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OTC medications, or over-the-counter medications, come in many varieties, nearly all of which can have harmful or dangerous interactions with other substances.
Even some herbal remedies can cause negative side effects if mixed with alcohol or illicit drugs. Every medication received from a pharmacy, including over-the-counter ones, must come with warnings about dangerous interactions, especially with legal substances like alcohol. However, effects can be unpredictable, particularly when illicit drugs are involved.
Around two-thirds of adults over the age of 18 in the US occasionally use alcohol, according to the Centers for Disease Control and Prevention (CDC). At the same time, 24.6 million Americans age 12 or older are past-month users of illicit drugs. The vast majority of people in the country will also use an over-the-counter medication at some point in their lifetimes. This leaves a lot of opportunities for these substances to mix.
Drugs and alcohol can increase or decrease the effects of an over-the-counter medication or cause any number of unpleasant side effects. Some of the most common of these effects include:
Many of these side effects can be very dangerous, both causing short-term risks and potential long-term damage. Alcohol and illicit drugs can also intensify certain side effects, such as sleepiness and lightheadedness, increasing the risk of accidents and injury upon operating heavy machinery, including vehicles. Particularly in older people, who are taking more prescription and over-the-counter drugs than ever before, there’s a higher risk of sustaining injury from falls.
Robotripping is a phrase used to describe drinking significantly large amounts of over-the-counter cough medications like Robitussin that contain the ingredient dextromethorphan, or DXM.
DXM is a decongestant and cough suppressant found in numerous over-the-counter medications. It is a synthetic drug that is a derivative of the opiate drug morphine. In high doses, it produces effects similar to those associated with dissociative hallucinogenic drugs like phencyclidine (PCP) and ketamine. At therapeutic doses, which are typically between 15 mg and 30 mg every 3-4 hours, it is relatively safe. Sometimes, people might experience mild sedation, drowsiness, headaches, nausea, and constipation at therapeutic doses, but these effects are rare and relatively mild.
The effects of abusing DXM are dependent on the dosage. The Drug Enforcement Administration (DEA) does not list DXM as a controlled substance, but it is listed as a substance of concern. The DEA describes four levels or plateaus of DXM abuse.
An individual who overdoses on DXM may experience extremely slowed thought processes, slurred speech, lethargy, irregular heartbeat, significant issues with motor coordination, unconsciousness, anxiety, paranoid delusions, hallucinations, and even hyperactive type behaviors.
First of all, most cold medications in liquid form contain a significant amount of alcohol. Mixing a cold medication with alcohol can result in an individual consuming a significant amount of alcohol that can lead to alcohol poisoning.
Findings by the Substance Abuse and Mental Health Services Administration (SAMHSA) have suggested that a significant percentage of individuals who abuse cough and cold medications also drank alcohol in conjunction with them. When combined with additional alcohol, the ingredients in cold medications like DXM can cause numerous problems.
Long-term chronic use of alcohol and cough medicines can lead to:
There are literally hundreds of ways that individuals can alter over-the-counter medications in order to abuse them. Typically, the following methods may be used:
The most common form of “alteration” used in the abuse of over-the-counter medications is altering the amount one is supposed to take. Individuals who abuse these drugs ignore the recommended dosage amounts and typically take extremely high amounts of the drug to achieve some effect.
The Federal Food, Drug, and Cosmetic Act defines what particular medications require a prescription. Individuals who are authorized to prescribe medications (physicians, nurse practitioners, veterinarians, dentists, etc.) are given their own Drug Enforcement Act number that allows them to prescribe medications.
The Controlled Substances Act of 1970 (part of the Comprehensive Drug Abuse Prevention and Control Act of 1970) initially determined many medications that would be designated as needing a prescription and what medications would be banned or deemed as being dangerous. The Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) are the primary regulatory bodies that decide whether a medication is safe and requires a prescription; they then implement the law.
Prescription drugs are considered to be substances that can only be safely used while an individual is under the supervision of a physician. Over-the-counter drugs are also considered to be substances that are best used under the supervision of a physician, but they are considered to be safe to use according to their instructions without the direct supervision and management of a physician. However, many over-the-counter medications can be dangerous if misused.
The process of adding, deleting, or changing the status of any medication can be petitioned by nearly anyone, including individual citizens, drug manufacturers, state drug authorities, etc. This process is often initiated by the DEA or the Department of Health and Human Services.
This question should be left to a physician who understands the individual and has assessed their situation. Anyone who has a question about taking any type of medication, for any reason, should consult with their physician. No person, regardless of their situation, should look to any source other than a physician regarding advice on whether or not to use any type of medication.
People should carefully read the instructions of any over-the-counter medication to determine what medications should not be used in conjunction with the medication they are taking. However, the final decision as to what medications one should use in conjunction with each other should be made by one’s physician. One should always consult with a physician before taking any medication in conjunction with another medication.
The practice of combining prescription medications or over-the-counter medications with other medications should also be left to one’s physician. As a general rule, one should not mix any medication with alcohol. Again, the best policy is to always consult with a physician regarding the use of multiple medications of any type, including the use of medications with alcohol.