Over-the-Counter (OTC) Medications Abuse & Addiction


Key Takeaways
- Overdosing on OTC drugs can cause severe organ damage.
- OTC abuse includes excessive use and using drugs for euphoria.
- Cough, cold, pain, and weight loss OTCs are commonly abused.
- Acetaminophen and NSAIDs are two types of OTC pain relievers.
Can You Abuse Over-the-counter (OTC) Medication?
When used as directed, OTC medications are safe for most people. However, they can interact with other substances, potentially resulting in dangerous side effects.
People with certain health conditions may have an increased risk of these side effects, which can include overdose, abuse, and addiction.
Other health risks associated with OTC medication overdose include:
- Liver damage
- Stomach bleeding
- Kidney damage
- Brain swelling
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How Are OTCs Abused?
Some people may use OTC medications for unintended purposes. For example, some people can use certain medications to self-medicate or achieve a high.
Abuse also happens when people alter OTC medications to use in recipes for dangerous street drugs. There is a risk that someone abusing OTC medications might move onto illicit drugs to achieve a more powerful reaction.
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What are Commonly Abused OTC Medications?
Certain OTC medications are abused more frequently than others. These medications are typically abused for their active ingredients.
Some of the most commonly abused OTC medications include:
Cough Medications (Dextromethorphan or DXM)
The recommended maximum daily dose of DXM is 120 mg, but taking a higher dose can result in loss of motor control, visual distortions, and out-of-body sensations.
Very high doses of DXM causes:
- Slowed breathing
- Blackouts
- Blurred vision
- Brain damage
- Changes in blood pressure
- Elevated body temperature
- Extreme drowsiness
- Heart palpitations
- Muscle twitching
- Rapid heart rate
- Vomiting
Cold Medications (Pseudoephedrine)
Pseudoephedrine is a stimulant used to relieve nasal and sinus congestion. Larger doses of pseudoephedrine might cause hallucinations or an intense high.
Abuse of this drug causes:
- Dizziness
- Irregular heartbeat
- High blood pressure
- Shortness of breath
- Seizures
Pseudoephedrine is also used as an ingredient in methamphetamine. Methamphetamine, meth, or crystal meth is addictive and extremely dangerous.
Decongestants
Nasal decongestant sprays can also lead to a “nasal spray addiction” in some users. This addiction typically forms with long-term and frequent use of nasal sprays. It also causes rebound nasal congestion.
Motion Sickness Medication (Dimenhydrinate)
Dimenhydrinate combats motion sickness and vertigo. Taken in high doses, it can cause certain side effects, such as:
- Psychedelic effects or hallucinations
- Coma
- Irregular heartbeat
- Nausea
- Seizures
- Death
Pain Relievers
OTC pain relievers are relatively safe when used as directed. However, they can be abused by taking more than the recommended dose or taking them for an extended period.
Some people might also combine them with other pain medications or alcohol. Misuse of over-the-counter pain relievers causes stomach problems and other complications.
There are two classes of OTC pain relievers: acetaminophen (i.e. Tylenol) and NSAIDs (i.e. Aspirin). Contact your doctor before using these or any other OTC medications.
OTC Drug Withdrawal Symptoms
It’s possible for the body to become dependent on OTC drugs and for someone to experience withdrawal if they stop using the drug.
Symptoms of OTC drug withdrawal include:
- Irritability and agitation
- Confusion
- Anxiety
- Physical discomfort or restlessness
Because these drugs are safe, recognizing an OTC drug problem is a challenge. They also don’t carry the same risks associated with obtaining the drug that you find with illicit drugs. However, abuse of or addiction to OTC medications is a serious problem.
If you or someone you love continues to use an OTC medication even after suffering negative consequences or is abusing these drugs in any way, it’s important to seek help.
How Does an Overdose Occur?
An overdose typically occurs when someone abuses the medication. Either by taking more medication than prescribed or by mixing it with other substances, both can be potentially fatal.
An overdose can occur even when someone uses the medication as intended. Over time, these drugs can alter your brain chemistry and build your tolerance, increasing the need for more doses to achieve the safe effect, potentially resulting in an overdose.
Because of this, it’s important to read and understand the instructions before taking the medication. You should also read a drug’s label before using it.
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Treatment Options for OTC Abuse & Addiction
Your treatment will depend on the type of drug being abused and the extent of the abuse. It’s also important that someone with a co-occurring disorder abusing OTC meds be treated for both issues simultaneously.
Treatment is available on an inpatient, outpatient, or partial hospitalization basis. Most people benefit from a combination of these therapies.
Treatment options include:
- Individual therapy
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Group therapy
- Family therapy
- 12-step programs
- Relapse-prevention
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- Sánchez-Sánchez et al. “Consumption of over-the-Counter Drugs: Prevalence and Type of Drugs.” Int J Environ Res Public Health, 2021.
- Center for Drug Evaluation and Research. “Understanding Over-the-Counter Medicines.” FDA, 2018.
- Ray et al. “Over the counter drugs and self-medication: A worldwide paranoia and a troublesome situation in India during the COVID-19 pandemic.” Annals of Medicine and Surgery, 2022.
- Sansgiry et al. “Abuse of over-the-counter medicines: a pharmacist’s perspective.” Integr Pharm Res Pract, 2016.
- Russo et al. “Use, Abuse, and Misuse of Nasal Medications: Real-Life Survey on Community Pharmacist’s Perceptions.” J Pers Med, 2023.
- Cheatle et al. “Treating pain in addicted patients: recommendations from an expert panel.” Popul Health Manag, 2014.

