Over The Counter Drugs: Use & Abuse
22 January, 2008, Manhattan: Oscar-nominated actor Heath Ledger found dead in his apartment. The cause of death was said to be from a possible overdose of a mixture of over the counter and prescription drugs, including painkillers, anti-anxiety drugs and sleeping pills. An Over The Counter (OTC) drug is a drug that is sold without the doctor’s prescription to treat common illnesses like pain, cough, flu, fever, headaches, heartburn, allergies, etc. It includes NSAIDs, paracetamol, aspirin, diphenhydramine, dextromethorphan, methamphetamine, asthma inhalers such as albuterol, ephedrine, etc. Since these are easily available to the general population, there is an increased risk of their inappropriate use. Especially at risk from these are the persons with weak immune system, elderly, pregnant women, adolescents and teenagers. Given below are some Over The Counter (OTC) drugs very common in use: Acetaminophen, which is more commonly known as paracetamol is an important Over The Counter (OTC) drug. It is widely used as an analgesic and an antipyretic agent. Higher than recommended doses of this drug are known to cause elevated levels of liver enzymes and eventual liver damage in adults. However, the increase in hepatic injury is greater when paracetamol is taken with an opioid (GR Bond, 2011). Less toxic side effects include anorexia, nausea, vomiting, malaise, anxiety, delirium, maculopapular rash, utricaria and an increase in prothrombin time. Aspirin and NSAIDs, another commonly used class of Over The Counter (OTC)drugs, have been known to cause GI problems like ulceration and gastric bleeding as well as cardiovascular problems such as hypertension, especially in patients with a predisposition. Kidney problems are also known to occur due to chronic administration of these drugs. Dextromethorphan (DXM or DM) is a cough suppressant and one of the active ingredients in many over the counter cold and cough medicines and sometimes used in other ailments ranging from pain relief to psychological applications. Street name for DXM is “Robo-tripping” or “Triple C”. It is one of the commonly abused drugs by teenagers in the US, who claim to turn “high” after taking an high doses of the drug. This drug is cheap and legal and thus readily available. Side effects of this drug include nausea, body itching, hallucination, dizziness, confusion, euphoria and coma. Over a long time, its abuse may lead to eventual liver or brain damage. In May 2005, five teenagers from the states of Washington, Florida and Virginia died due to the ingestion of toxic doses of pure DXM for recreational purposes. In all the cases, the drug was ordered through internet suppliers. The DXM concentrations in all 5 cases were well above therapeutic doses and in some cases the death was due to the drug’s interaction with other drugs. Postmortem drug DXM concentrations ranged from 950 to 3230ng/ml, whereas the minimum toxic concentrations for DXM are reported to be just at a level of 100-400/mg. Another Over The Counter (OTC)drug commonly abused is diphenhydramine, an anti-histamine having sedative effects for which reason it is also used as an Over The Counter (OTC) sleeping pill. It is commonly prescribed for motion sickness, allergies, cough, cold and insomnia. This drug is teratogenic, involving the brain, heart, genitourinary system of the fetus. Side effects due to overdose include low blood pressure, palpitations, confusion, irritability, stomach distress, dizziness, etc. This drug should be used with caution in pregnant and nursing women. It is ingested in high doses during suicidal attempts. There is also a risk of antimicrobial resistance among the population due to an increase over the counter usage of anti microbials. The Food and Drug Administration (FDA) is responsible for the safety regarding Over The Counter (OTC) drug administration in the USA. A part of its job is to review the ingredients and labeling the drugs with monographs, which assures whether the drug is safe to be used for self-treatment. It also sets warnings regarding the use of each drug. In Pakistan, however, no regulatory body exists for the registration and regulation of drugs. Over the counter drugs are often bought by the common masses, by a simple recommendation from the pharmacists. This is particularly alarming, since there is always a danger of over dosage and misusage of these drugs. Not much studies have been done on the OTC drug usage in Pakistan. It is understandable that a proper law is needed to curb this. Awareness among the uneducated masses regarding the contents of these medicines and proper labeling of common Over The Counter (OTC) should be done. Medicines should be kept away from children and adolescents and care should be taken when administering medicines to infants and elderly. Medicines should only be taken for the time prescribed by the doctor, to avoid addiction to certain drugs. Also care should be taken when other drugs are co-administered since there’s always a risk of drug-drug interactions. Pharmacies should ask for doctor’s recommendations when selling high-risk medicines. There should be a strict policy on advertisements of Over The Counter (OTC) drugs. Taking these measures will ensure a safe healthcare system and will bring us closer towards tackling challenges in public health.
There are also many rehab center in USA that are constantly helping people suffering from drug addictions to get back on track in their lives, Texas treatment centers for addiction are one of them that have done tremedous work for people.
About the author: Zunaira Abdul Ghaffar is a medical student at Dow Medical College. She can be reached at: [email protected]
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