Over-the-Counter Drug Abuse and Addiction

Over-the-counter (OTC) drugs are medications that don’t require a prescription. They’re used to treat minor illnesses and injuries, such as relieving congestion during a cold or treating minor back pain after too much yard work. Many people mistakenly believe these medications are harmless or don’t have any potential for abuse or addiction because they can be easily purchased at most stores.

The truth is that over-the-counter drugs are commonly misused because they’re so easy to get. Misuse may involve taking higher than recommended doses, using the medication more frequently than instructed or combining multiple drugs for specific effects. Understanding the potential risks of over-the-counter drug abuse and warning signs of addiction can help you recognize when it’s time to seek help.

One of the reasons over-the-counter drugs are so commonly misused is accessibility. These medications don’t require a prescription, and many are relatively inexpensive.

Medications such as cough syrup and caffeine pills are readily available at drug stores, grocery stores and gas stations. There’s also the common (but false) belief that nonprescription medications are safe at any dose because you can buy and administer them without any oversight or instruction from a medical professional.

In some cases, OTC medication abuse starts from a legitimate purpose. Someone may take sleeping pills to treat insomnia or combine over-the-counter pain relievers to treat an injury.

However, this can lead to psychological addictions and medication dependence, and combining medications can increase the potential health risks. It’s also possible to develop a tolerance to some ingredients, which can produce cravings and other withdrawal symptoms when you try to stop.

Some OTC drugs are more commonly abused than others. Learning about side effects can help you determine whether you or someone you love is misusing these medications.

Dextromethorphan (DXM) is a cough suppressant commonly found in OTC cold and flu medications, such as Delsym and Robitussin. It’s also sometimes included in other medications, such as decongestants and antihistamines, which can increase the risk of overdose if a person combines multiple drugs.

Common side effects of DXM misuse include:

• Dizziness
• Reduced motor coordination
• Slurred speech
• Hallucinations
• Anxiety
• Increased heart rate
• Difficulty breathing

DXM is often misused because it can cause feelings of euphoria or dissociation. In some cases, you may even experience hallucinations, which is where the term “robotripping” comes from. Common misuse patterns for dextromethorphan include taking more than recommended and combining it with alcohol or soda to make a medicated drink.

Antihistamines, such as diphenhydramine, the active ingredient in Benadryl, and doxylamine, found in medications such as Unisom and Zzzquil, work by calming the body’s histamine response. Drowsiness is a common side effect of this process. People may combine these medications with other substances, such as marijuana or alcohol, to increase the sedative effect or use them to counteract the effects of stimulants when it’s time to go to bed.

Common misuse patterns with antihistamines and sleep aids include taking very large doses, not being able to sleep without taking them and combining multiple medications for an increased effect. Misusing these drugs can cause confusion and increase the risk of delirium, especially in seniors or those who engage in polysubstance use. Poor coordination, falls and slower reaction times are also potential risks.

Antidiarrheals slow the digestive system to relieve stomach upset from traveler’s diarrhea or food reactions. One of the most common antidiarrheal medications is loperamide, sold under the brand name Imodium.

When taken in large amounts, loperamide can produce opioid-like effects, which can be a common driver for misuse. Signs of loperamide misuse include taking the medication when you’re not experiencing diarrhea, using it to produce a high and continuing to take it even after experiencing health complications.

Overdosing on antidiarrheals can be dangerous, with an associated increased risk of heart arrhythmias and cardiac arrest. Other side effects can include dizziness, respiratory distress and long-term bowel complications.

Decongestants, such as pseudoephedrine and phenylephrine, sold under brand names such as Sudafed and Mucinex, work by constricting the blood vessels in your sinuses and nasal passages. This helps reduce congestion and swelling, making it easier to breathe.

These over-the-counter medications also have a stimulant effect on the nervous system, which is a common reason for misuse. Taking pseudoephedrine-like products can increase heart rate and blood pressure and make you feel wired.

Taking more than the recommended dose of OTC decongestants can cause anxiety and panic symptoms and insomnia and increase the risk of serious heart complications. Using decongestants to feel alert or stay awake or combining them with other stimulant-like medications are signs of misuse.

Dimenhydrinate is one of the most common active ingredients in over-the-counter motion sickness medications, such as Dramamine and Gravol. These drugs work by changing signals in the brain and inner ear to alleviate the nausea and dizziness associated with motion sickness.

A common side effect of OTC motion sickness medications is drowsiness, and taking more than the recommended dose can cause sedation and altered mental status. This can include confusion, disorientation, blurred vision and poor coordination. Some people may also experience hallucinations and paranoia.

