Signs You’re Misusing Over-the-Counter Drugs and What to Do

Over-the-counter (OTC) drugs are meant to help - a headache, a cold, a stuffy nose. But when they’re taken in ways they weren’t designed for, they can turn dangerous. What starts as an occasional extra pill or a few extra teaspoons of syrup can spiral into something much worse. And it’s not just teens. People of all ages are misusing these meds, often without realizing how serious it is.

You’re Taking More Than the Label Says

It’s easy to think, "I just need a little more to feel better," but that’s where the line blurs. The FDA requires all cough syrups containing dextromethorphan (DXM) to carry a warning in bold font: "Taking more than directed may cause serious injury." That’s not just a formality. It’s a fact. A single dose of DXM is 15-30 mg. But people misusing it often take 100 mg or more - sometimes 1,000 mg or higher. At those levels, DXM isn’t treating a cough anymore. It’s causing hallucinations, out-of-body feelings, and even temporary paralysis.

One user on a health forum described being stuck on the floor for 8 hours after taking 1,200 mg of DXM. Their heart was racing at 147 beats per minute. That’s not a party trick - that’s a medical emergency. And it’s not rare. In 2022, over 14,000 calls were made to SAMHSA’s national helpline just about OTC drug misuse. Most of them involved people who thought they were "just experimenting."

Your Body Is Sending Warning Signs

Your body doesn’t lie. If you’re misusing OTC meds, it will show you. Look for these physical signs:

• Dilated or constricted pupils - This happens in 78% of DXM abuse cases. It’s not something you can fake.
• Slurred speech - Speech becomes thick and slow when DXM levels hit abusive doses. Studies show articulation errors jump from 2% at normal doses to 68% at high doses.
• Unexplained weight loss - Chronic users lose an average of 12.7 pounds over three months, often because they stop eating or feel too nauseous to keep food down.
• High body temperature - Fevers of 103°F to 105°F have been recorded. This isn’t a cold - it’s a toxic reaction.
• Heart rate spikes - Going from 80 bpm to over 160 bpm isn’t normal. It can trigger arrhythmias, especially if the product also contains acetaminophen.

And here’s the hidden danger: many cough syrups mix DXM with acetaminophen. The liver can only handle 4,000 mg of acetaminophen in 24 hours. One bottle of some syrups contains 650 mg. Taking just six bottles in a day? That’s 3,900 mg - right at the limit. Add a couple of Tylenol on top? You’re at risk for liver failure. The FDA recorded over 1,200 cases of liver damage from OTC meds in 2023 alone.

Your Behavior Has Changed

It’s not just about your body. Your actions change too. If someone you care about starts acting differently, pay attention:

• Secretive behavior - Locking doors, changing phone passwords, hiding pills in vitamin bottles. These aren’t quirks - they’re red flags. One rehab center found 87% of teens misusing DXM visited 3 or more pharmacies each month to avoid detection.
• Sudden drop in grades - GPA drops from 3.4 to 2.1 in one semester aren’t coincidence. Cognitive function declines with chronic use. Memory, focus, and decision-making all suffer.
• Unaccounted spending - Spending $127 a month on something you can’t explain? That’s the average amount teens spend monthly on OTC drugs. It’s often bought in bulk from gas stations or online.
• Isolation - Social interactions drop from 5.2 per day to 1.7. They stop calling friends, skipping family dinners, avoiding eye contact. It’s not shyness - it’s the drug.
• Risky behavior - Driving while high on DXM is 3.2 times more likely to lead to traffic violations. People report blacking out behind the wheel, not remembering how they got home.

The Mental Toll Is Real

OTC drug misuse doesn’t just mess with your body - it rewires your brain. Mood swings happen 5.7 times more often than in non-users. Paranoia episodes last 2 to 4 hours after the high fades. Some users describe emotional numbness that lasts over a day. It’s not "just being moody." It’s a neurological reaction.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, says high-dose DXM abuse causes changes in the brain similar to ketamine - a powerful anesthetic. After just six months of heavy use, users show an 8.3% reduction in hippocampal volume, the part of the brain responsible for memory and learning. That’s not reversible in all cases.

And it gets worse. One in three chronic DXM users develops persistent psychosis - meaning they hear voices, see things that aren’t there, or believe things that aren’t true - even when they’re not using. They need antipsychotic medication to function. That’s not a phase. That’s a psychiatric condition triggered by OTC drugs.

It Doesn’t Stop With OTCs

Here’s the scariest part: OTC drug misuse is often the first step toward something worse. Research from American Addiction Centers shows that 67% of people who start with cough syrup or loperamide end up using prescription painkillers or even heroin within 18 months. Why? Because tolerance builds fast. After 4 to 6 weeks, users need 3 to 5 times the original dose to feel the same effect. When that’s no longer enough, they look for stronger highs.

Loperamide - the active ingredient in Imodium - is another major concern. People take up to 100 pills a day (5,000 mg) to get high. The recommended dose is 16 mg. At those levels, it causes QT prolongation - a heart rhythm problem that can lead to sudden cardiac arrest. Since 2011, misuse of loperamide has jumped 278%. In 2023, the FDA approved the first treatment protocol using low-dose naltrexone to help people stop.

What To Do If You Recognize These Signs

If you see these signs in yourself or someone else, don’t wait. Don’t assume it’s "just a phase." Action now can prevent disaster later.

1. Stop the use immediately. Even one more dose could trigger a dangerous reaction.
2. Remove access. Lock up all OTC meds. Throw out expired or unused bottles. Many households keep these in unlocked cabinets - and that’s how misuse starts.
3. Call for help. SAMHSA’s National Helpline (1-800-662-4357) is free, confidential, and available 24/7. They’ll connect you to local treatment options.
4. Seek medical evaluation. A doctor can check liver enzymes, heart rhythm, and brain function. Blood tests can detect drug levels even after the high is gone.
5. Start therapy. Cognitive behavioral therapy (CBT) combined with family therapy has a 68% success rate in helping teens quit. For adults, motivational interviewing within 72 hours of recognition increases treatment success by 63%.

There’s also hope. Since 2021, 32 states have launched "Know the Dose" education programs in schools. In areas where these programs are active, first-time DXM misuse among 8th graders dropped by 29%. Prevention works. But it only works if people know the risks.

It’s Not About Willpower

People who misuse OTC drugs aren’t weak. They’re not "bad kids." They’re often trying to cope - with stress, anxiety, boredom, or trauma. The drugs offer a quick escape. But the cost is too high. The brain changes. The body breaks. The relationships fray. And the path forward often leads to something even more dangerous.

OTC doesn’t mean harmless. It means accessible. And accessibility doesn’t make it safe - it makes it easier to abuse. If you’re using these meds differently than the label says, you’re not alone. But you don’t have to stay that way. Help exists. Recovery is possible. And the sooner you act, the better your chances.