By Azoma Chikwe
Abuse of over-the-counter (OTC) medicines is most common among teens. They know they might find a cheap “high” right in their families’ medicine cabinets, often without being caught. Young adults have also abused OTC medicines, particularly in combination with other medicines, alcohol, and illegal drugs, which increases the risks.
Most drugs of abuse can alter a person’s thinking and judgment, leading to health risks, including addiction, drugged driving and infectious diseases. Most drugs could potentially harm an unborn baby; pregnancy-related issues are listed for drugs where there is enough scientific evidence to connect the drug use to specific negative effects.
Millions of people take cough and cold medicines each year to help with symptoms of colds, and when taken as instructed, these medicines can be safe and effective. However, several cough and cold medicines contain ingredients that are psychoactive (mind-altering) when taken in higher-than-recommended dosages, and some people may abuse them. These products also contain other ingredients that can add to the risks.
Abuse
What is in cough medicine that gets people high is dextromethorphan(DXM). This is the active ingredient in more than 100 over-the-counter cough and cold medicines. One teen in every ten has reported abuse of cough medicine to get high. Large doses can cause euphoria, distortions of colour and sound, and “out of body” hallucinations that last up to six hours.
Over-the-counter cough medicines that contain dextromethorphan often contain other medicines that can also be dangerous in an overdose. Although most people who abuse dextromethorphan will need no treatment, some people will. Survival is based on how quickly a person receives help at a hospital.
High doses of promethazine-codeine cough syrup can produce euphoria similar to that produced by other opioid drugs. Also, both codeine and promethazine depress activities in the central nervous system (brain and spinal cord), which produces calming effects.
DXM or dextromethorphan was introduced in the United States(US) in the ‘50s, and is the most commonly used cough suppressant in the U.S. DXM is now in more than 125 drugs for cough, cold, and flu.
Cough and cold medicines are usually sold in syrup, capsule, or pill form. They may also come in a powder. Young people are more likely to abuse cough and cold medicines containing DXM because these medicines can be purchased without a prescription. The codeine, which is an opiate, produces a feeling of euphoria. The cough syrup also contains a drug called promethazine, which acts as a sedative.
Effects
DXM abuse can cause : Loss of coordination, numbness, feeling sick to the stomach, increased blood pressure, faster heart beat, in rare instances, lack of oxygen to the brain, creating lasting brain damage, when DXM is taken with decongestants
Promethazine-codeine cough syrup can cause slowed heart rate, slowed breathing, high doses can lead to overdose and death. Also, cough and cold medicines are even more dangerous when taken with alcohol or other drugs.
People can get addicted to cough and cold medicines, High doses and repeated abuse of the medicines can lead to addiction. That’s when a person seeks out and takes the drug over and over even though they know that it is causing problems with their health and their life.
Medicines abuse can lead to death. Abuse of promethazine-codeine cough medicine slows down the central nervous system, which can slow or stop the heart and lungs. Mixing it with alcohol greatly increases this risk. Promethazine-codeine cough syrup has been linked to the overdose deaths of a few prominent musicians.
Dr Gabriel Omonaiye, said, “codeine is an opiod pain medication used to treat cough, diarrhea. For treating pain, it is usually combined with paracetamol or any non-steroidal anti-inflammatory drug such as aspirin. It is an analgesic drug that has the ability to relieve pain, having quite a number of actions in the body. Aside being used in cough mixtures; its primary function is to relieve mild to moderate pain in any part of the body. It could be used for post-operative pain like muscular pain and injuries.
“When it is used as a mixture in cough syrup, it is meant to have some relaximg effect on the respiratory system, this is because when people have cough they may have sore throat or pain in the chest with it. So, apart from helping to expectorate, that is to bring out sputum, it has a soothing effect to relieve some of the discomfort the individual may experience in the chest.
“in a simple and concise way, codeine is an opiod analgesic that is relatively short-acting, used essentially for the treatment of mild to moderate pain, a prescription drug occasionally used as part of cough mixture.”
