Over the Counter Drug Abuse on the Rise

In today's society, self-medication with over-the-counter (OTC) drugs is common. Unfortunately, so is the abuse of them. Statistics show that 80% of Americans' medical care comes from the OTC drugs they buy. As soon as we have any sign of pain, we turn to OTC medication. In fact, people rely on one kind of OTC product or another just to get through the day. But this trend of popping a pill to solve the problem of pain is giving America's youth the wrong idea. Teenagers and young adults, ages 12-26, are purposely abusing cough and cold medicine to get "high" because they don't understand how the body functions, and how dangerous OTC drugs are to it.

With new drugs continuously shelved, we expect there to be a medication for every ailment. But the truth is we need pain. Pain is physical suffering associated with a bodily disorder (such as a disease or injury) and accompanied by mental or emotional distress. Without it, our bodies wouldn't be able to function properly. Pain warns us when there is something wrong so the appropriate treatment method can be used. OTC medication may delay the treatment needed and may hide an underlying, perhaps chronic condition. It's easier for us in our busy lives to pop the pill instead of asking ourselves why we have the pain in the first place. When taken too often or too much, OTC drugs may even cause a serious health condition. For these reasons, pain is essential to life.

When taking a drug, it's important to understand the process of drug metabolism in the body. Solid drugs, such as tablets, must be broken down in the stomach and released into the bloodstream. This usually takes 30 minutes to 1 hour. Liquid drugs are absorbed into the bloodstream much faster than solid drugs since they don't need to be broken down. This takes 15 minutes to 45 minutes. This also means more of the drug will reach the bloodstream. After reaching the stomach, the drug will travel through the small intestine and be delivered to the liver. The liver is responsible for metabolizing the drug before it's passed on to the whole body circulation. This is called first-pass metabolism. From the liver to the bloodstream, the drug is further broken down, and what is left is distributed to bodily tissues for the desired effect. Finally, the drug is excreted by the kidneys into urine and eliminated from the body hours later. The time it takes this process depends on the person's age, weight, genetics, pre-existing condition(s), and the amount of food, if any, in the stomach.

Anytime you take more of a drug than is recommended on the label, you are abusing that drug. People think if 2 pills don't work for them, they can take 3. But the labels on these medicines clearly state all ingredients; there is more going into the body than just the extra milligrams of the drug. And because of the long process drugs take to metabolize, people actually overdose accidentally on these medications. Unfortunately, the drug may do irreparable damage to the body before any important symptoms develop. Most surviving victims of drug overdose are fortunate and have no long term effects; but some who are not so fortunate suffer from kidney, liver, or heart failure; and even death.

Because our medicine cabinets are full, from aspirin to Vicks Formula 44, teenagers have been led to assume OTC drugs are safe. Adolescents are curious and vulnerable, and when faced with peer pressure, may be tempted to experiment. Young adults who were once teenagers and experimented, are now hooked on one drug or another. And by the time they realize these OTC medicines can be dangerous, they simply don't care. Parents need to educate children: just because OTC drugs are readily available to the public without a prescription and are legal, this does not mean they are safe. When the Food and Drug Administration (FDA) approves a drug for OTC use, it's only considered safe and effective if taken at the recommended dose in the recommended time frame. William Bobo, M.D., says kids are abusing cough and cold medication because "...it's not an ugly drug. It's much less intimidating than snorting a powder or injecting a strange substance...it's a very familiar substance, in short, it is felt to be benign by abusers" ("It's Just Cough Medicine-Think Again!"). OTC medications are simply inexpensive and easy to take-much less frightening than hardcore drugs, such as cocaine-but still are as deadly.

The most common OTC drug being abused by teens and young adults is dextromethorphan, or DXM. It's a semisynthetic narcotic related to opium. It's found in Coricidin, Robitussin, Vicks Formula 44, Drixoral, Nyquil, and in more than 120 other cough and cold medicines. It's being abused to produce depressant and hallucinogenic effects. It's similar to the effects of PCP because it acts as a dissociative anesthetic, which means the user may have an out of body experience. DXM also gives users heightened perceptual awareness, lethargy, perceptual distortion, and a feeling of euphoria. The Drug Enforcement Administration (DEA) describes four "plateaus" recreational abusers of DXM try to achieve: 1st plateau is 100-200 milligrams and produces mild stimulation, 2nd plateau is 200-400 milligrams and produces euphoria and hallucinations, 3rd plateau is 300-600 milligrams and produces distorted visual perceptions and loss of motor coordination, 4th plateau is 500-1500 milligrams and produces dissociative sedation. These drugs are available as tablets, capsules, gel-caps, and syrups. Now not only is this drug easily accessed in drug stores, but it's also being sold on the internet in a pure powdered form, along with "how-to" instructions to use DXM. Street names for dextromethorphan include DXM, Robo, Skittles, Tussin, Triple-C, Candy, Vitamin D, and Velvet. If you're using the drug, you're "Robo-ing", "Skittling", or "Robo-Tripping". In May 2005, the FDA made an announcement to consumers about the dangers of dextromethorphan: "The agency is working with other health and law enforcement authorities to address this serious issue and warn the public of potential harm, after five recently reported deaths of teenagers that may be associated with the consumption of powdered DXM sold in capsules. DXM abuse, though not a new phenomenon, has developed into a disturbing new trend which involves the sale of pure DXM in powdered form. This pure DXM is often encapsulated by the 'dealer' and offered for street use."

