The term “drug addiction” is often linked to substances like heroin, methamphetamine, or cocaine. Many people envision drug addicts as destitute individuals with gaunt features and unkempt appearances. However, this stereotype doesn’t accurately represent the majority of drug addicts. According to the National Institute on Drug Abuse (NIDA), over-the-counter (OTC) drugs and prescription medications are actually the most frequently abused substances in the U.S., following alcohol and marijuana.
These drugs are more commonly abused due to their accessibility, and many users may not recognize their addictive potential. This is understandable since pharmacists and doctors are typically trusted sources for obtaining medication to treat illnesses or diseases. Despite appearing safe, any drug can be harmful if misused, and many commonly prescribed pain medications have the potential to be addictive. It’s crucial for consumers to be aware of the significant health risks associated with commonly used OTC and prescription drugs.
The Most Frequently Abused Over-the-Counter (OTC) Drugs
A pharmacist reaching for medication on the shelf
Since these medications are available without a prescription, they are more easily obtained and prone to misuse. OTC drugs are used to treat various ailments and symptoms, including cough, cold, constipation, pain, and more. The risk with these medications lies in their ingredients, which can be abused when taken in higher doses. The most commonly misused OTC drugs include:
Dextromethorphan (DXM)
DXM is a cough suppressant commonly found in various cold medications. It is most frequently abused through extra-strength cough syrups, tablets, and capsules. Misuse of DXM typically involves consuming more than the recommended dosage or mixing it with soda for flavor, a practice often referred to as “skittling” or “robotripping.” DXM may also be combined with other substances, such as marijuana or alcohol.
A 2008 study revealed that DXM was present in nearly half of all OTC medications in the U.S., making it an easily accessible and legal option for misuse. Well-known brands like Nyquil, Robitussin, and Theraflu are common sources of DXM abuse. Although DXM is classified as a synthetic opiate, it does not interact with opioid receptors but can still result in a false positive on opioid urine tests. When consumed in large quantities, DXM produces euphoric, hallucinogenic, and sedative effects.
The effects of DXM on the body are somewhat similar to those of alcohol and marijuana. At high doses, the drug can induce significant hallucinogenic experiences, including physical distortion, paranoia, and anxiety. Continued misuse to achieve a high can lead to addiction and severe health consequences. Long-term use can cause extensive damage to the stomach and liver. In extreme cases, an overdose of DXM can result in respiratory failure, severe mental effects, and nervous system damage. Common DXM-containing medications include:
Loperamide
Loperamide, an anti-diarrheal medication available in pill or liquid form, can produce effects similar to mild opioid highs. Often referred to as the “poor man’s methadone” due to its affordability and easy accessibility, loperamide is a synthetic opiate that, like DXM, does not bind to the brain’s opioid receptors. However, when consumed in extremely high doses, it can mimic the effects of other opioids.
The generic version of loperamide, commonly known as Imodium, is widely available in U.S. drug stores. Some individuals purchase large quantities of this drug from multiple stores to achieve a high or to alleviate symptoms of opioid withdrawal. Due to the increasing abuse of loperamide, the FDA implemented packaging restrictions to warn consumers about its potential addictive side effects and to limit the number of tablets per package.
When taken in high doses, loperamide can induce euphoric effects similar to those of opioids. However, misuse of this OTC drug can lead to severe side effects, including fainting, stomach pain, constipation, irregular heartbeat, and kidney problems. These risks are further exacerbated when loperamide is combined with other medications. Long-term abuse can cause significant damage to the stomach and liver, and in extreme cases, overdose can result in respiratory failure.
Common loperamide-containing medications include:
Antihistamines
Antihistamine abuse is a prevalent yet often overlooked form of OTC drug misuse. These medications are commonly used to treat allergic reactions, aid sleep, and address motion sickness. However, their sedative effects can become addictive for some individuals, particularly those with insomnia or those seeking a dissociative experience. While antihistamines do not cure colds, they block histamines from binding to cells, which reduces sneezing, itching, and mucus production.
Antihistamines also typically contain acetylcholine, which contributes to their sedative effects. When combined with substances like opioids, alcohol, or marijuana, the sedative effects of antihistamines are intensified. Misuse of antihistamines with alcohol can lead to liver damage and severe long-term health issues. Some individuals may become dependent on antihistamines to fall asleep, but long-term use can result in significant withdrawal symptoms and disrupt sleep patterns. Withdrawal from antihistamines can cause symptoms such as chest pain, insomnia, bladder pain, and kidney pain. Common antihistamine-containing medications include:
Caffeine
Caffeine is generally safe in moderate amounts, but overreliance on this stimulant can quickly lead to dependency. Excessive caffeine intake can cause high blood pressure, sweating, anxiety, and even convulsions. While coffee is usually consumed safely, some individuals turn to caffeine pills and highly concentrated energy drinks for a more intense caffeine fix. These products are particularly marketed toward teenagers and young adults to help them cope with the pressures of academia and the professional world.
