Commonly abused OTC and prescription drugs
International Day against Drug Abuse and Illicit Trafficking 2021 observation by IPS, Manipur State branch

Dr Nelson Loitongbam *

When we usually talk or think of drug abuse, we immediately think of illegal street drugs like Heroin, Cocaine, Methamphetamines or Brown sugar etc. but besides these the most commonly abused drugs are legal over the counter and prescription drugs that can heal and help us. But some can be addictive and dangerous if they’re used in a wrong way.

What are over-the-counter (OTC) medicines ?

Over-the-counter (OTC) medicines are those that can be sold directly to people without a prescription. OTC medicines treat a variety of illnesses and their symptoms including pain, coughs and colds, diarrhea, constipation, acne, and others. Some OTC medicines have active ingredients with the potential for misuse at higher-than-recommended dosages.

According to data from the United Nations Office on Drugs and Crime (UNODC), the prevalence of prescription drug misuse and related fatalities is increasing worldwide . Vulnerable groups at higher risk of misusing medications are adolescents and young adults; women; older adults; and healthcare professionals.

Other at-risk groups include people with mental illnesses, inmates and individuals suffering from acute or chronic pain, who might abuse opiate medications. A range of factors are thought to contribute to the non-medical use of prescription/OTC drugs, such as:

The perception of prescription drugs as more socially acceptable; Less stigmatising; Safer than the intake of illicit substances, as well as their likely lack of detection in standard drug screens.

Most commonly abused over-the-counter drugs

OTC drugs, when misused, can lead to abuse and thus increase the risk of addiction.The most commonly abused OTC drugs in the United States include sedative antihistamines, laxatives, and decongestants. Let’s take a look at several examples:

Dextromethorphan (DXM)

It’s not just prescription drugs that are a problem. Dextromethorphan is a common ingredient in over-the-counter cold and cough medicines--it helps stop the cough. But large doses can get you high and cause hallucinations. It’s popular among teens, since cough syrup is so easy to find in medicine cabinets. High doses also cause vomiting, rapid heart rate, and--rarely--brain damage.

Pseudoephedrine

This is a decongestant in lots of non-prescription cold medicines. While it helps clear up a stuffy nose, it’s also an ingredient in illegal methamphetamine pseudoephedrine can cause irregular heartbeat, shortness of breath, high blood pressure, dizziness and seizures.

Loperamide

It is anti-diarrheal that is available in tablet, capsule, or liquid form. When misusing loperamide, people swallow large quantities of the medicine to get euphoria. Loperamide misuse can also lead to fainting, stomach pain, constipation, eye changes, and loss of consciousness. It can cause the heart to beat erratically or rapidly, or cause kidney problems.

Diphenhydramine (DPH)

DPH acts on peripheral and central histamine H1 receptors, thereby reducing allergic symptoms and resulting in sedation, respectively. It is also used in sleep aids. It is abused for behavioral effects, such as elevated mood, a jolt to energy levels, and limited euphoria. In high doses, the drug can cause hallucinations, ringing in the ears, nausea, irregular heartbeat, seizures, coma and even death.

Promethazine

As an antihistaminic, promethazine is commonly used for symptomatic relief from nausea and vomiting, allergic conditions, motion sickness and the common cold. Often available with codeine in common cough suppressants, its abuse potential appears related to its calming and sedating effect, and enhancement of other co-ingested substances, such as benzodiazepines and opioids.

Chlorpheniramine

As a first generation antihistaminic, chlorpheniramine is used as a cheap sleep aid or anxiolytic. Its abuse has been related to pleasurable feelings such as euphoria, which reinforces the repetitive use of the drug and the possibility of developing drug dependence, but might also cause psychotic symptoms in predisposed individuals.

Acetaminophen

When it comes to the relief of minor aches and pains—most notably headaches—acetaminophen is a godsend. Acetaminophen overdose can result in liver failure, and chronic overuse of this OTC drug can result in increased liver enzyme levels, liver damage, and toxic hepatitis.

Antacids

Antacids are used to calm upset stomach with heartburn, acid indigestion, and sour stomach. Antacids, however, can lead to “acid rebound” with long-term use. Acid rebound refers to a paradoxical acid hyper-secretory state associated with heightened gastrin levels. Antacids can also significantly interfere with the absorption of various prescription drugs.

