5 Commonly Abused OTC and Prescription Drugs

When you hear about drug abuse, it is important to keep in mind that it is not always just about abusing street drugs like marijuana, heroin, or others. After street drugs, legally available medications are the next most commonly abused drugs in the world. The pharmaceutical industry has given us over-the-counter (OTC) and prescription drugs that help to heal us from many conditions. However, many of these medicines can also be abused since they are addictive in nature and dangerous if used in the wrong manner.

OTC and prescription drugs are sold legally, but they can be addictive and dangerous if taken in the wrong amount or wrong way, or in the wrong quantity. Here are some of the most commonly abused OTC and prescription drugs.

It won’t be wrong to say that prescription and OTC drug abuse has reached epidemic proportions in the US and many other countries in the world. An OTC drug is a medication you can buy without needing a doctor’s prescription, and a prescription drug, of course, means it can only be bought if you have a doctor’s note for the same. No matter how they are sold, the fact remains that both types of drugs have immediate and long-term consequences if abused, and in some cases, these consequences can even be deadly.^{(1, 2, 3)}

Many medicines carry the risk of abuse, but some of the most commonly abused drugs include opioids, depressants or sedatives, stimulants, and dextromethorphan. Let us look at some of the most widely abused medications:

1. Barbiturates

   Barbiturates are a class of drugs that are typically known as sedative-hypnotics. This class of drugs is so named due to their anxiety-relieving and sleep-inducing effects.

   Barbiturates are usually known to be dangerous because it is quite challenging sometimes to predict the correct dose, and even a slight overdose of these medications can lead to a coma or death. Barbiturates are known to be addictive, and it can lead to a fatal withdrawal syndrome.^{(4, 5)}

   Though the use and abuse of barbiturates have declined significantly since the 1970s, and doctors are also not prescribing barbiturates much, but barbiturate abuse is on the rise amongst teenagers. Earlier barbiturates have now been replaced with a safer group of drugs known as benzodiazepines.⁽⁶⁾

   Barbiturates include sedatives like pentobarbital (brand name: Nambutal), phenobarbital, and secobarbital (brand name: Seconal). These medications help a person deal with sleeping problems, anxiety, and in some cases, seizures. However, if taken more than what is prescribed, it is easy to get addicted to these drugs.

   High doses of barbiturates can cause breathing problems, especially if you consume them when drinking alcohol.⁽⁷⁾ It is important to seek help if you are unable to get through the day without taking barbiturates, as going into withdrawal can be life-threatening.⁽⁸⁾

2. Benzodiazepine

   The abuse of benzodiazepine is actually more common than you would think. Benzodiazepines replaced barbiturates as being a safer form of sedative medications, but the abuse of benzodiazepines is also quite common. If you do not seek help for treating this addiction, these medications can adversely affect your career, your physical and emotional health, and your relationships. Some of the familiar drugs from this class of drugs include Xanax and Valium, which are some of the most commonly prescribed tranquilizer medications in the world. When people who do not have a prescription start taking these drugs due to their sedating effects, it doesn’t take long to turn into an addiction.^{(9, 10)}

   Benzodiazepine might be prescribed for the following medical conditions:

   • Insomnia
   • Anxiety
   • Seizure control
   • Muscle relaxation
   • Alcohol withdrawal
   • Or administered before an anesthetic, for example, before a surgery.

   Benzodiazepines affect the central nervous system, thus relaxing muscles and producing sedation. It also helps reduce anxiety levels. While there are over 2000 different benzodiazepines, only 15 of these are presently approved by the US Food and Drug Administration for usage. These include:

   • Short-acting benzodiazepine: Xanax (alprazolam), Ativan (lorazepam)
   • Ultra-short acting benzodiazepine: Halcion (triazolam), Versed (midazolam)
   • Long-acting benzodiazepine: Klonopin (clonazepam), Valium, (diazepam), Librium (chlordiazepoxide)

   The abuse of benzodiazepines is typically related to the toxic these drugs produce and to their easy availability. They are either abused chronically or intentionally/accidentally taken in overdose. Serious illness or death is usually rare from benzodiazepine abuse by itself, though if they are taken with alcohol or mixed with other medications, it can lead to severe effects and even be life-threatening. The combination of benzodiazepine with alcohol can often be lethal.^{(11, 12)}

3. Dextromethorphan present in Cold and Cough Medicines

   Cough syrups that contain a suppressant known as dextromethorphan can cause substance abuse. Dextromethorphan is a common ingredient present in many OTC cough and cold medicines. Also known as just DXM, this ingredient can be found in syrups, capsules, throat lozenges, and even pills. However, many people are able to extract the DXM from cough syrup and transform it into a capsule or powder of pure DXM.^{(13, 14)}

   When people consume too much of DXM, they may experience ‘out-of-body experiences and hallucinations. Dextromethorphan also causes brain functions to be dulled down, especially the areas of the brain that control heart function and breathing. Taking too much of dextromethorphan can cause sensations and experiences that are similar to the ones caused by drugs like PCP and ketamine. These effects tend to last for as long as six hours.^{(15, 16, 17)}

   DXM can also cause users to experience trouble controlling their body parts, cause blurred vision, dizziness, impaired judgment, and slurred speech. Some of the other short-term effects of dextromethorphan include:

   • Excessive sweating
   • Paranoia
   • Conclusion
   • Nausea and vomiting – it has been observed that ingesting large quantities of cough syrup almost always causes a person to vomit.
   • Stomach pain
   • Restlessness
   • Irregular heartbeat
   • High blood pressure
   • Dry, itchy skin
   • Facial redness

   Though people are likely to assume that dextromethorphan is a safe medicine since it is easily available over the counter and without any prescription, but large quantities of the medicine can lead to many dangerous side effects as well, including seizures, loss of consciousness, brain damage, and even death.

