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Misuse and Abuse of Over the Counter Drugs
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Presented by:
A
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Connie Barker, RPh
S
James Byrne, JD, CASAC
Cindy Joslin, RN
Consumer Misperceptions and
Misuse of OTC Pain Relievers
American Academy of Family Physicians
 Misuse
of OTC pain relievers can lead
to medical problems, such as
gastrointestinal bleeding, ulcers,
kidney and liver damage.
Consumer Misperceptions and
Misuse of OTC Pain Relievers
Factors that may be contributing
misuse:
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Limited understanding of the ingredients
A belief that more is better
Unrealistic expectations about the normal range
and duration of symptoms
Ability of any medicine to fully relieve symptoms
A perception among the public that OTC
medicines are not “real” medicine.
Pseudoephedrine
Pseudoephedrine is a decongestant that shrinks blood
vessels in the nasal passages which is available in a wide
range of OTC products.
Do not use if have taken an MAOI in the last 14 days;
serious side effects can occur.
 Should avoid using if you smoke or are on any stimulant
medications, may increase risk of unpleasant side
effects.
 May interact with various medications including those
being given for HTN, heart disease, diabetes or thyroid
disorders.
 Death may occur with misuse!!!!

Pseudoephedrine
Common side effects :
Mild loss of appetite
 Warmth, tingling or redness under skin
 Skin rash or itching
 Feeling excited or restless, insomnia
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Pseudoephedrine
Serious side effects :
Fast, pounding, or uneven heartbeat
Decreased or difficult urination
Severe dizziness, anxiety, restlessness,
nervousness or trouble concentrating
 Increased blood pressure or chest pain
 Severe headache, blurred vision, unusual
weakness ,numbness, or seizure.
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Seek emergency medical attention !
Phenylephrine
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Phenylephrine is a decongestant that shrinks
blood vessels in the nasal passages which is
available in a wide range of OTC products.
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Do not use if have if have taken MAOI in past 14 days;
could cause serious life-threatening side effects if taken
before MAO inhibitor has cleared the body.
May interact with various medications including those
being given for the following conditions:
heart disease, HTN, glaucoma, migraines, enlarged
prostate, bipolar or any other mental illness, as well
as those given to treat circulatory, kidney or thyroid
disorders.

Phenylephrine

Should avoid taking if you are smoking or are
taking any stimulant medications to prevent
increased risk of side effects.
Common side effects:
Headache, dizziness
 Nervousness or feeling restless
 Upset stomach
 Difficulty sleeping
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Phenylephrine
Serious side effects, death may occur
from misuse :
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Extreme nervousness or restlessness
Severe dizziness, tremors or shaking
Unusual thoughts or behaviors
Hallucinations and/or insomnia
Fast, pounding or uneven heartbeat
Fainting, numbness and tingling
Decreased or lack of urination
Acetaminophen
Pain reliever/ fever reducer commonly found in a large
assortment of OTC products to treat a vast number of
symptoms.
MDD – 4 Grams/day. Higher doses can result in serious harm
especially combined with regular consumption of alcohol.
Side effects are rare when taken as directed. Serious side effects or
signs of possible overdose include:
Signs of an allergic reaction including: redness, rash/hives, swelling in the
mouth or throat and/or difficulty breathing
 Low fever with nausea, stomach pain and loss of appetite.
 Dark urine , clay-colored stools
 Jaundice ( yellowing of the skin or eyes)
**The intensity of these symptoms generally depend on the degree of
consumption and time frame for misuse, severe cases may result in
Acute Liver Failure.
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Acetaminophen Overdose
*Most common cause of Acute Liver Failure
in the Unites States
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More than 56,000 ER visits/year related to
Acetaminophen O.D. - most of which is accidental.
Cases of Acetaminophen related Acute Liver Failure on
the rise, ~500 deaths / year and growing.
Unintentional overdosing usually only recognized after
serious symptoms have developed - often as the result
of irreversible liver damage developed over time.
N-acetylcysteine administered within 12h of an acute
overdose can prevent liver injury in most cases.
Delay in administration of this therapy is associated with
greater morbidity and mortality.
Acetaminophen / Acute Liver
Failure
Three Clinical Stages :( phases )
First phase – initial 12 to 24h after ingestion >
patient has nausea and vomiting.
 Second phase - 24 to 48 h “ inactive or latent”
phase > patient feels fine.
 Third phase – 48 to 72h after ingestion>
elevated LFT’s begin to appear indicating degree
of liver injury/outcome.
