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6 Commonly Abused OTC Drugs

By Lan Pham, Jon McKenna
Medically Reviewed by Arpan Parikh, MD, MBA on July 12, 2021
A number of medications legally sold over the counter (OTC) can be dangerous and addictive if used the wrong way or in the wrong amount. Learn more about some of the most commonly-abused OTC drugs.

Street drugs and prescription medications aren’t the only culprits behind America’s substance abuse problem. A number of medications legally sold over the counter (OTC) can be dangerous and addictive if used the wrong way or in the wrong amount. Read on for more information about the causes and effects associated with the abuse of OTC drugs.

Cough Medicine

Marina Oksengorn, MS, LMHC, a treatment placement specialist with Acadia Healthcare in Boca Raton, Fla., tells WebMD Connect to Care that cough syrups containing the suppressant dextromethorphan can lead to substance abuse. Oksengorn says that abuse can occur "because of the medication’s hallucinogenic effects and the feelings of disassociation from reality that it can produce.” Oksengorn adds, “I have worked with many people for whom (these cough syrups) are their primary drug of choice, using up to 20 times the recommended dose at once.”

Loperamide

Loperamide, the active ingredient in Imodium, is available both over the counter and by prescription as a treatment for diarrhea. But it also acts as a “peripheral” opioid. This means that its effects on specific cellular receptors in the body outside of the central nervous system can mimic the effect of opioids on those receptors. Therefore, many people misuse loperamide either as a substitute for stronger opioids or to aid in their withdrawal from opioids.

“It is inexpensive, readily available over the counter, and not detectable in urine toxicology screens, making it an attractive choice for someone who is being monitored for substance use,” Oksengorn says.

Pain Medications

According to a 2017 article published in Integrated Pharmacy Research and Practice, pain reliever liquids or capsules containing codeine are among the most abused OTC medications. These drugs can produce a relaxed, calm feeling, according to the Mayo Clinic.

Sleep Aids

OTC sleep medications may help you get the rest you need. However, although a 2016 WebMD survey found that 18% of participants took OTC sleep aids every day and 41% had used them for a year or longer, these medications are not intended for long-term use.

A 2018 article published by UNC Health Talk notes that diphenhydramine, an antihistamine that is a common ingredient in OTC sleep medications, can predispose people to dementia if it's taken for a long period of time.

Allergy Medications

Diphenhydramine is also the active ingredient in Benadryl. According to the U.S. Food and Drug Administration (FDA), abuse of diphenhydramine has become a problem, particularly among teenagers looking to take excessive amounts of the drug in order to produce hallucinogenic effects. However, taking higher doses than recommended can also result in heart problems, seizures, coma, and death.

Decongestants

You can still buy nasal medications containing a strong decongestant called pseudoephedrine without a prescription. However, due to the frequent abuse of these medicationsincluding using them as an ingredient in methamphetaminethe FDA now requires pharmacies to keep them behind the counter, and there is a limit to how much pseudoephedrine you can buy in a month.

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