   Another dangerous side effect of DXM abuse is hyperthermia, which refers to an extremely high fever. This is especially a problem in places with a hot climate or when after having DXM, the users physically strain themselves. High body temperatures can easily cause coma or brain damage.

   It is possible to overdose on DXM, mainly if you are abusing the drug in pure powder form. A person who overdoses may experience seizures, brain damage, and it may even be fatal. People who abuse cold and cough medicines to get high do not realize that they are not just taking high doses of the drug DXM but of many other drugs. Combing DXM with other alcohol or other drugs significantly increases the likelihood of death or life-threatening conditions.

   A safe dosage of products containing DXM is just between 15 to 30 milligrams in 24 hours. It takes more than ten times this amount to get you high, and in that also, there are several stages of intoxication with DXM, depending on how much you take. The effects can last for half an hour to over six hours after consuming the drug.

   Taking high doses of acetaminophen (pain killer), pseudoephedrine (a common decongestant), alcohol, and antihistamines (remedies for allergic reactions) along with DXM can lead to many other serious health problems, including:

   • Liver damage
   • Heart problems
   • High blood pressure
   • Problems with the central nervous system

   It is estimated that one out of every ten teenagers abuse DXM.^{(18, 19)}

4. Oxycodone

   Pain relievers are one of the most abused medications in the world. A common opioid painkiller that is often abused is oxycodone, which is present in medicines like OxyContin, Percocet, OxyIR, Oxyfast, Roxicodone, and Percodan. Oxycodone is a drug very similar to morphine, and it is found alongside non-narcotic analgesics in many prescription drugs. For example, the drug OxyContin contains around 10 to 80 milligrams of oxycodone in a timed-release capsule that provides up to 12 hours of relief from pain. What separates these drugs from other pain relievers or analgesics is the long-acting formula that provides round-the-clock relief from pain to patients.⁽²⁰⁾

   People who abuse oxycodone tend to crush the tablet to snort it or dissolve it in water to inject it, which dramatically increases the risk of an overdose. Crushing or diluting the drug destroys the time-release mechanism of oxycodone, allowing the user to feel the complete and full effects of the drug at that time itself. Many users have compared the high of oxycodone to that of heroin. Street names of oxycodone include OC, oxy cotton, Kicker, Hillbilly Heroin, and just oxy, and percs for Percodan and Percocet.⁽²¹⁾

   Here are some of the symptoms of oxycodone abuse:

   • Excessive sweating
   • Constipation
   • Itching
   • Loss of appetite
   • Weight loss
   • Nausea and vomiting
   • Dry mouth
   • Abnormal dreams and thoughts
   • Headache
   • Fatigue
   • Anxiety
   • Confusion
   • Depression
   • Agitation
   • Insomnia
   • Depersonalization
   • Drowsiness
   • Slowed down breathing
   • Hallucinations

   Oxycodone triggers a rush of dopamine (the feel good hormone in the body) in the brain, which causes the person to experience a euphoric high. While most people use oxycodone for managing pain after an injury, illness, or surgery, many of them find that even after the pain has been relieved, they continue to crave the euphoric effects of the drug. So when their prescription expires, they may tell their doctor that they are still in pain and require oxycodone to deal with this pain. This is usually one of the first signs that you are becoming dependent on oxycodone.

   Oxycodone is not only addictive but also dangerous as it can make you feel like you can tolerate more and more of the drug, but in reality, it will precipitate respiratory failure, especially if you combine it with other drugs like benzodiazepines or alcohol.

   According to the US Drug Enforcement Administration (DEA), oxycodone abuse has been going on for over 30 years, and since 1996, there has been a dramatic escalation in this abuse.⁽²²⁾

5. Hydrocodone Drugs like Vicodin, Lortab, Lorcet

   These are prescription drugs that contain the opioid hydrocodone as well as acetaminophen. Opioids are known to cause constipation and drowsiness. High doses of these drugs can lead to dangerous breathing problems and can even be fatal.⁽²³⁾

   Hydrocodone is typically prescribed for the treatment of moderate to severe pain, and unlike codeine and morphine, hydrocodone is a semi-synthetic opioid. Doctors usually prescribe these medicines for the treatment of short-term pain. However, opioids are addictive in nature, and the regular use of these drugs can be habit-forming. And once the body becomes addicted to hydrocodone, you will experience withdrawal symptoms as soon as you try to quit taking them.

   While hydrocodone drugs are usually taken orally, those who abuse the drug often crush the pill to snort the powder or dilute the pill in water to inject it. The biggest sign of addiction to hydrocodone is when you are unable to stop or control the use of the drug despite wanting to do so.

There are many other medications that can be abused, including codeine; morphine; sleep medicines like Ambien, Sonata, Lunesta; amphetamines like Adderall, Mydasis; methylphenidate found in ADHD (attention deficit hyperactivity disorder), drugs like Daytrana, Metadate, Concerta, Ritalin; pseudoephedrine found in OTC cold medicines; and many others. It is, therefore, very necessary to be vigilant if you are yourself on some medication or if you happen to find a random pill in your child’s pockets or around the house.

If you are worried that you or a loved one is abusing prescription or OTC drugs, the best thing to do is to have a direct conversation with them or admit to yourself that you have a problem. Always explain the risks of medicines to your children and keep them out of reach of younger kids. Always get rid of the medication you don’t need any more and keep track of the ones you are using. There are many organizations that offer help to de-addict from drugs, and your doctor can help you find the best resource for de-addiction.

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