teen drug addiction

Teens and Over-the-Counter Drug Abuse

To many American families, drug abuse seems like a distant threat. In reality, potentially addictive drugs are as close as your neighborhood supermarket or household medicine cabinet.

Teens and Over-the-Counter Drug Abuse

While most parents are aware of the dangers of abusing prescription narcotics and street drugs, they may not realize that the medications they purchase without a doctor’s prescription can be just as harmful, especially in the hands of teens.

According to the 2006 National Survey on Drug Use and Health, almost 1 million Americans between the ages of 12 and 25 had used an over-the-counter (OTC) cough or cold medication for non-medical purposes in the past 12 months. Over 3 million people in this age group had used an OTC medication for recreational reasons at some point in their lives. However, Pharmacy Times notes that only 8 percent of parents who participated in one national survey knew about the risks of OTC drug abuse, and 45 percent of teenagers believed that these drugs had no hazardous side effects.

Whether they’re taken alone or mixed with harder drugs or alcohol, OTC medications can be extremely dangerous, even fatal. Because these products are legal, inexpensive and widely available, they are especially alluring to teens. But¬†over-the-counter drugs are often an introduction to harder, illegal substances, and it doesn’t take long for casual experimentation to turn into substance abuse and addiction.

The biggest mistake that a family can make is assuming that over-the-counter drug abuse is a problem that happens to someone else.

Understanding the risks of substance abuse and communicating your concerns to your kids are the two most important steps you can take to avoid losing a teen you love to substance abuse.

What Are Over-the-Counter Drugs?

Over-the-counter drugs are medications that you can buy legally without a doctor’s prescription. You don’t need to be diagnosed or treated by a physician in order to purchase these products, and in many cases, you don’t need any form of identification. You can simply walk into a pharmacy or store where medications are sold and buy them. The most widely abused drugs among junior high and high school students are the medications that most of us take on a regular basis:

    • Cough syrups and cold medicines. In 2005, the U.S. Food and Drug Administration (FDA) issued a warning to the public about the potentially harmful effects of cough and cold remedies containing dextromethorphan, or DXM. This warning followed the deaths of five teenagers who allegedly overdosed on DXM in capsule form. When taken in large doses, this cough suppressant can cause central nervous system depression, hallucinations and sensory disturbances. An overdose of DXM can lead to respiratory suppression, high or low blood pressure, seizures, fever, nausea and vomiting, sedation, dizziness, coma and death.
    • Energy pills. Over-the-counter energy pills containing caffeine and other central nervous system stimulants are usually considered harmless. But teens who take high doses of legal stimulants to stay alert, lose weight or increase their energy level may be putting their health at risk. A caffeine overdose can lead to heart problems, dehydration, anxiety attacks, insomnia and stomach distress.
    • Motion sickness drugs. Motion sickness is a common problem, and it’s not unusual to find medicines containing the chemicals dimenhydrinate or diphenydramine (the active ingredients in Dramamine and Benadryl, respectively) in American households. Teens who abuse motion sickness pills can experience mind-altering side effects, but they are also at risk of liver problems, kidney damage, heart failure, coma and death.
    • Nasal decongestants and allergy medicines. Pseudoephedrine is the active ingredient in many cold and allergy medications. But the over-the-counter drug that you buy to relieve a stuffy nose could be a stimulant with a high potential for abuse. Pseudoephedrine is an antihistamine that boosts energy and creates a euphoric buzz when taken in high doses. Because medications containing pseudoephedrine have been used illegally to make street drugs like methamphetamine, access to these products is now restricted in many states.
    • Weight loss supplements, appetite suppressants and laxatives. Whether they’re sold as tablets, capsules, powdered beverages, herbal supplements, teas or in any other form, these products have a high abuse potential for image-conscious teens. Many diet pills and laxatives contain synthetic or herbal stimulants that are supposed to boost the metabolism and facilitate fat-burning; however, these chemicals can also create a burst of energy that’s psychologically addictive. The side effects of weight-loss products range from a rapid heart rate and high blood pressure to severe dehydration, anxiety, tremors, heart failure and death.
    • Pain relievers. Pain relievers are among the most widely used over-the-counter medications, and when used appropriately, they can safely relieve discomfort. But when drugs like acetaminophen (Tylenol) or ibuprofen are abused, they can cause liver failure, gastrointestinal bleeding, heart and kidney problems. A study published in Pharmacoepidemiology and Drug Safety reveals that over 450 Americans die of acetaminophen overdoses every year, and that the number of fatalities linked to this common pain reliever has almost doubled in recent years.