Misusing motion sickness medications involves taking higher-than-recommended doses and using them when you’re not experiencing motion sickness. Combining these medications with alcohol, sedatives or other substances can significantly increase the risk of complications and adverse effects.

While caffeine is a substance many people consume daily, it can still carry serious risks when misused or consumed in high doses. Caffeine pills and energy drinks and shots often contain large amounts of caffeine, as well as other substances, such as B vitamins, that have a strong stimulant effect on the nervous system.

These OTC products keep you awake and can improve short-term focus, but they also increase heart rate and blood pressure and mimic the body’s stress response. At high doses, this can cause anxiety, panic attacks, insomnia, chest pain and cardiovascular symptoms.

Caffeine misuse often involves using high-dose products, such as pills and energy drinks, or combining multiple products to increase the effect. Constantly increasing use is another warning sign, as the body develops a tolerance, especially if you’re also experiencing anxiety, insomnia or withdrawal symptoms.

When you think of over-the-counter medication misuse, you may not think of common pain relievers, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. But these OTC drugs still belong on this page because of the risk of overdose or organ damage.

OTC pain relievers are used to treat everything from headaches and joint pain to fevers and systemic inflammation. While these drugs aren’t addictive in the sense of developing a physical dependence, people often take more than recommended or combine medications when seeking relief.

Exceeding the recommended dosages can result in organ damage, particularly to the liver, stomach and kidneys, abdominal pain, stomach bleeding and cardiovascular risks. Many people also don’t realize that these medications are also in common cold and flu drugs, which can lead to dangerous double-dosing.

When we’re talking about over-the-counter drug abuse vs. addiction, terms matter. Many health care and substance use treatment professionals prefer to use the terms “drug misuse” or “substance use disorder” rather than “addiction” or “abuse.”

Generally, drug misuse refers to using a medication in any way that goes against recommendations or instructions. This can include taking an extra pill or combining similar medications for a stronger effect.

Drug abuse or substance use disorder takes misuse one step further. It refers to purposely misusing a drug with the intention of getting high, altering your mood or mental state or otherwise affecting your brain or body. Common examples include using caffeine pills to suppress appetite for weight loss or drinking large amounts of cough syrup for a high.

Misusing or abusing a drug isn’t always the same as being physically dependent or addicted. Someone is physically dependent on a medication when they experience withdrawal symptoms when trying to reduce the dose or stop using it entirely.

Addiction is usually defined as continuing to use a substance, even when there are clear signs of physical, mental or emotional harm. Feeling like your substance use is out of control or experiencing strong cravings are also signs of over-the-counter drug addiction.

OTC drug dependence and addiction can be challenging to recognize because there are so many over-the-counter medications with different ingredients and different intended effects. Some over-the-counter products, such as pseudoephedrine and dextromethorphan, may be more likely to cause compulsive use, while others, such as laxatives, are more likely to have dangerous physical side effects without the classic addiction signs.

Because OTC medications are legal and readily available, it’s not always clear when there’s a problem. Recognizing the signs of misuse can help you understand if you or someone you love may need help for OTC drug abuse.

Behavioral signs of over-the-counter drug abuse are similar to those of other substance use disorders, including:

• Exceeding the recommended daily dosages
• Using OTC medications when you aren’t experiencing those symptoms
• Hiding your use, such as throwing away packaging before you get home or using cash to avoid drugstore transactions showing on your account
• Continuing to use over-the-counter medications even when they’re causing problems with work or school performance or your relationships
• Keeping a stash of medications in different places “just in case”

Physical and mental symptoms of over-the-counter addiction vary depending on the substance but can include:

• Dizziness and fainting
• Sedation
• Sleeping too much or experiencing insomnia
• Confusion and memory problems
• Poor coordination
• Mood swings
• Irritability and agitation
• Anxiety and panic attacks

It can take longer for misuse to become apparent with OTC medications.

OTC drug abuse signs include:

• Frequently finding empty packaging
• Using multiple products for the same symptoms
• Using drugs specifically marketed for nighttime during the day
• Complaining of frequent mystery symptoms that don’t seem to be related to a specific injury or illness

Over-the-counter medications are generally safe when taken for specific symptoms at the proper doses, but taking more than recommended or mixing substances can increase the risk of side effects and interactions.

Combining any substance, whether over-the-counter or prescription, can be dangerous, but some have a higher safety risk than others. Mixing alcohol, opioids or benzodiazepines with over-the-counter medications that have sedative effects can be especially dangerous. This combination can result in difficulty breathing, heart problems, loss of consciousness and even death.

