When you think of drug abuse what comes to mind? Marijuana, cocaine, and heroin mostly likely, but what about Robitussin, Midol, or Dramamine? Over the Counter drugs are becoming more and more abused in our society
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Introduction
OTC Drug Abuse: A Growing Problem
At Elmbrook Middle School, a 13-year-old is seizing. Upon arrival, your patient is responding to painful stimuli in care of the school nurse, who says she seized for three minutes. The girl has no history of seizures, takes no prescription medicines and has no allergies. The nurse says she had been acting strangely in class, as if she were drunk; however, she does not smell like alcohol. Physical exam reveals constricted pupils, diaphoresis and moaning upon palpation of the abdomen. While examining the patient you find a box of cold medicine capsules in her pocket. You suspect the child has overdosed on dextromethorphan, a drug in cold and cough medications.
This girl, like as many as 1 in 10 of her classmates, has been using over the counter medications to get high. Over the counter medication abuse has been on a steady rise in this country now for many years. Since 2000 there has been a fourfold increase in use of over the counter cough medicines to get high. Many teens view these drugs as safe because they take them medicinally on a regular basis and because they have a much more positive view than illegal street drugs. This combined with the ease in which these drugs can be acquired, seem to be the biggest factors causing the rise in abuse. What teens need to know is that these drugs are not safe. Between 1999 and 2004 there was a sevenfold increase in overdoses and poisonings related to abuse of over the counter cough medicines reported to poison control centers. When over the counter cough medicines are taken at extremely high levels they can lead to coma, seizures, serious psychosis and even death.
How can we help?
The most important thing that nurses and parents can do to prevent abuse of over the counter medications is to educate themselves and their teens. Warn teens of the dangers of over the counter medications when taken at levels above normal dosage, and assure them that they are anything but safe. Being able to spot the signs and symptoms of a potential overdose will also help ward off more serious complications and get emergency medical treatment immediately. Some of the symptoms of cough syrup overdose:
• Dilated pupils
• Rapid heart rate
• "Out of body" sensation
• Poor Comprehension of speech
• Blurred vision
• Hallucinations
• Decreased level of consciousness
Awareness of this growing problem is one way to help head off potentially life threatening overdoses. The following video addresses the problem as well.
Sources:
Over-the-Counter Drug Overdoses
Above The Influence
DXM- What Is It and Why Is It Important?
Now that we have discussed the growing problem of OTC medication abuse, we will now look at the substance that is most commonly abused. Dextromethorphan is found in more than 120 over the counter cold medicines and when taken in higher than recommended doses it can produce a high feeling. It's street names include DXM, robo, and skittles. When taken in normal doses (15-30 mg three to four times a day) DXM is an anti coughing agent and side effects are extremely rare.
The troubling thing about DXM is that is a semi synthetic morphine derivative meaning it is structurally similar to heroin and morphine but does not act on the same receptors. Instead at high doses DXM performs more like ketamine or the illegal street drug PCP. High doses of DXM can even cause the violent and disturbing behavior observed with PCP usage.
Most cases of abuse observed in the past has been done using high doses of OTC cough syrup, but more recently use of capsules and tablets to get high has increased. Powdered forms of DXM are sold illegally on the internet and the DEA has even seen DXM mixed with illegal street drugs such as ecstasy and methamphetamine on the black market. With these other forms of DXM available the high has gotten more dangerous. Teens especially tend to use DXM products in combination with alcohol making the risk that much great
Overdoses are particularly troublesome when it comes to DXM. Almost every over the counter product out there contains a different amount of DXM and may have many other drugs in them as well. Just 4 ounces of Robitussin or half a bottle has enough DXM to cause an overdose. Products that contain both DXM and antihistamines taken at high levels can cause anticholinergic toxicity in addition to DXM toxicity. Also, approximately 5-10% of Caucasians metabolize DXM poorly, making them more prone to overdose and death from toxicity.
What parents and nurses should take away from this is that DXM is a serious drug that is just as dangerous as a street drug in high levels. It is even under DEA review to be considered a controlled substance.
Sources:
DEA Office of Diversion Control
Teens and Over the Counter Medications- Should We Care?
Benadryl, Sudafed, and Tylenol. Teenager stabs friend to death. Teens hallucinating as if on illegal drug PCP.
Over the counter medications (OTC's) that are frequently used for good purpose are also being abused especially by teens. Teenagers between the ages of 13 and 17 are the most common abusers of OTC’s. The previously mentioned drugs were once held as simply drugs for allergies or headaches and are now being used mainly by teens to reach the same effect illegal or prescription drug due to the ingredients found in such drugs. Research has shown that 1 out of every 11 teens have abused an OTC. Thus, 10% of teens or 2.4 million repost abusing the over the counter cough medicine.
The variety of drugs are appealing to teens because of their cheap cost and easy accessibility. Teens have been found to mix OTC's with prescription drugs, street (illegal) drugs, and alcohol to increase the effect of the drugs and also crush pills and snort them. Over the years, there has been a jump in teenagers who abuse of such drugs. Drug treatment centers have had a 30% increase of admissions dealing with OTC abuse. Why should we focus on helping teenagers stay away from OTC abuse? OTC abuse increases the chance of such teenager abusing street drugs like Ecstasy and Marijuana.