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NSAIDS AND ASA
Nonsteroidal Anti-Inflammatory
Drugs
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Long term use may increase risks of heart attack, stroke,
renal failure and gastrointestinal bleeding.
Should not use if sensitive to Aspirin and/or have
reactive airway disease.
May cause drowsiness especially if taken with alcohol.
May interact with many medications which may cause
serious side effects.
Should avoid if on steroidal medications due to the
increased risk of GI bleeding.
Nonsteroidal Anti-Inflammatory
Drugs
Common side effects :
GI distress ( mild heartburn, diarrhea,
bloating, gas, constipation)
 Dizziness, headache, nervousness
 Rash or itching
 Blurred vision
 Tinnitus ( ringing in the ears)
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Nonsteroidal Anti-Inflammatory
Drugs
Serious side effects may include:
Severe allergic reaction, bleeding, chest
pain and difficulty breathing
 Abdominal pain, gastrointestinal bleeding,
decreased urination, renal necrosis and
hepatitis.
 Severe headache, confusion, depression,
impaired hearing, vision or speech, stroke
or seizure.
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www.drugs.com
Aspirin
Early symptoms of overuse :
Gastrointestinal distress, bruising, tinnitus and hearing
impairment.
Signs of Aspirin Poisoning include:
Rapid breathing, vomiting, bleeding, double vision,
extreme drowsiness, confusion, coma and eventually
death.
* Aspirin has been linked to Reye’s Syndrome,
a rare but serious condition that can affect children,
usually under the age of 18, who are recovering from
a viral infection.
Diphenhydramine
Diphenhydramine
Antihistamine used to safely treat various
symptoms of allergies and the common cold
when used as directed. Also used to suppress
coughs, treat motion sickness and to induce
sleep.
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Common side effects include: Sleepiness, fatigue,
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Symptoms of serious side effects or overdose
include: Extreme sleepiness and confusion, weakness,
dizziness, headache, dry mouth, ringing in the ears,
difficulty urinating, constipation, and enlarged prostate.
blurred vision, dilated pupils, shaking, flushing, fever,
hallucinations, insomnia and possibly seizures.
Transcultural beliefs
Healthcare systems in countries of origin may
influence individual beliefs re: responsibility for
health care.
 In many countries pharmacists may be
consulted before physicians re: medications
 In cultures where people are accustomed to
easily buying a wide variety of medications it is
common practice to share them with family and
friends.
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Transcultural beliefs
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Of the developed nations, only the U.S. and
South Africa do not have free access to health care.
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Many OTC medications abroad are now being sold in
blister packs only to discourage misuse.
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U.S. encourages self-reliance with ample supply of OTC’s
and numerous media advertisements for self medication.
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The U.S. is more restrictive than many countries re:
warning labels and use of OTC medications.
People use potentially addicting prescription or OTC medications in the following
manners:
For legitimate, prescribed medical treatment; for example,
methamphetamines for narcolepsy and opiates for severe trauma.
As an additional drug to use when the DOC is unavailable on the
streets.
As a booster for a more intense high.
As an alternative addictive drug when their DOC has been eliminated
from use by drug testing.
As an alternative addictive drug prescribed by physicians; for example,
amphetamines in diet clinics. These prescriptions may be issued either
naively by the physician or for profit.[9,10]
Data from the Drug Abuse Warning Network demonstrate the
following about people who abuse prescription or OTC medications:
They tend to be white.
They tend to be younger (when stimulants are
the DOC).
They tend to use opiates.
They tend to be women; women tend to use
tranquilizers and sedatives.
They tend to mix their medications with alcohol.
They tend to use prescription and OTC
medications in conjunction with alcohol as a
vehicle for suicide.
Nearly one in five teens (19 percent or 4.5
million) report abusing prescription
medications to get high; and one in 10 (10
percent or 2.4 million) report abusing
cough medicine to get high.
More than half of teens (55 percent or 13
million) don’t agree strongly that using cough
medicines to get high is risky.
A Short List of OTC Medicines with DXM
Alka-seltzer Plus Cold & Cough Medicine
Contac
Coricidin HBP Cough and Cold
Dayquil LiquiCaps
Delsym
Dimetapp DM
Drixoral
Pertussin
Robitussin
Sudafed
Triaminic
Tylenol Cold
Vicks 44 Cough Relief
Vicks Nyquil LiquiCaps
Street Names for DXM:
Candy
C-C-C
Dex
DM
Drex
Red Devils
Robo
Rojo
Skittles
Tussin
Velvet
Vitamin D.