In recent times, there has been an increase in the abuse of codeine. Statistics shows that about 33 million Americans use codeine each year for non-medical purposes. This is because it is less regulated than some opiates considered to be more dangerous such as morphine.
According to Omonaiye “there are a number of reasons why there is increase in the abuse of codeine, one of which can be linked to the easy accessibility of the drug, because codeine can be gotten over the counter. Ordinarily, codeine is a prescription drug, it is a controlled drug but you can get it over the counter in cough mixture. Ordinarily, people shouldn’t be able to get it without a prescription but in our environment the reverse is the case. People can go to any pharmacy and buy it as they like and this pose a problem. Some people go out to steal the drug; some even take the prescription of either their relatives or friends and impersonate them just to get the drug to feed their addiction.
“It is available as a single ingredient drug, dihydrocodeine , and in combination with aspirin that relieves pain or in mixtures for treatment of cough. Another reason is most people enjoy the euphoric effect that they get from codeine which is generally associated with opiates and this is common practice among young people who wish to take an overdose of cough syrup.”
Aside euphoric effect that can be derived from codeine, Dr Omo Bello opines that there are certain factors that can cause one to abuse the use of the drug. He said majority of those who abuse codeine, particularly youths, want to relieve themselves from stress of different forms.
“in Nigeria, you find majority of those who engage in substance abuse are youths, mostly students and they usually abuse codeine due to factors such as curiosity, frustration, stress, rejection, failure, peer pressure, excitement etc. They get themselves roped in it due to the stress that comes with being a student, being on their own, away from the eyes of their guardians or parents. They take solace in codeine cause of its short effect which typically starts working after half an hour with maximum effect at two hours, lasting for about two to six hours. Some don’t understand that they are abusing the drug because for them it is not the same as other opiates like morphine.”
Because a doctor’s prescription is not needed, many mistakenly believe that over-the-counter (OTC) medicines are safer than prescription medicines and illegal street drugs. They are in fact safe and effective when taken as directed, but even OTC medicines,including herbals,can cause serious and potentially fatal side effects when abused.
Easily abused medicines
There are top ten medicines currently abused by teens and adults. They include :
Dextromethorphan
This is the active ingredient in more than 100 OTC cough and cold medicinesl. One teen in every ten has reported abuse of cough medicine to get high. Large doses can cause euphoria, distortions of colour and sound, and “out of body” hallucinations that last up to 6 hours. Other dangerous side effects including impaired judgment, vomiting, loss of muscle movement, seizures, blurred vision, drowsiness, shallow breathing, and a fast heart rate. When combined with alcohol or other drugs, a large dose can lead to death.
Pain relievers
Adults and teens have taken pain relievers in doses higher then recommended because they want the medicine to work faster. They don’t think of the side effects. They don’t know that liver failure can happen with large doses, and that stomach bleeding, kidney failure, and cardiac risks are heightened when taking large doses of pain killers.
Caffeine medicines and energy drinks
OTC caffeine pills or energy drinks or pain relievers with caffeine have all been abused for the buzz or “jolt of energy” they seem to impart. Large doses of caffeine can cause serious dehydration, gastric reflux, panic attacks, and heart irregularities that have occasionally been linked to accidental deaths, particularly in those with an underlying heart condition. Taking too much of a pain reliever can also cause serious side effects as noted above.
Diet pills
In large doses, diet pills can create a mild buzz. But misuse of diet pills can also signal a serious eating disorder. Abuse of diet pills often starts with trying just a few in order to lose weight. But these OTC medicines can be highly addictive. Although the Food and Drug Administration agencies have banned several of the most dangerous stimulants commonly found in OTC diet pills—phenylpropanolamine, ephedrine, and ephedra—other ingredients in these OTC products can be dangerous. To cite an example, bitter orange is a common ingredient that acts much like ephedrine in the body. It can cause nervousness and tremor, rapid and irregular heartbeat, high blood pressure, stroke, heart failure, and death. Many other diet pill ingredients cause digestive problems, hair loss, insomnia, anxiety, irritability, extreme paranoia, blurred vision, kidney problems, and dehydration. Furthermore, even the most “natural” diet preparations can have serious side effects when misused, particularly those containing ephedra. An earlier ban on ephedra pertained only to diet pills considered dietary supplements, not herbal remedies such as teas and Chinese preparations.
