Unwanted Addiction: Understanding the Addictive Qualities of Over-the-Counter Drugs

Can you get hooked to over-the-counter (OTC) drugs and develop an unwanted addiction? The answer depends on a number of factors. The drug in question and its particular qualities are one factor. So are the reasons you’re taking the drug in the first place. In certain cases, OTC medications can be as addictive and dangerous (causing life-threatening complications) as some illicit drugs — especially when used in conjunction with alcohol or other substances.

Psychological factors also can play a part in some OTC medicines becoming more habit-forming than others. For example, if you’ve convinced yourself you need a particular medicine in order to get to sleep every night, that medicine can become more addictive than a cough medicine you use only very rarely.

Unwanted addiction is only one facet of a discussion regarding the addiction dangers of OTC drugs, however. The other reality is that OTC drugs are prone to abuse by certain populations, especially teens looking to experiment recreationally, (but also those with already existing substance abuse issues). What many don’t know is the extent to which OTC drugs are abused in this country. OTC and prescription drugs (together) are the most abused drugs by Americans aged 14 and older — second only to alcohol and marijuana, according to a report by the National Institute on Drug Abuse (NIDA). Worse yet, rates of OTC drug abuse appear to be climbing, the same report stated.

Unwanted Addiction to OTC Sleeping Pills

OTC sleeping pills like Advil PM, Nytol, Simply Sleep, Sominex, and Tylenol PM can be habit-forming, contrary to the common claim on many of their packaging labels. Many of these drugs contain the antihistamine, diphenhydramine, which blocks histamine receptors in the brain associated with wakefulness, with the result that users experience drowsiness.

Packaging instructions indicate these pills are safe when taken for two weeks or less, but a 2015 Consumer Reports National Survey found that of the 20 percent of adults surveyed who took OTC sleeping pills within the previous year, almost one in five reported they took the drug daily for longer than two weeks. Even more troubling was the fact that 41 percent of these users reported they used these drugs for a year or longer.

Just how addictive are these pills? The director of Columbia University’s Epilepsy and Sleep Division of the Department of Neurology, Dr. Carl Bazil, explained in an article in Consumer Reports: “The pills are not ‘addictive’ in the physical sense, but there can certainly be a risk for a psychological dependency.”

In other words, you can’t develop a bona fide physical dependency on OTC sleeping pills. However, you can convince yourself you need them to such a degree they become habit-forming; and psychological dependency is one dimension of addiction (physical dependency being the other).

OTC Drug Abuse Among Teens and Drug Addicts

OTC drugs are also prone to abuse by certain populations, particularly teens looking to experiment and adults with existing substance abuse histories. The same NIDA report cited above stated that one out of every 10 teens has used a cough medicine to get high. (The next section contains more information regarding how OTC cough medicines are abused.)

Clients with drug abuse histories are also susceptible to misusing OTC medications. In one California study in The Journal of the American Board of Family Medicine (JABFM), 16.2 percent of drug court clients surveyed admitted to abusing OTC medications, mostly ephedrine and other stimulants. (Before Food and Drug Administration regulations banned it, ephedrine frequently made its way into OTC diet pills. Today these weight loss pills contain other stimulants that mimic ephedrine; bitter orange reportedly is one such stimulant.)

The same JABFM study cited records of OTC-related emergency room visits in the year 2002, showing OTC and prescription drugs accounted for 4 percent of the 1.9 million patient emergency room admissions. Admitted ER patients experienced side effects, complications or overdoses related to the following OTC drugs:

• Aspirin
• Cough syrup
• Diphenhydramine and other antihistamines
• Sleep aids
• “Legally obtained medications”

Commonly Abused OTC Drugs

Certain OTC drugs are more prone to abuse, because of their mind-altering and euphoric effects at higher dosages. For example, dextromethorphan (DXM), a cough suppressant ingredient, is the active ingredient in more than 100 OTC cough and cold medicines, including Nyquil and Robitussin. When taken in large doses, DXM can produce euphoria, hallucinations and dissociative effects similar to those of the illicit drug, ketamine. Teens have been known to take five to ten times the recommended dose of DXM.

At these levels, the drug can be dangerously toxic. Another scary potential side effect is psychosis. Moreover, those who abuse DXM can fall prey to dependence, withdrawal and even chronic addiction. In addition to DXM, many other OTC drugs are prone to abuse.

Most commonly abused over the counter drugs:

• Cold medicines (Pseudoephedrine) – When abused, pseudoephedrine can produce euphoric, stimulant effects.
• Antihistamines (Coricidin HBP) – At higher doses, Coricidin has the potential to cause euphoria, psychosis, a dissociative state, and (rarely) dependence, according to one study.
• Motion sickness pills (Dimenhydrinate) – These produce mild euphoria, relaxation, and have even been known to produce hallucinogenic effects at higher doses.
• Diet pills (Rapture) – There is at least one reported incident of psychosis related to misuse.
• Sleep aids (Sominex, Nytol and Sleep Eze) – Their excess consumption can cause delirium, confusion and hallucinations.

Among teens looking to experiment, these 10 OTC medicines are the most popular drugs of abuse.