Over-the-Counter Drugs - Usage Trends

Usage Trends

Typically, over-the-counter drug use is not tracked in surveys of illicit drug abuse because these medicines are not considered illegal. But the Partnership for a Drug-Free America (PDFA) began including questions on OTC drug abuse in its 2003-2004 survey. Results of the 2004 Partnership Attitude Tracking Study (PATS) were released on April 21, 2005. According to the study's authors, "an alarming number of teenagers are abusing a variety of … over-the-counter (OTC) medications to get high." Results indicate that about 9 percent of teens, or around 2.2 million young people, had experimented with cough syrup and other over-the-counter products purely for their intoxicating effects. PATS researchers see this as a sign that "OTC medicine abuse has penetrated teen culture."

The Growing Problem of Dextromethorphan Abuse

The trend in experimental OTC drug use is riskier than it may sound. A twenty-year-old Texas man was found guilty of "intoxication manslaughter" after deliberately misusing an OTC drug. (Man-slaughter refers to the unintentional killing of a human being.) The man testified in court that he had taken thirty Coricidin tablets in order to hallucinateVisions or other perceptions of things that are not really present.. While driving under the influence of the Coricidin, he struck and killed another driver. Beth Wilson reported in the Amarillo Globe-News that the driver was sentenced to seven years in prison and received a $7, 000 fine.

Coricidin contains dextromethorphan, a common but potentially dangerous ingredient in multi-symptom cough, cold, and flu remedies. (An entry on dextromethorphan is included in this encyclopedia.) According to the 2004 "Pulse Check" report released by the Office of National Drug Control Policy (ONDCP), Coricidin HBP Cough & Cold is the "particular brand [that] contains the highest concentration of dextromethorphan, making it the most popular among users." Cough and cold tablets like Coricidin contain 30 milligrams of dextromethorphan hydrobromide and 4 milligrams of chlorpheniramine maleate.

Abuse of products containing these substances is especially high in the southern and western parts of the United States. "Pulse Check" researchers noted that "in Tampa/St. Petersburg, [Florida], incidents are reported of adolescents taking 20 to 43 tablets at a time, sometimes in combination with another over-the-counter medication, dimenhydrinate (Dramamine)." In addition, according to the

Many over-the-counter cough medicines contain dextromethorphan. Doctors recommend using measuring cups so that the proper dosage is taken. Photograph by Leitha Etheridge-Sims.
Many over-the-counter cough medicines contain dextromethorphan. Doctors recommend using measuring cups so that the proper dosage is taken. Photograph by Leitha Etheridge-Sims.

report, dextromethorphan-related "overdoses and thefts from groceries and pharmacies" were on the rise. By 2005, some pharmacies in Florida, Colorado, and Oregon had placed these products "behind the counter" and were limiting sales to one box per customer.

Dextromethorphan has generated considerable attention for its mind-altering effects. But the other active ingredient in Coricidin—chlorpheniramine maleate—has also been shown to impair judgment in users. The case of a mysterious plane crash in Florida in late 2003 was eventually linked to chlorpheniramine. After a lengthy investigation, it was determined that the engines and propellers of the twin Cessna 441 were in working order at the time of the crash. According to the National Transportation Safety Board (NTSB), the pilot had a high level of chlorpheniramine in his system at the time of the crash. According to the NTSB crash report: "Post accident toxicology testing of the pilot's blood revealed chlorpheniramine, an over-the-counter sedating antihistamine, at more than ten times higher than the level expected with a typical maximum over-the-counter dose."

The Pseudoephedrine/Methamphetamine Connection

Methamphetamine, one of the most dangerous illicit drugs of the early twenty-first century, is brewed from the active ingredient in some

OTC Abuse and the Elderly

OTC drug abuse is not just a teenage problem. It also affects adults, including the elderly. In general, many people overuse or misuse OTC drugs because they believe that they are safe to use. Some people think that OTC drugs are milder than prescription drugs, but fail to remember that some of those same OTC medications were once available by prescription only.

Drug abuse, or misuse, by the elderly occurs for a variety of reasons. As people age, they may require daily use of one or more prescription medications to treat a variety of ailments. According to Maura Conry in Geriatric Times in 2000, the elderly "use 30% of the prescriptions written and 40% of OTC drugs sold in the United States." Thus, seniors may be taking several prescriptions and OTC drugs that counteract with one another and not realize it.

"Since metabolism rates slow down considerably as we age, many prescription and OTC medications stay in the body longer and increase the likelihood of harmful drug interactions," note the authors of "Chemical Dependency and the Elderly." Such problems cause more than 100, 000 deaths each year. "Patients have arrived at emergency rooms and hospitals after taking 15 or more drugs and OTC remedies," noted Conry. Emergency staff are hard-pressed to determine the cause of the problem when so many drugs are involved.

Many seniors may not realize that combining certain medications causes serious side effects, and they may be accidentally combining drugs with the same active ingredient. Some seniors have multiple doctors, such as a primary care physician and a cardiologist. On occasion, patients forget to tell each doctor what prescriptions they are already taking or what OTC drugs they use. Plus, many get their drugs from multiple sources: samples from the doctor's office, OTC drugs from the grocery store, and prescriptions from the local drugstore or by mail order. In such cases, no one source is checking whether the amount and type of drugs being used on a daily basis are safe.

The article "Abuse and Misuse of Medications in the Elderly" and other medical sources point out various problems that seniors face when using drugs. These problems include: 1) being unable to read the label; 2) being unable to hear the doctor or pharmacist's instructions; 3) being unable to understand the warnings on the label and how they apply to him or her; 4) being forgetful and taking too many or not enough doses at prescribed times; 5) taking more drugs than prescribed when chronic pain or conditions don't respond to the usual dosage; and 6) becoming confused about when to take the medicine and how much to take.

over-the-counter cold products. (An entry on methamphetamine is available in this encyclopedia.) Amateur drug makers in home laboratories produce the drug by cooking ephedrinePronounced ih-FEH-drinn; a chemical substance that eases breathing problems. or pseudoephedrinePronounced SUE-doh-ih-FEH-drinn; a chemical similar to ephedrine that is used to relieve nasal congestion. and mixing it with other easy-to-obtain chemicals. The FDA banned ephedrine-containing pills and powders in 2004, but as of mid-2005, illicit supplies were still available through the Internet. Pseudoephedrine remains a key ingredient in legal OTC cold medicines.

Some cold relief products containing pseudoephedrine are used in the illegal production of methamphetamine, a dangerous drug. Some pharmacies have taken steps to monitor closely the sales of such products, placing these over-the-counter medicat
Some cold relief products containing pseudoephedrine are used in the illegal production of methamphetamine, a dangerous drug. Some pharmacies have taken steps to monitor closely the sales of such products, placing these over-the-counter medications behind the counter. AP/Wide World Photos.

In 2004 and 2005, lawmakers throughout the United States began efforts to restrict access to pseudoephedrine-containing OTC medicines. Several states, including Michigan, Oklahoma, and Oregon, passed laws that made it harder to purchase products like Sudafed (which contains pseudoephedrine hydrochloride). The restrictions include: 1) placing the product "behind the counter" in the pharmacy area of drugstores, where a careful count of the stock can be maintained; 2) requiring photo identification to prove the buyer is at least eighteen; 3) requiring buyers to sign a logbook at the time of purchase; and 4) limiting the number of pills that can be sold per transaction. In August of 2005, Oregon became the first state to pass legislation making pseudoephedrine a prescription-only drug. Oregon lawmakers hope that the new law, scheduled to take effect in mid-2006, will reduce the number of illegal meth labs operating in the state.