Over the Counter drugs, or OTC drugs, are any drug or medication which can be purchased legally without a prescription. OTC drugs or medicines treat various symptoms that people can suffer from, including illnesses, headaches, digestive issues, pain, inflammation, and many more.
Some OTC drugs have a potential for misuse because they contain ingredients that can produce a "high" at higher-than-recommended dosages. Many of these can even cause addiction. US consumers make around 26 trips per year to retail stores and pharmacies to purchase OTC medications, spending almost $350 annually. But they only visit physicians three times a year on average. OTC medications are utilized by people to address their healthcare issues, mainly to save costs and time. Due to their affordability and accessibility, they play a vital role in the country's healthcare system. But these same benefits have also become liabilities, making OTC drugs one of the most abused types, particularly among American youth.
The History of Over the Counter Drugs
Over the counter drugs are not something that "began" per se. Instead, virtually all drugs were OTC until they were made not so. Even more generally, there is no historical inception of over the counter medication. Instead, there is a point where drugs began being controlled, thus, giving birth to the term "Over-the-Counter."
To understand this, we must first examine the Pure Food and Drug Act of 1906. This Act was the first of a series of significant consumer protection laws, which led to the creation of the Food and Drug Administration. Under the law, drug labels had to list any of the ten ingredients deemed "addictive" or "dangerous". Alcohol, morphine, opium, and cannabis were all included on the list of these addictive and dangerous drugs. The 1906 Act paved the way for the Food and Drug Administration's eventual creation and is generally considered to be that agency's founding date. Next came the Harrison Narcotics Tax Act. This was enacted in 1914 and was a United States federal law regulating and taxing the production, importation, and distribution of opiates and cocaine products. It initially appeared to be concerned with the marketing of opiates. However, a clause applying to doctors allowed distribution "in the course of his professional practice only." This clause was later interpreted to mean that a doctor could not prescribe opiates to an addict, since addiction was not considered a disease. Many doctors were consequently arrested, and some were imprisoned, teaching the medical community quickly not to prescribe opiates to drug addicts. This was the beginning of the restriction of prescribing in America.
Prescribing is not a strictly modern phenomenon. Humans have prescribed drugs since around 2000 BC. Records of prescribing and dispensing medications have been found throughout history since then, in cultures like ancient Greece up to modern times. But just because drugs were prescribed for specific medical purposes doesn't mean that they were likewise restricted. All drugs could be legally obtained as well without a prescription until they were restricted. The Controlled Drug Act of 1970 was the first concerted effort to classify and restrict drugs based upon their abuse and addiction potential. The legislation created five classifications (schedules), with varying qualifications for a substance to be included in each. Classification decisions are required to be made on criteria including potential for abuse, currently accepted medical use in treatment in the United States, and international treaties. Since its inception, the Act has been amended but continues to be the prevailing and controlling method of drug restriction. Prescribing laws are based upon the scheduling of drugs per the Controlled Drug Act. Because of drug scheduling and subsequent prescribing guidelines, over the counter drugs originate by default of not being controlled. But they still must be approved, and cannot be sold carelessly for human consumption without control.
In the United States, all OTC substances' manufacturing and sale are overseen by the Food and Drug Association. Information must be printed on all labels through this restriction, which includes ingredients, dosing, guidelines, and warnings for those products that can be misused. Certain OTC medications may fall into categories that necessitate age restrictions or other special limitations, like quantity limits. Individual states may have specific guidelines, like Oregon, where products containing pseudoephedrine can only be obtained with a prescription. The meth problem there became so bad that cold medicines containing the meth manufacturing product, pseudoephedrine, have become highly restricted. These products may be purchased in other states but only with valid identification and with daily quantity limits. Other states have looser guidelines on the ingredient comparatively.
What do Over the Counter Drugs Look Like?
There are so many different kinds of over the counter medications available for purchase in the United States. There are approximately 800 OTC active ingredients available today that make the more than 100,000 OTC products that exist in the US healthcare marketplace. OTC medicines should not be confused with dietary supplements (vitamins, minerals, and herbs) that have different rules.
Effects of Over the Counter Drugs
Because there are so many OTC drugs, and a lot of them can be misused, we will only be discussing those commonly abused.
Dextromethorphan (DXM) is one of the most commonly abused Over the Counter drugs currently. This medication is used as a cough suppressant and sold in various preparations. It is commonly found in syrups and cold tablets. Psychoactive effects occur when the drug is taken at higher-than-recommended dosages. Short term effects of high doses include euphoria, drunkenness, hallucinations, and slurred speech.
DXM's adverse effects include dizziness, nausea, vomiting, and increased heart rate and blood pressure. The long-term effects of abusing DXM are unknown.