Dextromethorphan is safely taken in 15-30 milligram doses. Teens and young adults, as described by the four "plateaus", are taking as much as 1500 milligrams in one dose. Taking these large quantities is dangerous and may produce serious side effects and complications. These include impaired judgment and mental functioning, loss of coordination, dizziness, nausea and vomiting, hot flashes, hallucinations, brain damage, seizures, confusion, blurred vision, paranoia, excessive sweating, slurred speech, abdominal pain, irregular heartbeat, high blood pressure, headache, lethargy, numbness of fingers and toes, redness of face, dry and itchy skin, and death. The other concern is when these kids are drinking cough syrup and/or popping pills, they are overdosing on more than one medication. Cough and cold medicines also contain acetaminophen, which is a pain reliever that causes liver damage when taken in excess; doxylamin succinate, which is an antihistamine; ephedrine sulfate, which is a decongestant; and inactive ingredients and fillers. Shannon Miller, M.D. says, "In spite of these serious potential adverse effects of DXM, the dangerous behavior it induces, and the ingredients ingested along with DXM-containing cough medicines, abusers keep returning because of the drug's legal status and easy access" ("It's Just Cough Medicine-Think Again!").

The FDA and DEA are working toward a solution, but what can we do? The first step is awareness. Parents should understand that OTC drug abuse is a serious problem. The truth is, OTC drugs are being abused just as often, if not more, than illegal drugs. Parents should calmly talk to children about the effects of drugs: how they make someone feel, the overdose risk, and long-term damages. Lisa Elliott, PhD, a children's behavioral health specialist says, "If we as parents do not take the responsibility to educate our children about drugs, they are going to get that information from other people, and that information may not be right. Often, without that information, because of peer influence and the desire to fit in, kids will just go ahead and experiment, and they have no idea what they're doing." The National Center on Addiction and Substance Abuse recorded that nearly half of the middle and high school students they surveyed said parents never talked to them about the dangers of drugs.

To keep your child safe, take these steps: 1. Monitor the OTC drugs in your home. Keep track of how much medicine is in each bottle. 2. Avoid overstocking OTC drugs in your home. 3. Don't allow your child to keep OTC drugs in his bedroom, backpack, or school locker. 4. Monitor your child's internet use. Watch for web sites your child may be visiting that promote OTC or other drug abuse. 5. Role model responsible use of OTC and prescription medications. 6. Talk to your child about all drugs: illegal, prescription, and OTC. Still worried? Watch for these signs: 1. Your child takes large amounts of cold or cough medication, or takes medication when not ill. 2. OTC drugs seem to vanish from your medicine cabinet. Don't just assume, ask. 3. Look for OTC drugs stashed in your child's room or backpack. 4. Watch for changes in your child's behavior, such as sudden mood swings or failing grades.

With so many serious side effects, OTC drugs, particularly dextromethorphan, should only be used as directed on the label. It takes hours for the body to metabolize drugs, and pain is required to know when something is wrong. When in doubt, see a doctor. If 2 pills isn't working for you, there may be need for a prescription. Remember, your kids are always watching, even when you think they aren't. Teenagers and young adults need to be informed of how the body functions, and the dangers of overdosing on OTC drugs to get "high". Although over-the-counter drugs are legal and readily available, they are not safe from abuse. Public awareness of the serious abuse of these medicines is imperative to correct the problem.

Sources used:
"Cough and Cold Medicine Abuse" KidsHealth. http://kidshealth.org/PageManager.jsp
"Drug Overdose" Health A to Z. http://www.healthatoz.com/healthatoz/Atoz/ency/drug_overdose.jsp
"FDA Warns Against Abuse of Dextromethorphan (DXM)" FDA Talk Paper. http://www.fda.gov/bbs/topics/answers/2005/ans01360.html
"It's Just Cough Medicine-Think Again!" http://www.tnclearinghouse.com/factsheets/DXM.htm
"Drugs and Chemicals of Concern: Dextromethorphan" DEA Office of Diversion Control.
http://www.deadiversion.usdoj.gov/drugs_concern/dextro_m/dextro_m.htm