Over-The-Counter (OTC) Drug Addiction, Abuse, And Treatment

What Are Over-The-Counter (OTC) Drugs?

Over-the-counter (OTC) drugs are medications that can be purchased without a prescription from a licensed healthcare provider at pharmacies, drugstores, or supermarkets. They are relatively inexpensive, can be purchased in-store or online, and have no age requirement or limit on the amount purchased (except for pseudoephedrine).

When used as directed, they can help treat many conditions, including symptoms of the common cold and flu, allergies, and pain relief associated with menstrual cramps, headaches, and muscle aches.

Although OTC drugs are widely accessible and are generally considered safe, they can still be abused. OTC drugs are some of the most commonly misused legal substances in the US, behind marijuana and alcohol. Statistics from the Monitoring the Future survey show that 3.7% of the population abused cold and cough medicines in 2024.

Any OTC drug use outside of what’s recommended is considered abuse. People misuse OTC medications for a variety of reasons, including their easy accessibility, their psychoactive and mind-altering effects, and to self-medicate mental illnesses like anxiety and depression.

Although less potent than other substances, OTC drugs still pose a risk for developing an addiction, overdose, and dependence. Abusing OTC drugs can lead to health problems, including memory loss, kidney failure, heart problems, and death.

Commonly Misused OTC Drugs

Some commonly abused OTC medications include cough medicines (dextromethorphan), cold medicines (pseudoephedrine), and motion sickness pills (dimenhydrinate).

Cough Medicines

The main active ingredient in cough medicines is dextromethorphan (DXM), often indicated by “DM” on the product packaging. DXM works as a cough suppressant to control cough and is effective when used as directed. However, it is commonly abused for its euphoric, hallucinogenic, and dissociative properties.

At high doses, DXM has been described to have similar effects as ketamine or PCP, giving an “out of body” experience. This form of misuse is commonly referred to as “robotripping” or “dexing”.

Cough medicine misuse is popular among young people, as these medications are often easily accessible in medicine cabinets at home.

The Drug Enforcement Administration lists different dose-dependent plateaus, as experienced by people who abuse DXM. The maximum recommended daily dose of DXM is 120 mg; beyond that, intoxication and dangerous side effects begin to appear.

• A dose of 100-200 mg induces mild stimulation and euphoria.
• A dose of 200-400 mg leads to stronger euphoria and hallucinations.
• A dose of 300-600 mg causes loss of motor coordination and visual distortions.
• A dose of 500-1500 mg leads to out-of-body sensations.

High doses of DXM can cause:

• Breathing problems
• Blacking out
• Muscle twitching
• Extreme drowsiness
• Heart palpitations
• Changes in blood pressure
• Elevated body temperature
• Vomiting
• Rapid heart rate
• Blurred vision
• Muscle twitching
• Brain damage

Major brands of cough medicine containing DXM that are commonly abused include Delsym, Mucinex, Robitussin, NyQuil, Vicks, and Theraflu.

Cold Medicines

Pseudoephedrine is a stimulant and the active ingredient in many cold medicines. It is used to relieve nasal and sinus congestion from the common cold or allergies. Pseudoephedrine is commonly abused for its stimulant effects, and sometimes for its hallucinogen effects or an intense “body high”.

Pseudoephedrine is also used to create illicit drugs like methamphetamine since it has a similar chemical structure to that of amphetamine, although its effects are slightly weaker. Due to its misuse, it is more strictly regulated. People must show identification to prove they are 18 years or older to purchase pseudoephedrine, and there is a monthly limit on the amount an individual can purchase.

Abusing pseudoephedrine can cause irregular heartbeat, shortness of breath, high blood pressure, dizziness, and seizures. Common cold medicine brands that contain pseudoephedrine include:

• Sudafed
• Advil Cold and Sinus
• Claritin-D
• Mucinex D
• Tylenol Sinus Severe Congestion Daytime
• Zyrtec-D

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Motion Sickness Pills

Dimenhydrinate is an over-the-counter antihistamine used to treat nausea, vomiting, and dizziness associated with motion sickness and vertigo. When misused, it is known to produce feelings of euphoria, induce visual and tactile hallucinations, and have anxiolytic effects. As a result, it is often abused for its psychedelic properties, and when combined with alcohol, it can produce sedative effects. It is also misused to self-medicate for its antianxiety effects.

In high doses, the drug can cause hallucinations, ringing in the ears, nausea, irregular heartbeat, seizures, coma, and death.

The drug is considered a deliriant when taken in high doses (between 200 and 1200 mg, depending on body weight). Common brand names for motion sickness pills that contain dimenhydrinate include Dramamine, Driminate, and Gravol.

