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Over-the-Counter Drugs of Abuse

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drugabuse-shutter208347919-over-the-counter-drugsIt is a common misconception that only illegal drugs are dangerous. There are many different over-the-counter (OTC) drugs with psychoactive, or mind-altering properties that may lead to a number of serious medical and mental health consequences if abused for the mere purpose of getting high.

These harmful effects of OTC drugs frequently are compounded when they are combined with alcohol or other drugs.

Commonly Abused Over-the-Counter Drugs

Some people may choose to abuse OTC drugs as opposed to illegal drugs, due to the assumption that if they’re sold at the pharmacy as medication then they must be safe.

Contrary to popular belief, OTC drugs can be addictive and life-threatening when misused or abused. Below are some of the most common OTC drugs that people abuse.


Dextromethorphan (DXM) is the active ingredient found in many different OTC cough syrups, such as Robitussin and Nyquil. It can produce psychoactive effects when taken in larger doses than recommended and has become a popular legal drug of abuse, especially combined with other substances, such as alcohol and MDMA, according to the Center for Substance Abuse Research (CESAR).

Teenagers and those looking for a cheap and easy way to get high may abuse DXM because it is commonly found in the house and can be purchased at almost any local pharmacy.Users may abuse DXM for its mildly stimulating, euphoric or hallucinogenic properties but taking more than the therapeutic dose can be dangerous. Some adverse effects include:

  • Dizziness.
  • Dissociative states.
  • Hallucinations.
  • Coordination problems.
  • Impaired judgment.
  • Nausea.
  • Vomiting.
  • Slurred speech.
  • Seizures.

Learn how to help a DXM addict.


Ephedrine is a harmful central nervous system stimulant that used to be contained in various diet pills but was banned by the FDA in 2004 due to potential detrimental effects on cardiovascular health. Ephedrine use can stress the heart muscle and results in increased blood pressure. Many athletes have used and continue to use the drug to enhance performance, and in doing so, subject themselves to these health risks. Ephedrine is of a similar molecular structure to that of amphetamines and elicits similar effects. The FDA found that evidence was lacking related to the effectiveness of ephedrine as a long-term weight-loss supplement and, furthermore, that use of the drug could result in severe health consequences – including an increased risk of death.

That hasn’t stopped people from abusing ephedrine though. In 2011, the FDA seized $70,000 worth of ephedrine-containing products imported by a major marketing group, seven years after it had been banned for unreasonable health risks. Additionally, there are dozens of websites from which users can purchase ephedrine online with little fear of legal ramifications. Many of these websites falsely state that ephedrine is legal to sell and purchase. Ephedrine is also present in some asthma medications, such as Bronkaid and Primatene, and many people looking for a fat-burner will abuse these over-the-counter medications intended for the relief of asthmatic symptoms.

Athletes and dieters aren’t the only ones abusing ephedrine. Sometimes people in club and rave settings may use ephedrine as a substitute for ecstasy. Among the negative side effects are:

The sale and purchase of ephedrine is NOT legal.

Beware of online sites that falsely assure consumers that ephedrine is legal to buy and sell.

  • Nausea.
  • Dizziness.
  • Heart palpitations.
  • Heat stroke.
  • Memory loss.
  • Psychosis.
  • Stroke.
  • Seizures.
  • Heart attack.
  • Anxiety.
  • Difficulty urinating.
  • Stomach irritation.
  • Kidney stones.
  • Tremors.
  • Sleep problems.

Caffeine Pills

For millions of people, caffeine, which is a central nervous system stimulant, has become an integral part of their lives. Consumer markets feature an abundance of caffeinated products such as coffee, energy drinks, and caffeine pills. It is the most popular psychoactive drug consumed in the world (Daly, Holmen, & Fredholm, 1998) but has been shown to cause physical dependence and withdrawal symptoms upon cessation of use.

Although safe when taken in moderate amounts, it can be fatal when abused in large doses in order to get high or stay awake. In fact, taking too many caffeine pills can lead to an overdose.

Signs and symptoms of a caffeine overdose include:

woman with headache
  • Increased thirst.
  • Arrhythmia (irregular heartbeat).
  • Rapid heartbeat.
  • Vomiting.
  • Dizziness.
  • Fever.
  • Hallucinations.
  • Muscle twitching.
  • Convulsions.
  • Confusion.
  • Breathing problems.


People with eating disorders, such as anorexia or bulimia, may abuse laxatives with the intention of losing weight; however, laxatives don’t remove calories and can cause serious health consequences.

Laxatives are often taken after a binging episode, in which the person wants to rid the body of food. Various studies have revealed that anywhere from 10-60% of those suffering from an eating disorder abuse laxatives, and that those containing GI-tract stimulants are the most commonly abused (Roerig, Steffen, Mitchell, & Zunker, 2016). It’s important to note that the stimulants contained in laxatives are not the same as stimulant drugs such as methamphetamine or cocaine; they simply increase muscular contractions throughout the gut in order to increase transit time of ingested food and promote bowel movements. Abuse can be perpetuated by the temporary weight gain and bloating that occurs when laxative use is discontinued.