Street Names for DXM
Abuse:
Dexing
Robotripping
Robodosing
PLATEAU 1
DIZZINESS, NAUSEA, VOMITING, DIARRHEA,
LOSS OF COORDINATIONS, SWEATING, COLD
FLASHES BLURRED VISION AND DILATED
PUPILS, SLURRED SPEECH, HEACACHES
SKIN SENSITIVITY, REDNESS IN THE FACE,
DRY SKIN AND MOUTH, TREMORS AND
INVOLNTARY TWITCHING, LOSS OF
CONSCIOUSNESS
NUMBNESS OF FINGERS AND TOES,
ABDOMINAL PAIN, IRREGULAR HEARTBEAT,
ACHES, SEIZURES, PANIC ATTACKS,
PSYCHOSIS
Figure 2. Percentages of Use of Specific Over-the-Counter (OTC)
Cough or Cold Medications in the Past Year among Past Year OTC
Cough and Cold Medication Misusers Aged 12 to 25: 2006**
NYQUIL
ROBITUSSIN
CORICIDIN
Photo credit: Jacob Wackerhousen
SLEEP AIDS
LAXATIVES/DIURETICS
DIET PILLS
CAFFEINE
MOTION SICKNESS
Dimenhydrinate
 meclizine
 cyclizine
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PAIN RELIEVERS
HERBALS
ALOE VERA
DANDELION
Physicians need to watch for prescription and OTC
medication abuse. Treatment strategies include (1)
inquiring about prescription, OTC, and herbal drug use at
the initial examination (even though many individuals are
drug-abuse savvy, some are naïve and do not realize that
OTC medications can be problematic); (2) inquiring about
drug use during office visits; (3) providing disposal
containers that patients can use to dispose of their
unused or unneeded prescription or OTC medications; (4)
treating pain aggressively and appropriately; (5)
practicing careful record keeping of prescription refills
and controls over prescription blanks; (6) referring
patients who are addicted to medications to 12-step
programs such as Alcoholic Anonymous, Narcotics
Anonymous, and Pills Anonymous; and (7) considering
detoxification
The DASIS Report: Prescription and Over-theCounter Drug Abuse Admissions
In 1999, 87 percent of substance abuse treatment admissions
for prescription and over-the-counter (OTC) drug abuse were
among Whites.
Substance abuse treatment admissions for abuse of
tranquilizers and sedatives were more likely to be female.
Admissions for abuse of prescription stimulants and OTC drugs
were more likely to be male.
http://www.oas.samhsa.gov/2k2/OTCtx/OTCtx.cfm
From 1999 to 2004, there was a seven-fold increase in cases
related to the abuse of DXM reported to poison control centers
nationwide. Most of these cases were among 15- and 16-yearolds. (Bryner, 2006)
http://www.mediacampaign.org/newsroom/press08/rx_rpt_2008.pdf
Siberian Amanita Muscara Powder. Botanic
Specimen. For educational and research
purposes only….
But it must be understood that within this mushroom is heaven
and hell. While with one experiment you can find bliss, within
the next you may find terror….
http://www.everyonedoesit.co.uk/onli
ne_headshop/Siberian_Amanita_Mu
scara_Powder.cfm?iProductID=229
8&iProductCategoryID=553
Stages of Addiction
1. Use - The ingestion of alcohol or other drugs without the
experience of any negative consequences.
2. Misuse - When a person experiences negative consequence
from the use of alcohol or other drugs it is clearly misuse. A large
percentage of the population misuses drugs or alcohol at some
point in their life.
3. Abuse - Continued use of alcohol or other drugs in spite of
negative consequences.
4. Dependency/Addiction - The compulsive use of alcohol or
other drugs regardless of adverse or negative consequences.
http://www.solutions4recovery.com/addiction_stages.htm
RESOURCES
www.nclnet.org/takewithcare/media/misperceptions.htm
www.medicinenet.com
www.webmd.com
www.drugs.com
www.Reutershealth.com
www.mayoclinic.com
www.oas.samhsa.gov/2k2/OTCtx/OTCtx.cfm
www.erowid.org
www.samhsa.com
www.medscape.com
www.drugfree.org
www.solutions4recovery.com/addiction
Purnell & Paulanka, eds. Transcultural Healthcare 3rd Edition, 2008