What About Behind-the-Counter Drugs?

“Behind-the-counter” (BTC) drugs are available without a doctor’s prescription, but access to these products is more restricted than OTC products.

Behind-the-counter drugs are stored in locked displays or in areas that are inaccessible to the public, like the shelves behind the pharmacist’s desk. The drugs¬†included in this category and the restrictions imposed on them vary from state to state. In some states, consumers must show ID to verify their age before they can buy one of these products. Common BTC drugs include some nasal decongestants, cough syrups, emergency contraceptives and allergy medications.

When used as directed on the label, OTC and BTC drugs are usually effective and safe. But when you take more than the recommended dose, combine the drug with other drugs (including alcohol), or take the medication in a way that’s not recommended, you are putting yourself at risk of dangerous side effects, including addiction, overdose and death.

How Are Drugs Classified?

In the United States, drugs are classified into categories based on their safety, medical use and potential for abuse. The Center for Drug Evaluation and Research, a division of the FDA, is in charge of reviewing the safety and efficacy of drugs sold without a prescription. Drugs that are sold over the counter must meet the following criteria:

  • They have relatively few adverse side effects when used as directed.
  • They are considered to be non-addictive when taken in therapeutic doses.
  • They offer proven health benefits that outweigh potential side effects.
  • The average consumer does not need a physician’s guidance to diagnose or treat the condition.

Drugs that have a high abuse potential are classified as controlled substances, a process that is overseen by the U.S. Drug Enforcement Administration (DEA). Controlled substances include many legitimate prescription medications as well as illicit drugs. There are five classifications, or schedules, of controlled substances:

    • Schedule 1: Drugs that are considered to be extremely dangerous and highly addictive. These drugs, which include heroin, Ecstasy, LSD and many others, have no accepted use to the medical community.
    • Schedule 2: Schedule 2 drugs have less abuse potential than Schedule 1 substances, but they are still considered to be dangerously addictive. Cocaine and methamphetamine fall into this category, as do many narcotic pain relievers (oxycodone, hydromorphone) and behavioral medications (Ritalin, Adderall).
    • Schedule 3: This class includes moderately addictive substances that have a lower abuse potential than Schedule 1 or 2 drugs. Medications in this category include Vicodin and Tylenol with codeine.
    • Schedule 4: Drugs with a relatively low risk of physical or psychological dependence are classified as Schedule 4. These include many sedatives and hypnotic medications, including Ativan, Xanax and Ambien, as well as a number of pain relievers.
    • Schedule 5: Drugs in this category contain low doses of narcotics and are considered to be the least addictive of the controlled substances. Certain pain medications and cough syrups that contain codeine are included in this category.

Are OTC Meds Addictive?

Controlled substances are considered to be the most hazardous and addictive of drugs. However, it’s unsafe to assume that OTC and BTC medications are safe and non-addictive. Many of the active ingredients in non-prescription medications, like DXM, Dramamine and pseudoephedrine, can produce symptoms of tolerance, dependence and withdrawal, such as:

  • Physical cravings for the drug
  • The need to take higher doses of the drug to get the same “high”
  • Feelings of depression or anxiety when you can’t use the drug
  • Failure to quit using the substance, in spite of your best intentions
  • Resorting to illegal or unethical behavior (stealing, lying, selling drugs) in order to get your substance of choice

Non-prescription medications are not habit-forming when they’re taken as directed on the label. But when these products are misused for recreational reasons, they can be as harmful to your health as prescription narcotics or illegal drugs, warns the National Institute on Drug Abuse.

Why Are Teens at Risk?

teens at riskIt’s natural for teens to take risks. In healthy families, adults set limits that keep teenagers from taking these risks too far. But even in the strongest of families, teens can be lured into experimenting with drugs and alcohol. Experimentation often begins with substances that are close at hand, inexpensive and easy to obtain, like OTC medications.

Why are OTC drugs so tempting to teenagers? Because they’re sold in pharmacies, grocery stores and convenience stores, these medicines appear to be safer than illicit drugs or prescription medications. And because it’s legal to buy and use OTC products, teens don’t have to worry about getting arrested for misusing them.

The Internet makes it easier than ever for teens to purchase OTC drugs, or the active chemicals in these medicines, without their parents’ knowledge. Drugs like DXM are sold online and can be purchased in a variety of forms, including pills, powders and capsules. To avoid liability, suppliers label these drugs as “Not for Human Consumption” or “For Research Purposes Only.”

