Over-the-counter drugs as substances of abuse: review of an unrecognized phenomenon
Over-the-counter (OTC) medicines, which are available without prescription, are often abused. Health professionals and the general population are rarely aware of this phenomenon. In this context of abuse, OTC medicines are generally ingested for their psychotropic properties rather than their intended purpose. The most widely abused categories of OTC medicines include antitussives, antihistamines and decongestants. Among the most popular substances are dextromethorphan, dimenhydrinate, chlorpheniramine and pseudoephedrine. The most frequent OTC medicine-induced psychotropic effects include euphoria, hallucinations, stimulation and increased vigilance. Side effects frequently consist of tachycardia, hypertension, irritability, agitation and loss of coordination. More severe side effects like psychosis, convulsions, respiratory depression, coma and death can also occur. Children and adolescents are most likely to abuse OTC medicines. Apart from abuse, dependence has also been described with OTC medicines. Consequently, it appears important to recognize and manage appropriately OTC medicine abuse in susceptible individuals.