Laxatives and herbal diuretics
Like diet pills, some teens and young adults also abuse OTC laxatives and herbal diuretics (water pills), to lose weight. Laxatives and herbal diuretics can cause serious dehydration and life-threatening loss of important minerals and salts that regulate the amount of water in the body, acidity of the blood, and muscle function.
Motion sickness pills
Motion sickness pills that contain dimenhydrinate (Dramamine) or diphenhydramine (Benadryl) taken in large doses can cause one to feel high and have hallucinations similar to street drugs. The dose needed to cause these symptoms varies widely according to body weight and tolerance. Some teens and adults may take as many as 40 pills of dramamine, for example, to experience the desired high. Extremely high doses of dramamine have caused dangerous irregular heartbeats, coma, heart attacks, and death. Long-term abuse can cause depression, liver and kidney damage, memory loss, eye pain, itchy skin, urine retention, and abdominal pain.
Sexual performance medicines
OTC sexual performance medicines, often purchased via the internet, are sometimes abused by teens and adults who are drinking to counteract the negative effects of alcohol on sexual performance. These medicines can cause heart problems, especially when combined with alcohol or when taken in large doses.
Pseudoephedrine
This nasal decongestant and stimulant is found in many cold medicines. Its similarity to amphetamines has made it sought out to make the illegal drug methamphetamine. The medicine has also been taken as a stimulant to cause an excitable, hyperactive feeling. Abuse may be less common with pseudoephedrine than with other OTC medicines due to a federal law requiring it to be kept behind the pharmacy counter, limiting the purchase quantity, and requiring photo identification prior to purchase. However, people have taken pseudoephedrine to lose weight, and athletes have misused the medicine to increase their state of awareness and to get them “pumped up” before a competition. Dangerous side effects include heart palpitations, irregular heartbeats, and heart attacks. When combined with other drugs, such as narcotics, pseudoephedrine may trigger episodes of paranoid psychosis.
Herbal ecstasy
This is a combination of inexpensive herbs that are legally sold in pill form and swallowed, snorted, or smoked to produce euphoria, increased awareness, and enhanced sexual sensations. Marketed as a “natural” high, the main ingredient is ephedra, an herb banned but only in dietary supplements. The product can be purchased in gas stations, health food stores, drug stores, music stores, nightclubs, and online. It is easy to overdose on the product because the dose needed for desirable effects varies widely. The adverse effects can be severe, including muscle spasms, increased blood pressure, seizures, heart attacks, strokes, and death.
Other herbals
Other herbal products are increasingly being abused for their stimulant, hallucinogenic, and euphoric effects. Besides being legal, another draw is that many herbals are not detected during routine urine drug screens. One example is salvia, which is ingested or smoked to experience a short-lived distortion of reality and profound hallucinations. Users can experience severe anxiety, loss of body control, extreme psychosis, and violent behavior. They are also at risk for accidents and injuries that may result from an altered mental state. Some countries have regulated the sale of salvia. Another example is nutmeg, which is eaten as a paste to experience giddiness, euphoria, and hallucinations. Nausea and vomiting set in within an hour and hallucinations begin within 3 hours and can last for 24 hours or more. Effects such as blurred vision, dizziness, numbness, palpitations, low blood pressure, and rapid heartbeat may occur.
One of the greatest difficulties with preventing OTC drug use is that few teens and adults realize the danger. Unlike the risks associated with illegal street drugs like cocaine and heroin, the risks associated with OTC drug abuse are given little thought and attention. Teens and young adults who learn about the risks of drugs at home are 50 per cent less likely to abuse drugs.