Other Commonly Misused OTC Drugs

Loperamide is an OTC antidiarrheal agent used for the symptomatic relief of non-specific acute diarrhea, as well as chronic diarrhea that is associated with inflammatory bowel disease. Loperamide is an opioid agonist, and when taken in high doses, it can produce opioid-like effects because it crosses the blood-brain barrier when excessive amounts are taken.

Loperamide is much cheaper, and because it is readily available over the counter, people misuse and abuse it for its opioid-like euphoric high. It is also misused to help alleviate opioid withdrawal effects in people who have a physical dependence on opioids and are experiencing opioid withdrawal effects.

To produce opioid-like effects, loperamide must be taken in extremely high doses, which cause dangerous side effects such as cardiac arrhythmias, respiratory depression, fainting, and sudden death. Immodium is the brand name antidiarrheal medication that contains the active ingredient loperamide.

OTC laxatives are used to help treat constipation by softening the stool in the large intestine or stimulating bowel movements by increasing water loss. They are commonly misused to achieve weight loss, and laxative misuse is often associated with people who have a history of eating disorders, such as anorexia nervosa or bulimia nervosa, or who have body dysmorphia.

Misusing laxatives can result in severe dehydration and a reduction in electrolytes that can contribute to cardiac arrhythmias, kidney damage, and other irreversible organ damage.

Common OTC laxative brands include:

• Dulcolax
• Senokot
• MiraLAX
• Milk of Magnesia
• Colace
• Benefiber

OTC diet pills are commonly misused. They are FDA-approved for weight loss and work by decreasing the amount of dietary fat absorbed in the intestines. The primary medication is orlistat, marketed under the brand names Alli and Xenical.

Other “diet pills” are diuretics such as caffeine pills, which are misused as weight loss pills but only decrease water weight and therefore are not effective at reducing body fat. Misuse and abuse of diet pills can worsen an existing eating disorder or increase the risk of developing a new eating disorder. It can also lead to dehydration, malabsorption issues, electrolyte imbalances, loose stools, rectal and abdominal pain, anal fissures and tears, and acute kidney injury.

Can You Get Addicted To Over-The-Counter Drugs?

Yes, it is possible to become addicted to over-the-counter drugs. Because OTCs are so readily available, people assume that addiction cannot occur; however, they have a high potential for misuse and alter the brain’s chemistry over time by interfering with serotonin and dopamine.

Misusing OTC drugs can lead to an increased tolerance, and some of these medications can cause physical dependence, resulting in withdrawal effects when stopped.

Studies have shown that OTC medications such as loperamide, DXM, and pseudoephedrine are known to cause withdrawal effects when stopped or reduced. As a result, a person often continues to misuse these medications to prevent these unwanted withdrawal side effects.

Common symptoms of OTC drug withdrawal include:

• Confusion
• Irritability
• Agitation
• Anxiety
• Mood changes
• Insomnia
• Stomach cramps
• Diarrhea

Some of the signs of an OTC drug addiction include continuing to use the drugs despite the known consequences, developing a tolerance, experiencing withdrawal effects, and spending an excessive amount of time or money using or getting them.

Signs Someone Is Abusing Over-The-Counter Drugs

People misuse OTC drugs for many different reasons, including to get high or self-medicate. Spotting signs of OTC abuse can help someone seek treatment faster, especially if there is an underlying mental health disorder or addiction. The following are common signs associated with OTC drug abuse:

• Purchasing or storing large quantities of cold, cough, or antidiarrheal medicines despite having no signs or symptoms of a current illness.
• Hiding pill bottles or boxes, credit card statements, and pharmacy receipts
• Emptying containers of pills and putting them in a plastic bag
• Rapid changes in weight and appetite
• Rapid changes in sleep patterns
• Neglecting hygiene
• Odd or erratic behavior
• Drastic changes in mood
• Aggression
• Withdrawal from hobbies, friends, family, and a decline in school or work performance
• Sudden change in friend groups
• Lying or hiding about whereabouts

Treatment For Over-The-Counter Drug Addiction

Over time, OTC drug abuse can have unhealthy and irreversible consequences on your physical and mental health, so seeking treatment is important.

Addiction to OTC medication is most commonly treated on an outpatient basis with psychotherapy approaches, such as cognitive behavioral therapy, individual therapy, and group therapy sessions. However, if there is a co-occurring addiction, mental health disorder, or eating disorder, then inpatient rehab may be an option.

The goal of treatment is to uncover any underlying triggers, unhealthy thought patterns, or behaviors that lead to the addiction and develop healthy coping skills to navigate cravings and harmful thoughts.

Forming a healthy support system is an essential component of addiction treatment, whether this is a close-knit group of friends and family, online support groups, or in-person addiction support groups. Attending a 12-step group like Narcotics Anonymous can provide community and support to help with lasting recovery.

If you or someone you care about is struggling with an addiction to OTC drugs, contact a treatment provider or browse our rehab directory to explore your available treatment options.