Energy drinks like Monster, Red Bull, and Rockstar cater to the high demand for concentrated, sugary doses of caffeine. Although these beverages are relatively harmless in moderation, combining them with other substances or consuming them excessively can pose significant risks. For instance, a single can of Red Bull contains nearly 50 grams of sugar, over 100 mg of caffeine, and additional stimulants such as taurine, guarana, and ginseng. It is recommended that adults limit their caffeine intake to no more than 300–400 mg per day to avoid adverse health effects.
Caffeine pills are another risky method of consumption, with the potential for overdose if not used cautiously. A commonly used caffeine pill, NoDoz, is popular among truck drivers for long hauls, but it is also taken by individuals to meet work and academic demands. Like energy drinks, caffeine pills can provide a boost but can lead to negative side effects such as elevated heart rate, anxiety, and sweating if more than the recommended dose is consumed.
Diet Pills (Ephedra)
Diet pills, which include both prescription and over-the-counter supplements, are designed to assist users in managing their weight. Many of these pills function similarly to stimulants, affecting the body’s natural weight processing and suppressing appetite. Some diet pills are even classified under the Controlled Substances Act. Notable examples include Benzphetamine, Diethylpropion, and Mazindol.
Due to their stimulant-like properties, diet pills share similarities with amphetamines in terms of potential for abuse and withdrawal symptoms. Like amphetamines, these pills can enhance performance, boost energy, and induce feelings of euphoria. As legal stimulants, they have a higher risk of abuse compared to prescription medications. Dependency on diet pills is not uncommon, particularly among individuals with eating disorders or other underlying mental health conditions. Some of the most frequently abused diet pills include:
The Most Commonly Abused Prescription Drugs
Prescription drug abuse is a significant issue in the United States. According to the latest survey on substance use by SAMHSA, there are currently 3.3 million individuals aged 12 and older misusing prescription pain relievers. Among these users, 60% cited pain relief as their primary reason for misuse, and over half reported obtaining their most recently misused pain relievers from a relative or friend. Addressing this issue is challenging because many people genuinely need pain management for serious injuries or chronic conditions. Other frequently abused prescription drugs include central nervous system (CNS) depressants, such as benzodiazepines, and stimulants, such as methylphenidate and amphetamine.
Opioids
Opioids are frequently abused due to the euphoric effects they produce. Commonly misused prescription opioids include Oxycodone (OxyContin), Codeine, Fentanyl, and Meperidine (Demerol). These synthetic opioids are used to manage chronic or acute pain, as well as to numb and assist in cold treatments. Although these drugs are considered safer than heroin, they interact with the brain’s opioid receptors in a similar way. Opioid addiction can lead to severe withdrawal symptoms, including intense cravings, runny nose, insomnia, and chills.
Benzodiazepines
Benzodiazepines, or “benzos,” belong to the sedative drug category and are classified as Schedule II-IV drugs by the DEA. These medications offer calming and sedative effects similar to opioids but pose a lower risk of overdose when used alone. However, when combined with opioids, they significantly increase the risk of fatal outcomes. Unlike opioids, which target opioid receptors, benzodiazepines act on GABA receptor molecules, which are involved in cognitive processes rather than vital functions. As a result, the primary risks associated with benzos include mental drowsiness, amnesia, and impairments in learning and motor control, rather than respiratory depression.
Benzodiazepines induce feelings of calmness and relaxation. At higher doses, they can cause vertigo, drowsiness, and muscle incoordination. The effects of benzos can last from a few hours to over a day, depending on the dose and individual tolerance. While these drugs are prescribed to alleviate anxiety, nervousness, restlessness, and insomnia, improper use can exacerbate these symptoms. Common benzodiazepines include Xanax (Alprazolam), Klonopin (Clonazepam), Rohypnol (Flunitrazepam), Valium (Diazepam), Librium (Chlordiazepoxide), Ativan (Lorazepam), Dalmane, and Serax.
Stimulants
Stimulant drugs serve both medical and recreational purposes. Medically, they are prescribed to treat ADHD and are designed to enhance alertness, and attention, and increase blood pressure, heart rate, and breathing. Recreationally, stimulants are used to achieve heightened alertness, energy, and a pleasurable sense of well-being. When injected or smoked, stimulants can induce intense euphoria. Common forms of stimulants include amphetamines (such as Adderall and Dexedrine), methylphenidate (like Ritalin), cocaine, methamphetamines, and pseudoephedrine.
In Conclusion
Drug and alcohol addictions are among the most damaging issues affecting individuals and communities today. The journey to recovery for ourselves, our families, and our communities begins with acknowledging the dangers of these substances. At Sunrise Recovery, we are committed to providing a supportive network and resources to help you overcome addiction. Visit our website to learn more about our drug and alcohol rehabilitation centers.