Robo. Syrup. Skittles. Dex. Tussin. Triple C. What are the meanings to these terms? Are they new candies filling the stores? Not necessarily. These are only some of the few terms used by teenagers to describe overt the counter medications used specifically to reach a "high" effect. Being conscious of such terms will help the general public be aware and knowledgeable of code words teenagers can be using. Following the suggestions previously mentioned and others that will be mentioned will help to lower this statistic of OTC abuse amongst teens and increase the frequency with which parents must discuss the risk involved with OTC abuse.
Help for Troubled Teens by Troubled Teen 101. 2009. http://www.troubledteen101.com. Retrieved October 15, 2009.
Associated Press. "Judge says Lincoln man remains mentally ill." August 13, 2008. http://journalstar.com/news/local/article_9367ba34-4eeb-5f98-b203-daffa93ff181.html
National Drug Control Policy. Parents. The Anti-Drug. 2007. http://www.recres.org/publications/OTCdrugs_RR.pdf
Danger! OTC drug abuse effects:
Over the counters medications are just as serious as prescribed drugs. Drug abuse with over the counter medications can harm the body just as street, prescription, and other substances when used incorrectly. Over the counter drugs (OTC) are less potent than those prescribed by medical professional but, all drugs have real potential for harm and can even be fatal when abused alone and/or taken with other drugs. When not taken correctly, over-the-counter medications can cause very serious medical problem such as depression, brain damage, heart damage, stroke, seizure, liver complications, and many other serious complications to bodily functions. Taking OTC medications for granted can be hazardous to your health. Spending the time to read the label and staying within the suggested dose can greatly reduce addiction risk and other adverse side effects. Then do additional homework to make sure you have all the information you need to avoid a drug disasters. Safety should be the first thing thought about when taking any medications. Sometimes people think just because the medication is not prescribed by a doctor they won’t interfere with other medications their taking or have no risk for addiction. Wrong!! Communication between the physician, pharmacist and patient is essential in preventing side effects of OTC’s and drug abuse. The first most effective line of defense used to prevent or reduce drug abuse is education, teaching the side effects of using certain substances.
Sources:
actiononaddiction.org.uk
pdrhealth.com
associatedcontent.com/the_sideeffects_of_overthecounter_drugs
Be careful……..OTC drugs are accessable to anyone!
· Read the drug label carefully.
· Make sure you know what ingredients the product contains and understand any warnings or possible adverse effects.
· If you don't understand something, ask your doctor or pharmacist about it.
· If you take any prescription drugs, ask your doctor before taking an OTC drug.
· Don't stir medicine into your food or take capsules apart (unless your doctor tells you to). This may change the way the drug works.
· Don't take vitamin pills at the same time you take medicine. Vitamins and minerals can cause problems if taken with some drugs.
· Don't mix medicine into hot drinks unless the label tells you to. The heat may keep the drug from working as it should.
· Don’t take medicine with alcoholic drinks
Why do people prefer otc drugs to prescription drugs?
People may prefer to self medicate instead of getting a prescription because:
• Costs- Prescription medications can be very expensive. Even though there may be a generic alternative available for some but others don’t have that option.
• Convenience- Not having to make the trip to the doctor’s office
• No insurance- Doctors visits are very expensive and a person without insurance will not go unless absolutely necessary.
• Just doesn’t think they are sick enough to go the doctor.
If more people are self medicating with over the counter drugs then there is also a bigger risk for over dose if not used correctly.
Nurses: How we can help
As a nurse, one of the most important things we can do for our patient is communicate, teach and assess. We should teach our patients the dangers and risks that over the counter medications posses. We can never assume if a person knows the dangers or has read the directions for taking it. Many Americans use over the counter medications while some use the medication correctly, others abuse the drug to overdose or for recreational purposes. Some people innocently commit the mistake because they do not know they are doing anything wrong. Using critical thinking skills, we should question our patients if suspect overdose, and teach the right way to use the medication.
For patients who take multiple medications, we could advise them to invest in a tracker, medication log or medication separator. This will allow patients to see all the prescription and over the counter medications they’re taking and hopefully prevent overdoes. Preventing the misuse of medications is a team effort. It’s up to the pharmacist, doctor, nurse and patient to know what drugs are being taken and possible drug interactions that could occur and the correct way to use them. Most importantly the consumers are responsible for their well being and are a huge part in preventing overdose and abuse.
Suggested Further Reading
Nurses:
- http://news.nurse.com/apps/pbcs.dll/article?AID=2006602270305
- http://www.projectghb.org/prescription_drug.htm
Parents:
- http://www.dare.com/parents/documents/18-32.pdf
- http://www.businessweek.com/careers/workingparents/blog/archives/2009/01/did_you_know_th.html
Teenagers:
- http://www.teendrugabuse.us/over_the_counter_drug_abuse.html
- http://www.dxmstories.com/