Laxatives work by artificially stimulating the bowels to empty. With continued abuse, this can cause a range of detrimental effects such as:

  • Loss of minerals, water, and electrolytes.
  • Organ damage, particularly to the heart and kidneys, due to mineral and electrolyte imbalance.
  • Possible heart failure.
  • Colon infection or cancer.
  • Bleeding and subsequent anemia.
  • Irritable bowel syndrome (IBS).
  • Severe dehydration, leading to kidney damage, weakness, and tremors.
  • Laxative dependency (the colon functions inadequately on its own and requires the laxative in order to pass wastes.
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Pseudoephedrine is the active ingredient in nasal decongestants, such as Sudafed. It is used to relieve symptoms associated with a cold, allergies, or hay fever. What was once available on the shelves of pharmacies is now regulated by having to show identification and sign for the medication behind the pharmacy counter.

The amount you are allowed to buy is limited as well – this limitation having been put in place due to the illegal production of methamphetamine from pseudoephedrine pills. Still, some people abuse pseudoephedrine in order to experience euphoria and a stimulant-like effect. Some harmful side effects of pseudoephedrine abuse include:

  • Weakness.
  • Dizziness.
  • Stomach pain.
  • Nausea.
  • Vomiting.
  • Breathing problems.
  • Irregular heartbeat.

Motion Sickness Pills

Some people have begun abusing motion sickness pills, such as Dramamine, in order to get high. These antihistamine medications can be safe and therapeutic when taken as directed for relief of the symptoms associated with motion sickness. However, they are abused by some people because they can produce mild euphoria and relaxation. Higher doses can cause hallucinations as well, similar to those of hallucinogens such as LSD and mushrooms.

Some serious side effects of abusing motion sickness pills include:

  • Dizziness.
  • Nausea.
  • Blurred vision.
  • Amnesia.
  • Eye pain.
  • Itchy skin.
  • Ringing in the ears.
  • Stomach pain.
  • Arrhythmia.
  • Cardiac arrest.
  • Kidney and liver damage.
  • Depression.
  • Agitation.
  • Delirium.
  • Coma.

Other Dangers

Some of dangers associated with abusing over-the-counter drugs result from a common household analgesic included in many combination formulations. Many OTC drugs contain acetaminophen, which can cause acute liver failure when taken in excess.

Acetaminophen is the active ingredient in Tylenol and is also contained in various flu and cold medications. It is also a component of many opioid painkillers, such as Percocet and Vicodin. It’s common for people to mix medications, unaware of their ingredients. If you’re taking Percocet, for example, not realizing it contains acetaminophen and then combine it with Tylenol, you inadvertently risk an acetaminophen overdose.

Acetaminophen overdose can result in the following:

  • Convulsions.
  • Stomach pain.
  • Loss of appetite.
  • Jaundice (yellow skin and eyes).
  • Diarrhea.
  • Nausea.
  • Vomiting.
  • Excessive sweating.
  • Metabolic acidosis.
  • Fulminant hepatic failure.
  • Coma.

Dangerous Drug Interactions

Acetaminophen and Alcohol

Acetaminophen can produce harmful effects in the liver when abused alone, but when combined with alcohol, the liver-damaging effects are multiplied. Alcohol puts significant stress on the liver if consumed in excess, but simultaneously drinking and taking OTC medications containing acetaminophen further lowers the threshold at which irreversible liver damage occurs.

Alcohol and acetaminophen don’t even have to be taken at the same time in order to have damaging results. If you have a hangover from drinking too much the night before, Tylenol should be avoided, as it can still have detrimental consequences on the liver. It is never a good idea to mix alcohol and pills, and this potentially devastating health development underscores the risks.

DXM and Alcohol

cough syrup being poured into a spoon

One popular drug combination is that of alcohol and cough syrup. Abusing this combination is particularly dangerous, since DXM can act as a central nervous system depressant at high doses and alcohol also depresses the CNS. Alcohol and cough syrup’s  synergistic effects can increase drowsiness, respiratory depression, and the risk of overdose and death.

Alcohol and Codeine-Containing Cough Syrups

Alcohol is also often combined with codeine-containing cough syrups. This combination, which has been popularized by hip hop culture, is referred to as “purple drank” or “sizzurp” and can cause life-threatening effects, such as respiratory depression and extreme sedation, similar to that of DXM and alcohol. Codeine is an opioid like heroin and morphine, and when taken in excess, especially with alcohol, it can cause the heart to stop beating and lead to death.

Ephedrine and Caffeine

Many athletes use a combination of ephedrine and caffeine in order to enhance athletic performance, but these two stimulants can enhance the thermogenic effects of each other; the dangerous spike in body temperature can increase the individual’s risk of suffering from heat stroke.

Many OTC drugs are potentially hazardous if abused, but combining them increases your odds of experiencing dangerous consequences. Always tell your doctor all of the medications you are prescribed before beginning a new one. Certaim drug interactions can produce life-threatening results and require immediate medical attention.

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Lauren Brande, MA, has dedicated her life to psychological research. She started off her career with a scholarship from the Western Psychological Association for her undergraduate work in perceptual processing. In 2014, she achieved her master of arts in psychology from Boston University, harnessing a particular interest in the effects that drugs and trauma have on the functioning brain.

She believes that all research should be accessible and digestible, and her passion fuels her desire to share important scientific findings to improve rehabilitation.

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