Common Causes of Over the Counter Drug Abuse

Understanding Over-the-Counter Drug Abuse

The abuse of over-the-counter (OTC) medicines is a growing concern, particularly in light of the COVID-19 pandemic. These drugs, which are readily available without a prescription, can offer relief for a variety of symptoms. However, their misuse can lead to serious health risks.

Impact of Over-the-Counter Medicines

Over-the-counter medicines play a crucial role in healthcare due to their accessibility and broad range of uses. They can alleviate symptoms of common ailments such as coughs, colds, headaches, and allergies. However, the COVID-19 pandemic has led to a sharp increase in OTC medicine consumption. Many individuals have turned to these drugs to manage symptoms like fever, fatigue, nasal congestion, and cough, with self-medication prevalence ranging between 33.9% and 51.3% [1]. This surge in use underscores the importance of understanding the potential for misuse and abuse of these readily available medicines.

Misconceptions and Risks

A common misconception about over-the-counter medicines is that they are safe for unlimited use. This belief can lead to overuse or misuse, particularly during periods of increased stress or anxiety. The COVID-19 pandemic, for instance, has brought about fear of infection, isolation, loneliness, and financial worries, leading to a 25% increase in global prevalence of mental health problems such as depression, anxiety, and stress. These issues are often associated with drug abuse, including OTC medicine abuse.

OTC drug abuse can lead to serious health risks, such as physical dependency and harmful side effects. In some cases, it can even be fatal. Furthermore, because OTC drugs are legal and easily accessible, they can be especially tempting for young people, who may view them as a "safe" way to get high. This misconception only exacerbates the issue, highlighting the need for comprehensive education about the safe use of OTC medicines and the potential dangers of misuse.

In conclusion, while over-the-counter medicines are an important part of managing minor health issues, their misuse can lead to serious problems. With the added stressors of the COVID-19 pandemic contributing to an increase in OTC drug abuse, it's more important than ever to raise awareness about the potential risks associated with these medicines and promote safe and responsible use.

Factors Contributing to OTC Drug Abuse

Understanding the common causes of over the counter drug abuse is essential for prevention and intervention efforts. Several factors contribute to this issue, including the influence of the COVID-19 pandemic and various psychological and social factors.

Influence of COVID-19 Pandemic

The outbreak of COVID-19 has significantly impacted the use and potential misuse of over-the-counter (OTC) medicines. The pandemic has led to an increase in the utilization of these medicines due to symptoms like cough, fever, fatigue, and headaches, resulting in a sharp rise in OTC medicine consumption [1].

In addition to physical symptoms, the COVID-19 pandemic has also brought a wave of stress, fear of infection, isolation, loneliness, and financial worries for many individuals. These factors have led to a 25% increase in global prevalence of mental health problems such as depression, anxiety, and stress, which are often associated with drug abuse, including OTC medicine abuse.

Conflicting evidence on COVID-19 therapy and management, coupled with increased stress, anxiety, panic, and health insurance loss, have heightened the risk of OTC medicine misuse during the pandemic. Misuse of these medicines can lead to adverse events, mask symptoms of severe health problems, and potentially result in drug-drug interactions.

Psychological and Social Factors

Apart from the influence of the COVID-19 pandemic, other psychological and social factors also contribute to the misuse of OTC medicines. Factors such as poor pharmacovigilance legislation, stress, fear of infection, and financial worries have been cited as contributing to the increased abuse of these medicines even before the pandemic.

Furthermore, the prevalence of self-medication has increased, with individuals using OTC medicines without medical supervision to manage symptoms. During the COVID-19 pandemic, this ranged between 33.9% and 51.3%, indicating a significant portion of the population potentially at risk for OTC drug abuse.

Understanding these factors is crucial to addressing the issue and implementing effective strategies to prevent and treat OTC drug abuse. This includes promoting awareness about the potential risks and consequences, enhancing pharmacovigilance measures, and providing support for individuals struggling with stress and mental health issues.

Commonly Abused OTC Medications

Delving into the common causes of over the counter drug abuse, it's crucial to address two of the most commonly misused over-the-counter (OTC) medicines: Dextromethorphan (DXM) and Loperamide.

Dextromethorphan (DXM) Abuse

Dextromethorphan (DXM) is found in many OTC cold medicines and is often misused in combination with other substances such as alcohol and marijuana. Misuse of DXM products containing acetaminophen can lead to liver damage, a serious physical consequence that emphasizes the risks associated with over-the-counter drug misuse.

Moreover, an overdose on cold medicines containing DXM can lead to life-threatening reactions or even death. The misuse of DXM can slow or stop breathing, resulting in hypoxia, which can have both short- and long-term mental effects, nervous system effects, coma, permanent brain damage, and death.

Furthermore, misuse of DXM can lead to addiction, characterized by continued use despite health problems and failure to meet responsibilities. Withdrawal symptoms from DXM have not been extensively studied, highlighting the need for more research in this area.

