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.
Common Side Effects of OTC Drugs & Alcohol
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:
- Nausea or vomiting
- Changes in blood pressure
- Loss of coordination
- Abnormal behavior
- Heart problems
- Liver damage
- Impaired breathing
- Internal bleeding
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.
What Is Robotripping?
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.
DXM Abuse Effects
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.
- When DXM is ingested at doses of 100-200 mg, there are feelings of mild stimulation. Judgment and reasoning can be affected. Slight issues with response time and motor coordination can also occur.
- When a person uses 200-400 mg of DXM, they begin to experience hallucinations and feelings of euphoria. Hallucinations can be significantly dangerous and can result in accidents, issues with poor judgment, and severe emotional distress. In addition, a person’s judgment and motor functioning will also be affected significantly more at this dosage than at lower doses. This can result in accidents, poor decision-making, and emotional distress. Combined with the potential for hallucinations, this can create a dangerous situation.
- When a person consumes 300-600 mg of DXM, they will experience hallucinations, visual distortions (objects can be blurred or misconstrued), and significant issues with motor coordination. This can result in a potential for severe issues as an individual may not be able to trust their own perception of the environment. This increases the risk for accidents, issues due to poor judgment, and other problems associated with hallucinations and poor motor control.
- When individuals consume more than 600 mg of DXM, they become extremely sedated, lose their perception of reality, and often begin to think they are not real or they are detached from their body. At this level, an individual’s motor functioning is extremely affected, including significant issues with respiratory suppression, lower blood pressure, etc. The DEA reports that there have been fatalities associated with taking high doses of DXM.
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.
What Can Happen if You Mix a Cold Medication with Alcohol?
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.
- Potential issues associated with suppression of the central nervous system (CNS) may occur. Most of these cold medications have CNS depressant effects, and alcohol is also a CNS depressant. These substances slow the firing rates of the neurons in the central nervous system, including the neurons in areas of the brain that maintain vital functions like breathing. When these neurons are slowed down to a significance extent, it can result in oxygen deprivation (hypoxia or anoxia) that can result in substantial damage to the brain and/or other organs.
- At higher doses, many of the untoward effects that occur as a result of DXM and other substances in cold medications are enhanced, such as the development of hallucinations, issues with visual perception, increased sedation, and poor motor control. Combining alcohol with the substances enhances their effects and can result in them occurring much more quickly and to a significantly more dangerous level.
- Individuals may become extremely ill and dehydrated as a result of vomiting.
- There are significant alterations in an individual’s cardiovascular functioning when these medications are mixed. Heart rate may decrease, and blood pressure may decrease or increase. This may lead to heart attack and even stroke.
- Seizure risk as a result of combining these drugs is significantly increased.
- Panic attacks or other issues with anxiety may occur.
- Individuals may become overheated, which can lead to further complications and increase the potential for dehydration.
Long-Term Effects of Cough Medicine and Alcohol Abuse
Long-term chronic use of alcohol and cough medicines can lead to:
- Significant liver and/or kidney damage
- Highly toxic levels of acid in the body
- Respiratory issues that are associated with the respiratory suppression that both drugs induce
- Long-term damage to the brain as a result of respiratory suppression
- The development of physical dependence on alcohol
- Psychological issues, such as anxiety, depression, poor motivation, mood swings, and increased sensitivity to stress
How Are Over-the-Counter Medications Altered for Abuse?
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:
- If the medication is in pill form, it can be crushed and snorted. It can also be mixed with liquid and taken orally or even injected. In some cases, pills can be crushed and smoked.
- Pills can also be crushed and mixed with other pills and used in the manners described above.
- Liquid medications can be mixed with other liquids.
- Pills and liquid medications can be mixed together and consumed orally.
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.
Who Determines if a Medication Requires a Prescription or Not?
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.
Should You Take an Over-The-Counter Medication if You Have a Chronic Illness?
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.
Should Anyone Mix OTC Medications with Other Medications?
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.