How OTC Medications Can Increase the Dangers of Substance Abuse

Aches, Pains, and Cough

In the United States, there are more than 80 classes of OTC medications, and each class has a seemingly endless list of brand options to choose from. However, the general popularity of OTC medications is exemplified in pain relievers and cough medications. These drugs are easily accessible, and according to information from Medscape, annual doses of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen in the U.S are a staggering 30 billion and 25 billion, respectively. These drugs include ibuprofen, aspirin, and acetaminophen. 

Some doctors say acetaminophen is the most dangerous of all OTC drugs, specifically because of its link to acute liver failure. Just like liver failure that alcoholism causes, acetaminophen increases the risk of liver failure by either long-term use of the drug or taking more than the recommended dosage amount (overdosing). In fact, unintentionally overdosing is highly common among acetaminophen users, even when no other drugs are involved. However, when other drugs are used, especially illicit drugs with a high potential for abuse,  we can understand the increased risk more clearly.  

Interaction With Other Drugs

Not only is acetaminophen a popular drug on its own, but it can also be found in some of the strongest prescription medications, such as hydrocodone. Hydrocodone is part of the opioid drug class, the same as fentanyl and heroin, and it is regularly prescribed for pain and cough. Since hydrocodone is highly potent and addictive, its brand name prescriptions (Lortab, Norco, Vicodin) are mixed with acetaminophen to treat pain while seeking to decrease the addictive potential of pure opioid pain relievers.

Acetaminophen and NSAIDs

This is part of how OTC drugs like acetaminophen can increase the dangers of substance abuse. If someone is addicted to an opioid that contains acetaminophen, like hydrocodone, they might be unaware that the drug contains acetaminophen, or at least how much. If this person runs out of their hydrocodone supply or wants to avoid an opioid overdose, they might assume that taking Tylenol is a safer option. However, combining this with the amount of acetaminophen already in their system could push them into an overdose, which could be life-threatening. 

According to Medline, NSAIDs such as ibuprofen and aspirin increase the risk of heart attack or stroke. While these can happen without any drug combination, there is an increased risk for those taking antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Some examples of these drugs include Lexapro, Prozac, and Cymbalta. 

The increased risk of combining these two drugs has to do with intracranial hemorrhage, a life-threatening condition of bleeding in the skull that causes increased pressure on the brain. This condition can lead to brain damage and/or death. Antidepressants are not as addictive compared to other substances, such as opioids or alcohol. Still, ongoing use can make the likelihood of combining the drug with a household pain reliever such as NSAID a high risk.

Cold and Flu Medicines

Cold and flu medicines can be dangerous because they often contain acetaminophen and are susceptible to the same overdose and liver risks. People also use these medicines to make methamphetamine illegally, which also makes them dangerous. OTC cold medicines can contain ingredients such as pseudoephedrine, which is one of the base ingredients for meth production. These OTC medications have been targeted by Congress, leading to the Combat Methamphetamine Epidemic Act in 2005. This law moved these drugs from store shelves to behind the counter, where they can only be sold in limited and documented quantities. In this sense, these drugs are dangerous not only because of what they are but because of what they can become.

Alcohol

What all of these OTC medications share is their increased risk when mixed with alcohol. Alcohol, like these OTC medications, is a common household item. This means the risk of mixing these drugs with alcohol is much higher compared to other illicit substances. Since alcohol ranks among the highest occurrences of all SUDs, the risk of mixing these drugs together is crucial to be well informed of. 

What This Means 

No medication, prescription or over-the-counter, is without risks. Just like prescription medications, OTC medications come with warnings and dosage amounts that allow them to be used safely. As with prescription medications, OTC drugs can produce dangerous outcomes even when taken as prescribed. Store-bought drugs are much more dangerous when they are mixed with other substances that are susceptible to addiction and abuse. 

When this happens, not only are the side effects intensified, the risk of overdose and death becomes much higher as well. Understanding this increased danger should not only help us use OTC and prescription medications safely, but it should also help us understand how important it is to seek professional medical help if we or someone we know regularly uses OTC medications alongside illicit substances.