Loperamide Misuse

Loperamide, an anti-diarrheal, is another commonly misused over-the-counter medicine. It's available in various forms and is sometimes misused to lessen cravings and withdrawal symptoms, leading to euphoria similar to other opioids.

Misuse of Loperamide can lead to various health issues such as fainting, stomach pain, constipation, eye changes, loss of consciousness, erratic heartbeats, kidney problems, and more. The physical consequences of loperamide misuse can be severe, especially when combined with other interacting medicines.

Similar to DXM, an overdose on medicines containing loperamide can also lead to life-threatening reactions or death. Breathing can slow or stop, causing hypoxia with short- and long-term mental effects, nervous system effects, coma, permanent brain damage, and death [2].

Loperamide misuse can also lead to addiction, with withdrawal symptoms that have not been extensively studied. While there are no medications approved specifically to treat DXM or loperamide addiction, behavioral therapies like cognitive-behavioral therapy and contingency management may be effective in treating addiction to these OTC medicines.

Health Risks of OTC Drug Abuse

Abusing over-the-counter (OTC) medications comes with a myriad of health risks, including physical consequences and the potential for addiction and withdrawal. Understanding these risks is crucial in the prevention and treatment of OTC drug abuse.

Physical Consequences

Misuse of OTC medications can lead to severe physical health issues. For instance, misusing DXM products containing acetaminophen can result in liver damage. Simultaneously, the misuse of Loperamide, an OTC medication commonly used to treat diarrhea, can lead to fainting, stomach pain, constipation, eye changes, loss of consciousness, erratic heartbeats, kidney problems, among other health issues. These effects can be especially severe when combined with other interacting medicines [2].

An overdose of cold medicines containing DXM or loperamide can lead to life-threatening reactions or even death. Similar to other opioids, overdosing on these substances can cause breathing to slow or stop, resulting in hypoxia. This lack of oxygen can lead to short- and long-term mental effects, nervous system effects, coma, permanent brain damage, and death.

Additionally, adolescents' misuse of OTC medications can lead to significant health risks, including psychosis, agitation, tachycardia, seizures, addiction, and dependence. Misuse of OTC medications is associated with an increased likelihood of using other substances such as marijuana, cocaine, prescription drugs, stimulants, sedatives, and alcohol [3].

Addiction and Withdrawal

The misuse of OTC drugs like DXM or loperamide can lead to addiction, characterized by continued use despite health problems and failure to meet responsibilities. Withdrawal symptoms from DXM and loperamide have not been extensively studied but are a significant concern.

While there are no medications approved specifically to treat DXM or loperamide addiction, behavioral therapies like cognitive-behavioral therapy and contingency management may be helpful in treating addiction to these OTC medicines [2].

In conclusion, the common causes of over the counter drug abuse can lead to severe physical consequences and addiction. It's essential to recognize these risks and seek professional help if you or someone you know is struggling with OTC drug abuse.

Prevention and Treatment of OTC Drug Abuse

The misuse of over-the-counter (OTC) drugs is a serious issue that requires effective prevention and treatment strategies. These include developing abuse-deterrent formulations, promoting safer medications, disposing of unused medications properly, and leveraging the role of pharmacists.

Strategies for Prevention

One of the strategies for preventing OTC drug abuse is the development of abuse-deterrent formulations (ADF) for opioid medications. The FDA calls for these formulations to prevent misuse by methods such as snorting or injection. ADF opioids in the market have shown to decrease the illicit value of drugs. This medication regulation has been effective in reducing the prescribing of opioid medications.

Another strategy is the development of safer medications, including non-addicting pain medications, which is a public health priority. Researchers are exploring alternative treatment approaches that target signaling systems in the body, such as the endocannabinoid system, to find new treatments for pain management [4].

Proper disposal of unused or expired medications can also prevent OTC drug abuse. Patients should follow FDA guidelines or visit DEA collection sites for safe disposal. Moreover, patients should inform healthcare professionals about all prescriptions, over-the-counter medicines, and dietary supplements they are taking before obtaining any other medications.

Behavioral Therapies for Addiction

Pharmacists play a crucial role in monitoring OTC medication use among specific populations, such as elderly patients who take multiple medications. They can be proactive in managing OTC medication abuse by utilizing their clinical skills, providing oral and written medication information, and developing trust among patients.

Various strategies have been employed by pharmacists to control over-the-counter medication abuse. These include keeping implicated products out of sight, questioning the purchase of these products, refusing to sell the implicated product, referring to a physician, referring to a drug and alcohol abuse team, and involvement in harm reduction programs.

Effective behavioural therapies for addiction treatment are integral to the recovery process, complementing the above preventive measures. These therapies help patients understand the root causes of their addiction, develop coping mechanisms, and build a strong support network. With the right combination of prevention and treatment strategies, it is possible to combat the common causes of over the counter drug abuse.

References

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988622/

‍[2]: https://nida.nih.gov/publications/drugfacts/over-counter-medicines

‍[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302752/

‍[4]: https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/how-can-prescription-drug-misuse-be-prevented

‍[5]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774309/