may result from an altered mental state. Some states have regulated the sale of salvia. Another example is nutmeg, which is eaten as a paste to experience giddiness, euphoria, and hallucinations.11 Nausea and vomiting set in within an hour, and hallucinations begin within 3 hours and can last for 24 hours or more. Effects such as blurred vision, dizziness, numbness, palpitations, low blood pressure, and rapid heartbeat may occur.
- Pain relievers: Adults and teens have taken pain relievers like acetaminophen (Tylenol) and ibuprofen (Motrin) in doses higher than recommended not to get high but because they mistakenly believe the medicine will work faster.9 They don’t think of the side effects. They don’t know that liver failure can happen with large doses of acetaminophen, and that stomach bleeding, kidney failure, and cardiac risks are heightened when taking large doses of ibuprofen.
January 28-February 3 is the third annual National Drug Facts Week (NDFW), a health observance that aims to shatter myths about drugs. It’s a week set aside for communities and parents to encourage teens to get the facts about drug abuse. One of the greatest difficulties with preventing OTC drug abuse is that few teens and adults realize the danger. Unlike the risks associated with illegal street drugs like cocaine and heroin, the risks associated with OTC drug abuse are given little thought. So join this important national effort during NDFW by learning more about the risks of OTC drug abuse and sharing the facts with the teens and young adults in your life. The websites with the references that accompany this article are a great place to start. Teens and young adults who learn about the risks of drugs at home are up to 50% less likely to abuse drugs.13
1) Over The Counter Drug Addiction. Symptoms of OTC drug abuse (2001). www.overthecounterdrugaddiction.com/Symptoms-of-OTC-Drug-Abuse.htm
2) Drug Enforcement Agency. Prescription for disaster. How teens abuse medicine (August 12, 2012). www.justice.gov/dea/pr/multimedia-library/publications/prescription_for_disaster_english.pdf
3) Teen OTC & Prescription Drug Abuse. Dextromethorphan (2008). www.teenoverthecounterdrugabuse.com/dextroamphetamine.html
4) Council on Drug Abuse. Dextromethorphan (2011). www.drugabuse.ca/dextromethorphan
5) Palo Alto Medical Foundation. Drug use and abuse (stimulants) (October 2012). www.pamf.org/teen/risk/drugs/stimulants/
6) Teen OTC & Prescription Drug Abuse. Most commonly used OTC drugs (2008). www.teenoverthecounterdrugabuse.com/commonly-used-otc-drugs.html
7) Therapeutic Research Faculty. Bitter orange. Natural Medicines Comprehensive Database Consumer Version. 2009.
8) Seely KA. Teenager OTC drug abuse. Arkansas Department of Health (November 2, 2011). www.archildrens.org/documents/Services/IPC/MedicationMisuse_PresentationHandout_Grayscale.pdf
9) TeenHelp.com. Types of OTC drugs abused. (2013) www.teenhelp.com/teen-drug-abuse/types-otc-drugs-abused.html
10) Monson K, Schoenstadt A. Abuse of pseudoephedrine. MedTV (February 12, 2009). http://cold.emedtv.com/pseudoephedrine/abuse-of-pseudoephedrine.html
11) Teen OTC & Prescription Drug Abuse. The dangers and effects of herbal drugs (2008). www.teenoverthecounterdrugabuse.com/dangers-effects-herbal-drugs.html
12) Richardson III WH, Slone CM, Michels JE. Herbal drugs of abuse: an emerging problem. Emerg Med Clin N Am. 2007;25:435-457.
13) Fuller D. Attention, parents: UC research reveals a secret about your medicine cabinet. University of Cincinnati (October 29, 2012). www.uc.edu/news/NR.aspx?id=16780