Taking multiple medications with the same ingredient, especially if it’s a sedative, can also increase the risk of adverse effects. Many over-the-counter drugs have multiple active ingredients, so it’s important to always double-check the label to avoid accidental double-dosing.

Overdosing on over-the-counter medications can cause major side effects, organ damage and death. If you think someone has taken more than the recommended amount of an OTC drug and is experiencing seizures, severe chest pain, difficulty breathing or confusion or you can’t wake them up, seek medical attention immediately.

Don’t wait to see what happens or if they can sleep it off. Calling 911 immediately may save someone’s life.

Over-the-counter drug misuse is a serious problem, but statistics can be challenging to find due to the medications being legal to obtain and a lack of reporting.

In the United States:

• Misuse of over-the-counter drugs results in approximately 178,000 hospitalizations per year, according to the Defense Health Agency.
• Eighth-graders have the highest misuse rates for cough and cold medicine at 4.4%, according to the 2024 Monitoring the Future study.
• Acetaminophen overdoses are responsible for 100,000 U.S. Poison Control Center calls every year, according to the Iowa Poison Control Center.
• 61% of emergency department visits related to OTC cough and cold medications were due to misuse, according to a study involving incidents from 2017-2019.
• 48% of poisonings and emergency room visits involving over-the-counter medications involved misuse by adolescents, according to a 2018 study published in INNOVATIONS in Pharmacy.

Recovering from over-the-counter drug misuse usually involves more than just stopping the medication. A comprehensive treatment program addresses the physical, mental and emotional aspects of addiction and includes an individualized recovery plan.

Many people don’t seek treatment for over-the-counter drug misuse because the medications are legal and they don’t think it’s “that big of a deal.” The truth is that these medications can result in psychological dependence, tolerance and withdrawal symptoms that can make it challenging to stop on your own.

Professional substance use treatment can help if you’ve had multiple failed attempts to stop misusing OTC medications, are experiencing withdrawal symptoms or feel like your substance use is negatively affecting your physical or mental health. Polysubstance use or continuing to use OTC drugs even after experiencing dangerous side effects are also signs professional treatment may be necessary.

If you’ve been consuming large doses of OTC medications over a long period of time, you may have an increased risk of withdrawal symptoms. Supervised detox keeps you as comfortable as possible while your body adjusts until you’re medically stable.

Whether someone needs detox depends on the drug and whether they combined various substances. There may be additional monitoring considerations if you’ve been using large doses of over-the-counter sedatives or stimulants or you’re experiencing major health issues, such as seizures, delirium or organ damage.

Treatment for over-the-counter drug abuse and addiction can involve several levels of care. Which one is right for you depends on your usage patterns, the relative safety risk, your home environment and support system and whether you have any co-occurring conditions.

Inpatient or residential treatment may be appropriate if there’s a strong history of polysubstance use, particularly if it involves opioids, benzodiazepines or alcohol. Partial hospitalization and intensive outpatient programs allow you to attend rehab for a large portion of the day while still going home at night.

Outpatient treatment may be an option if you’ve been using for a shorter period of time or you’re mostly dealing with psychological dependence. It can also be a step-down option after completing a residential or partial hospitalization program.

Treatment for OTC drug misuse often includes behavioral therapy, addiction-specific counseling sessions and support groups. These approaches can address the underlying triggers for misuse and help you develop healthier coping skills. They can also be necessary if you have co-occurring mental health issues, such as anxiety, depression or post-traumatic stress disorder, that fuel your desire to use.

Relapse prevention for over-the-counter drug misuse helps you plan for what happens after completing rehab. This can include creating a specific plan to follow when you experience a trigger and developing a variety of tools and strategies for stress management.

It can also be tailored specifically to your previous use patterns. For example, if you often used over-the-counter medications when you couldn’t fall asleep, your relapse prevention plan is likely to include sleep hygiene routines. Other potential strategies involve always reading labels to avoid accidental double-dosing and reducing access to OTC meds when at home.

OTC drug misuse can escalate quickly, and it often flies under the radar because the medications are legally obtained. What started as trying to treat a legitimate injury, illness or other health concern can turn into dependence and a cycle of abuse before you realize there’s a problem.

Remember that over-the-counter drug misuse isn’t a personal failure, and resources are available to help you stop and regain control over your life. If you’re experiencing negative physical, mental or emotional effects due to substance use, have tried unsuccessfully to quit or feel like your substance use is out of control, it’s time to reach out for help.

RehabNet is a free, confidential resource that can help you find the right treatment center for your unique needs and preferences. Reach out today to take the first step.