Loperamide is another commonly abused OTC drug. It is an active ingredient in anti-diarrheal drugs and is derived from a chemical relative of opium. When taken in higher-than-recommended dosages, Loperamide can produce effects similar to opioids. These include euphoria, drowsiness, and mild intoxication. The drug is also misused to alleviate opioid withdrawal symptoms in people who are addicted to drugs like painkillers and heroin. Because it can be easily found and purchased, Loperamide is often resorted to when opioids cannot be found. The long-term effects of Loperamide abuse are unknown, but immediate dangers of high doses of Loperamide include fainting, stomach pain, constipation, loss of consciousness, cardiovascular toxicity, pupil dilation, drowsiness, dizziness, and kidney failure from urinary retention. Addiction can occur and is similar to opioid addiction with withdrawal symptoms that include severe anxiety, vomiting, and diarrhea.
Diphenhydramine is yet another common household drug that gets abused readily. The medication is an antihistamine and is commonly used to treat allergies and insomnia. Diphenhydramine can produce sedation and euphoria, but may also cause a burst of energy in the individual in high doses. The drug is commonly taken as a sleep aid and combine with other medications or drugs and alcohol to induce intoxication. Because it has so many effects and is used for many different conditions, the drug can easily be misused.
Over the Counter Medication Overdose
Each different OTC medication may have a different overdose toxicity level, which will also vary from person to person. These medications can all cause an overdose in different ways. Some may cause toxicity of the liver or other organs, like Loperamide, which can cause cardiac toxicity. Drugs like DXM can cause breathing problems and issues with other organs. Poison Control is an excellent resource for learning how to assist someone who is potentially overdosing on an OTC substance. Because there are so many OTC drugs, giving all of that information to the public is pointless because they could not possibly remember it. Poison Control keeps updated lists of OTC medications and their adverse effects, and will quickly advise on the appropriate course of action during an emergency.
Over the Counter Medication Addiction
Addiction to OTC drugs can occur just the same as with any other substance. There is a common misconception that if a drug is available without a prescription, it is "safe." OTC medications are still drugs, and they can be abused and cause addiction.
Regardless of how addictive a substance may be, physically, anyone can become addicted to the chemical cascade produced from indulging in virtually any chemical substance. Some people can even become addicted to non-chemical experiences, like gambling. But for addiction to occur, there must be a problem.
Initially, drugs are not the problem. They are a solution to it. The person struggles with some difficulty in life, which could be anything from physical pain to mental or emotional issues. Whatever it is, the substance alleviates this or provides an escape in some way. The person will continue to take the drug, experiencing relief and reward, and reinforcing the cycle of addiction. When the person doesn't have the drug, the problem returns, but now is worse because it has been neglected, and the root cause has been ignored.
Because the person is abusing the substances and knows this is wrong to whatever degree, they will feel guilty. To remove this guilt, they will rationalize their drug use by coming up with reasons why it is okay. This process is known as justification. They will also keep their drug use hidden from anyone who would try to get them to stop, which may involve outright lying, with omissions being commonplace. This serves to drive a wedge between them and their loved ones, and they will isolate to avoid further feelings of guilt or concerns of getting caught.
When it comes to over the counter medications, addiction can occur insidiously. The person may first take them for a valid reason, such as a cold. Perhaps they discover that it also makes them feel good, so one night, when they are particularly stressed out, they recall this and take some cough medicine to relax and get some extra sleep. But this time, they take a double dose to make sure it works because they are so stressed out.
Now they feel excellent and have found a way to wind down each night. This cycle can quickly get out of hand, and one day before a work meeting, the person may take a swig of cough syrup to calm their nerves. It helps, and their addiction soon becomes full-blown.
How to help a loved one addicted to over-the-counter drugs
If someone that you know is struggling with addiction to over the counter drugs, do not take this lightly. It can seem easy to dismiss the seriousness of such an addiction because the drugs are perceived as safe and often non-habit forming. But this is far from the case and many OTC drugs can be even deadlier than illicit drugs because they’re not intended to be consumed in high doses. They frequently have other medicines or compounds withing the drug which are toxic when consumed in excessive levels. Every time the person uses, they are playing roulette with their life.
These drugs can cause real dependence and withdrawal. Some of them contain very small amounts of chemicals that are similar to addictive drugs like opioids or stimulants like meth. When taken in excess, they cause serious addiction and dependence and can be tough to treat.
Much like alcohol, OTC drugs can be purchased almost everywhere by anyone who is an adult. Some may not even have age restriction depending on where they are being sold. This can make recovery very challenging when compared to illicit drug addiction where the person isn’t constantly surrounded by their drug of choice.
You must approach the person if you suspect that they are addicted to OTC drugs. Keep in mind that they may be embarrassed to admit their addiction because of the stigma attached, and the stereotyping that exists about addiction. Many people who are addicted to OTC drugs also use this as a rationalization for how they couldn’t possibly be addicted, so don’t buy into it.