Prescription Drug Abuse

Prescription drug abuse has become a concerning modern-day epidemic. This is especially true among young adults and adolescents, where their use has surpassed all use of illicit drugs, with the exception of marijuana.

Traditionally, concern has centered on opioids, benzodiazepines and stimulants, but other widely prescribed drugs may be misused, abused or diverted for non-medical purposes. Young people take prescription drugs for recreational purposes (e.g. to get ‘high’); to relieve anxiety or relax; or to improve academic performance. Drugs might be acquired from friends or relatives, directly prescribed by a doctor, obtained from a drug dealer or via the internet.

Some commonly abused prescription drugs

Barbiturates

These are sedatives like phenobarbital, pentobarbital, and secobarbital . They help with anxiety, sleep problems, and some seizures. But if you take more than prescribed, you can get addicted. High doses can cause trouble breathing, especially if you use them when you drink alcohol. If you can’t function without barbiturates, get help. Going into withdrawal can be dangerous.

Benzodiazepines

Alprazolam, clonazepam and diazepam are examples of benzodiazepines - another type of sedative that can help with anxiety, panic attacks, and sleep problems. They work well and they are safer than barbiturates. But overused, and even used as prescribed, they can also lead to physical dependence and addiction. Stopping these medications abruptly can be dangerous. If you feel you depend on these medications, talk to your doctor. Prescription drugs shouldn’t be shared. They are only for the person with the prescription.

Sleep Medicines

If you have trouble sleeping, drugs like zolpidem, eszopiclone, and zaleplon can help you get the rest you need. But if you use them longer than your doctor suggests, you may become dependent and need them to sleep. Practicing sleep hygiene skills is the best way to deal with sleep problems. Although they’re not as addictive as some sleeping pills, doctors are concerned about abuse if they’re not taken as prescribed.

Codeine and Morphine

Some of the most commonly abused prescription meds are painkillers - specifically, opioids. These drugs dull pain, but in large doses they can also cause a euphoric high-and dangerous side effects. Doctors usually prescribe morphine for severe pain and codeine for milder pain or coughing. Manipur has been facing the problem of abuse of codeine containing cough syrups since the 1980s and it is still continuing.

Dextropropoxyphene

It is an opioid analgesic used to treat mild to moderate pain.it can be abused as a standalone or as a combination with other drugs. A combination of Dicyclomine, Paracetamol and Dextropropoxyphene commonly known as Spasmoproxyvon (SP) in Manipur. It works by relaxing the muscles of the stomach and intestine and stops sudden muscle spasms. This drug was and still is widely abused in our State.

It was banned by the Government of India in 2013 because of reports of its misuse and also because of its side-effects like respiratory depression and heart conduction abnormalities. SP is attributable for a high number of overdose complications and deaths including suicidal deaths in the country and even in our State.

Tramadol

Tramadol is synthetic opioid analgesic. The drug is easily available and widely prescribed for pain management. First marketed in the 1970s, tramadol was said to have a low-abuse potential and even used to lessen the symptoms of opioid withdrawal. However, its abuse liability and diversion were soon recognized as it began to be widely abused. The Govt. of India brought the drug under the Narcotic Drugs and Psychotropic Substances (NDPS) Act. on 26th April 2018 and is now not available freely.

Amphetamines

When prescribed, stimulants like amphetamines can help people with ADHD. But some people use amphetamines to get high, to boost energy and alertness, or to keep their weight down. You can get addicted to stimulants. High doses can cause a dangerous rise in body temperature, irregular heartbeat, and even cardiac arrest.

Methylphenidate

This is a stimulant ADHD drug, in India this drug also falls under the NDPS Act. Taking a combination of such stimulants with common nasal decongestants can cause dangerously high blood pressure or an irregular heartbeat.

Other Prescription drugs reported to be abused

There are reports of certain prescription drugs being abused as a recent trend. They include Quetiapine, a second generation antipsychotic, Gabapentin and Pregabalin which are approved for epilepsy and neuropathic pain disorders. Abuse of antidepressants like Bupropion and Venlafaxine has also been on the rise.

Conclusion :

The abuse of prescription and OTC drugs has become of increasing public concern across the globe. The current drug scenarios are greatly challenging healthcare providers and pharmacists, particularly during the COVID-19 pandemic. These healthcare professionals and the public should be vigilant and develop strategies to ensure continuity of care for people who use drugs and people with drug use disorders, and prevent possible medicines misuse and diversion.