Experimenting with OTC drugs is far from harmless, especially when they’re combined with other medications, street drugs or alcohol.


The Journal of Analytical Toxicology reports that in three different incidents in three states, five teenage boys died of an overdose of the cough suppressant DXM, which they purchased through Internet suppliers. In all of these cases, the boys had ingested far more than the recommended dose of DXM. Three of the boys had also taken diphenhydramine, the active ingredient in Benadryl. One had taken alprazolam, a prescription anti-anxiety medication, and two had taken drugs containing cannabinoids, which are found in marijuana.

Teens abuse non-prescription drugs in a variety of ways. Pills, capsules, gel tablets and syrups can be taken straight out of the package or bottle and ingested by mouth. Tablets and pills can be ground up into a powder, which can be snorted nasally or blended with energy drinks or alcoholic beverages. Dextromethorphan can be used by sipping liquid cough remedies from the bottle or by mixing cough syrup with other drinks. When taken in powder or pill form, DXM provides a faster high without the
need to ingest large volumes of fluid. Street names for dextromethorphan include Robo or Tussin (from Robitussin, a popular cough suppressant), Skittles, Triple C and Dex. Using dextromethorphan to get high is sometimes known as “robo-tripping.”

Protecting your teens from OTC drug abuse isn’t easy. Even if you safeguard your home against potentially hazardous medications, you can’t guarantee that your teenager won’t be able to obtain these drugs at school or a friend’s house. Educating yourself and your children about the dangers of non-prescription substance abuse is the best place to start. Sharing meals, talks and activities with your teen on a regular basis will keep the line of communication open and help you detect warning signs of drug abuse.

What Are the Warning Signs?

Because OTC and BTC medications are legal and accessible, the red flags of drug abuse may not appear right away. But some of these warning signs may appear from the beginning:

  • Secretive, self-isolating behavior
  • Hanging out with new “friends”
  • Avoiding family meals and activities
  • Abandoning favorite hobbies or sports
  • A decline in academic performance
  • Poor personal grooming habits
  • Frequent complaints of a cough or cold, with requests for cold medication
  • Making unexplained purchases online
  • Spending a lot of time on websites that promote OTC drug use
  • Discarded medication packets or bottles
  • Sleeping too much or too little
  • Wearing sunglasses at inappropriate times
  • Acting confused, hyperactive or giddy
  • Sudden changes in weight
  • A loss of motor coordination
  • Unexplained changes in mood or affect
  • Cool, clammy skin
  • A rapid pulse

The more you know about the side effects of OTC and BTC medications, the more likely you are to catch these physical and psychological changes.

Learn about the medications that you and your family take on a regular basis. Don’t be afraid to talk with your teenager or to ask questions about changes in his or her behavior. If you feel that you’re out of your depth, don’t hesitate to reach out for help from qualified addiction professionals who specialize in working with teens.

Is Treatment Needed?

muir wood residentialThe decision to seek treatment for a teen is often a very difficult one. Some parents are reluctant to confront a troubled adolescent about substance abuse for fear that the behavior will get worse. Others can’t bear to confront the painful fact that their child is using drugs. The fact is that teens who abuse over-the-counter medications need professional intervention just as much as those who drink or take street drugs. Getting treatment from a rehab facility that specializes in adolescent substance abuse provides the following important benefits:

  • Psychological testing to identify co-occurring psychological or behavioral disorders
  • Professional intervention to prevent the long-term consequences of drug abuse
  • Access to therapists who have advanced training in adolescent development and psychology
  • Support from peer groups that consist of teenagers who are working to overcome addiction
  • Intensive educational programs to help teens maintain their academic progress while in rehab
  • Family counseling sessions to strengthen personal relationships and build a stronger, more supportive home environment
  • The opportunity to heal through therapeutic, activity-based programs, like equine therapy and adventure therapy

The innovative rehabilitation programs at Muir Wood are designed to address the unique challenges faced by teenage boys. We understand that today’s teenagers face enormous pressure as they make the transition from boyhood to adulthood. Our evidence-based treatment models can guide adolescents through this difficult phase, so they can create healthy, purposeful lives.

If a young man in your life is struggling with addiction, we’re here to help. With over 25 years of experience working in the field of adolescent substance abuse, the professionals at Muir Wood can provide the support and referrals you need to give your son the very best chance at a successful future. Call our treatment team for a confidential discussion of your needs.