It is important to be direct but approachable. Never become angry with them. Rather than give them an opportunity to lie to you, do not ask them if they are using drugs. Instead, tell them what your concern is and let them know that you want to listen and help. They may not be forthcoming, but that’s okay. What you are doing is letting them know that you know and moving the situation to the forefront.
If they become upset with you or defensive, they are probably lying. They will likely try to get out of the conversation as soon as possible so look out for this as confirmation of your suspicions. Just remember that the reason why they have not told you yet is because they know you do not approve. There is no need to drive this point home.
If they are honest with you, perfect. Get them help immediately. You can always call the number on this page and get help with finding treatment or intervention services. If they continue to lie, it may be time to investigate the matter. Remember, their life is on the line. Just because they made it through today doesn’t mean that tomorrow, they will be so lucky.
Over the Counter Medication Treatment
Specific treatment for over the counter medications doesn't exist. At least, not specifically. Little is known about the subject because it is understudied, so there are no known treatment interventions for most OTC drugs. Those like Loperamide, which mimic another drug, may have inherited interventions by default. Opioid treatment and overdose medications are effective for Loperamide abuse and overdose, and those who are addicted can enter opioid dependence treatment programs and experience results.
Otherwise, most people who arrive at treatment for OTC medication addiction are viewed as anomalies and refereed to traditional rehabilitation programs for general substance abuse. This consists mainly of 12 Step inpatient treatment programs. Inpatient treatment is where the person lives and stays at the facility for the rehabilitation process's duration. This may not be necessary, however, depending on the severity of the addiction. OTC drug addiction may respond to outpatient treatment adequately depending upon individual drug use and life circumstances.
Over the Counter Medication Abuse Statistics
- Roughly 1 in 4 teenagers know someone who has abused OTC cough medicine to get high. 75% of teens believe that abusing OTC cough medicine to get high is risky. That means that 25% don't think it's risky. Additionally, approximately 1 in 30 teens reports abusing OTC cough medicine to get high.
- In 2019, it was reported that 3.2% of eighth-graders had abused non-prescription cough medicine within the last year. The same was true of 2.6% of 10th graders and 2.5% of 12th graders.
- More than one in three households (40 million) uses dextromethorphan-containing OTC medicines each year. Two-thirds of adults choose to self-medicate with an OTC medicine when they develop a cough.
- Statistics from the NSDUH show that abuse of dextromethorphan is at its highest prevalence among 12-to-17-year-olds. Just under 2% of teens in this age group report abuse of OTC cough-cold products in the past year. This declines to 1.5% in young adults and then drops significantly.
- In 2006, a survey showed that 5.4 % of 8th, 10th, and 12th grade students reported non-medical use of OTC cough medicine in the past year. Voluntary efforts by more than 20 national and regional retailers have been made to stop selling OTC cough medicine to consumers under 18. According to the market research firm IRI, between legislative and voluntary measures, 88–90 % of the market does not sell dextromethorphan to those under 18.
- Between 2010 and 2015, the National Poison Data System showed a 91% increase in intentional loperamide exposures with 11 related deaths, and 13 deaths in one year in 2016-2017.
Key Word List for Over The Counter Drugs
|OTC||Over the Counter, meaning the drug or medication does not require a prescription to possess or obtain.|
|Prescription||An authorized medical professional's instruction for someone to take a particular medication in a specific way. This authorizes the person to obtain and possess the drug, and the pharmacy to dispense it legally.|
|DXM||Dextromethorphan, a cough suppressant medication that has abuse potential and is available over the counter.|
|Robotripping||The process of consuming large quantities of DXM and getting high. "Robo" comes from the brad Robitussin cough syrup, a common medicine that contains DXM. "Tripping" comes from the slang term used to describe hallucinating. It was initially coined to describe taking acid but has been extended to refer to taking any hallucinogen. Robotripping is a conjunction of these two terms.|
|Triple C's||A slang term for the medication Coricidin Cough and Cold, a commonly abused brand because it contains DXM.|
|Poor Man's PCP||Another slang name for DXM.|
|Lope Dope||A slang name for the drug Loperamide, an opioid relative used to treat diarrhea that has high abuse potential.|
|Poor Man's Methadone||Another slang name for Loperamide.|
|Rehabilitation||The process of restoring someone or something to a former capacity. In terms of addiction, this means that they are no longer actively addicted to or abusing chemical substances and become productive members of society again. This is usually achieved through substance abuse treatment services such as detox, inpatient, and outpatient treatment.|
|Toxicity||The state of becoming toxic, or achieving levels of concentration of a particular substance within a system that causes the system's failure or damage. For a specific organ, this could include tissue damage or organ failure.|