UAB Medicine News


How to Spot Over-the-Counter Drug Abuse in Family Members

OTC Drug Use

When your child has a cold or your husband sprains an ankle, you probably don’t think twice about reaching for cough syrup or acetaminophen. After all, you can purchase over-the-counter (OTC) medications without a prescription, so they’re perfectly harmless, right?

That isn’t always the case. OTC medications are drugs, and just like illegal drugs, they can be abused. Because most are easy to buy and tend not to cause suspicion, OTC drug abuse often goes undetected.

Gani Folami is a substance abuse counselor at Beacon Recovery, a UAB Medicine-affiliated outpatient substance abuse treatment program for adults and teens. He says OTC drugs are misused in three primary ways. “Using more than is recommended on the packaging can be abuse,” Folami says. “So can taking the drugs specifically to get a certain feeling or mixing OTC drugs to get high.”

OTC Drugs of Choice

One of the most frequently abused OTC drugs is dextromethorphan (DXM), which is found in many extra-strength cough suppressants. Available in liquid, tablet, or gel capsule form, these cough medicines often contain antihistamines and decongestants in addition to DXM.

“Cough medicine can trigger a high close to that of marijuana, though not as strong as opioids,” Folami says. Some teenagers mix prescription codeine cough syrup and soda to make “sizzurp” or “purple drank,” but they may use OTC cough syrup if the more desirable prescription-strength formula is not available to them.

Abuse also is common with loperamide, found in anti-diarrheal OTC medications such as Imodium. “Loperamide can have effects similar to opioids when mixed with other substances or when taken in large quantities,” Folami says. This drug is available in tablet, capsule, or liquid form.

Pseudoephedrine, a decongestant often used to make methamphetamine, has stimulant properties and can be misused by girls and women hoping to lose weight. Products containing pseudoephedrine (such as Sudafed) do not require a prescription but are kept behind retail sales counters. In Alabama, you must be at least 18 years old and present a valid identification to buy pseudoephedrine, and purchases are limited to 3.6 grams per day and 7.5 grams per month.

Dimenhydrinate, an ingredient found in motion sickness medications such as Dramamine, is an antihistamine that can cause feelings of intense euphoria and even trigger hallucinations when taken in larger doses.

Signs of OTC Drug Abuse

To help spot potential OTC drug misuse or abuse in family members, look for the following signs and symptoms, many of which are similar to the effects of illegal drug use:

Physical changes

  • Overeating or undereating
  • Gaining or losing large amounts of weight
  • Sleeping too much or too little
  • Clumsiness, jerky movements, or slurred speech

Behavioral changes

  • Secretive or suspicious behaviors
  • Believing or acting as though others are against them
  • Memory problems
  • Losing interest in pastimes or socializing
  • Sudden changes in friendships
  • Angry outbursts, crying, or blaming
  • Poor performance at school or work

More generally, pay attention to how your child, spouse, or other family member is using an OTC medication. Potential red flags include:

  • Taking more than the recommended dosage
  • Taking doses more frequently than indicated on the packaging
  • Continuing to take the medication once the health issue has resolved
  • Drinking alcohol while taking the medication
  • Combining several OTC medications without being instructed to do so by a doctor

If a family member is misusing DXM, symptoms may include excitability or fatigue, stomach pain, sweating, or vision changes. Potential signs of misusing loperamide include stomach pain, constipation, and rapid heart rate. Pseudoephedrine abuse can trigger dizziness, nausea, vomiting, and restlessness, while dimenhydrinate can cause flushing, dilated pupils, and hyperactivity or drowsiness.

Confirming Suspicions

If you suspect OTC medication abuse, Folami suggests checking the medicine cabinet first. “Most of us have cough syrup at home, so if a family member is abusing it, you’ll be able to see how fast they are using it.” Similarly, look for evidence of online bulk ordering of OTC drugs and empty medicine bottles in the trash.

A family member with an OTC drug problem may rationalize the need for more medication, blaming their use on worsening allergies or frequent diarrhea. You may notice that their breath, clothing, or room smells like medicine, or that they are trying to cover up medicinal scents with breath mints or air fresheners. “If you notice any of these things, ask questions, check their room, and look in cabinets,” Folami advises. “If they don’t cooperate when you want to talk about it, that’s another possible indicator.”

Getting Help

OTC medications can be addictive, and they can be a gateway to more serious illegal drugs, so it’s important to seek help immediately. Long-term OTC drug abuse can lead to liver and kidney damage and harm the nervous system. It’s also possible to overdose on OTC medications, which can cause permanent brain damage or even death.

Folami says talk therapy can help those who are misusing or abusing OTC medications by teaching them to change the thought patterns that lead to drug use. “Addressing the problem early can prevent serious addiction problems and avoid the tragedy of an overdose,” he says.

If you suspect your child has a substance abuse issue, call UAB Beacon Recovery at 205-917-3733, extension 103, to schedule an evaluation.

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