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

Most people think over-the-counter (OTC) drugs are safe because you can buy them without a prescription. But taking more than the label says, using them for a high, or mixing them with other substances can land you in the hospital-or worse. You don’t need to be a drug addict to be in danger. Sometimes, it starts with just one extra pill to make a cold go away faster. Or a few extra spoonfuls of cough syrup to feel numb. By the time you notice something’s off, it’s already too late.

You’re Taking More Than the Label Says

The bottle says take one tablet every four hours. But you’re taking two. Or three. Or you’re swallowing a whole bottle because you heard it’ll make you feel good. That’s not just misuse-it’s poisoning. Dextromethorphan (DXM), the active ingredient in many cough syrups, is harmless at 15-30 mg. But at 200 mg, it starts to cause hallucinations. At 500 mg, you lose control of your body. At 1,000 mg or more, you’re risking brain damage.

The FDA requires all DXM products to have a bold warning: “Taking more than directed may cause serious injury.” That’s not a suggestion. It’s a red flag. In 2023, a Johns Hopkins study found that after this warning was added to packaging, adolescent misuse dropped by 14.3%. But it’s still happening. People are taking 10, 15, even 20 times the recommended dose. And they’re doing it in secret.

Your Body Is Sending Warning Signals

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

• Dilated or unusually small pupils-78% of DXM abusers show this change
• Slurred speech that doesn’t go away after a few hours
• Unexplained weight loss-some users drop over 12 pounds in three months
• Heart racing at 120-180 beats per minute when you’re just sitting down
• Body temperature spiking to 103°F or higher
• Nausea, vomiting, or stomach pain that won’t quit

These aren’t side effects. They’re signs your organs are under attack. DXM often comes with acetaminophen (Tylenol). Taking too much of that combo can destroy your liver. The FDA says 4,000 mg of acetaminophen a day is the max. But people taking 10-20 cough syrup bottles a day are hitting 10,000-20,000 mg. That’s not a hangover. That’s liver failure waiting to happen.

You’re Acting Different-And You Can’t Explain Why

Behavior changes are often the first clue someone close to you notices. If you’re the one doing it, you might not realize how much you’ve changed.

• You’re hiding meds in vitamin bottles, candy jars, or empty pill cases
• You’re visiting three or more pharmacies in a week to refill the same product
• You’ve started lying about where you’ve been or who you’ve been with
• You’re spending $100-$150 a month on cough syrup with no explanation
• You’ve stopped hanging out with friends or answering calls
• You’re getting lower grades, missing work, or forgetting important plans

Tennessee Department of Health data shows that 89% of teens misusing OTC drugs saw their GPA drop by at least 1.3 points in one semester. That’s not laziness. That’s brain fog from chemical overload. And it’s not just teens. Adults do it too. They think it’s harmless because it’s legal. But the brain doesn’t care if the drug is sold at a pharmacy or on the street.

You’re Feeling Things You Shouldn’t

OTC drugs don’t just mess with your body. They mess with your mind. If you’re experiencing any of these, you’re not just “feeling off”-you’re in the middle of a drug-induced episode:

• Visual snow-seeing static on surfaces, even when you’re not high
• Paranoia that lasts for hours after the high wears off
• Emotional numbness that sticks around for a full day
• Feeling like you’re outside your body-like you’re watching yourself from the ceiling
• Memory gaps-you can’t remember the last 2-8 hours, even when sober

Dr. Nora Volkow, director of the National Institute on Drug Abuse, says high-dose DXM abuse creates dissociative states like ketamine. Chronic use reduces hippocampal volume by 8.3%-that’s the part of your brain that handles memory and learning. That damage doesn’t always reverse. And in 31% of long-term users, it leads to persistent psychosis-hallucinations and delusions that stick around even after stopping the drug.

You’re Mixing It With Other Stuff

Some people think combining OTC meds with alcohol, energy drinks, or antidepressants makes the high better. It doesn’t. It kills.

DXM and alcohol together? That’s a recipe for respiratory depression-your breathing slows until it stops. DXM and stimulants like caffeine or Adderall? That’s a 3.2x higher chance of dangerous heart rhythms. And loperamide (Imodium), which some people use to get high for opioid withdrawal, can cause fatal arrhythmias. The FDA reported cases where users took 100 tablets a day-5,000 mg-when the max safe dose is 16 mg. That stretched their QT interval beyond 500 ms. Normal is 350-440 ms. At 500 ms, your heart can suddenly stop.

What to Do If You Recognize These Signs

If you’re seeing these signs in yourself or someone you care about, don’t wait. Don’t think it’s “just a phase.” Here’s what actually works:

1. Stop immediately. Even one more dose could push you over the edge.
2. Call a professional. SAMHSA’s National Helpline (1-800-662-HELP) is free, confidential, and available 24/7. They’ll connect you to local treatment.
3. Don’t try to detox alone. Withdrawal from DXM can cause severe anxiety, depression, and insomnia. In 78% of cases, people need antidepressants to get through it.
4. Get family involved. Studies show cognitive behavioral therapy combined with family therapy has a 68% success rate at 6 months. Individual therapy alone? Only 42%.
5. Secure your meds. Lock your medicine cabinet. If you’re the one using, ask someone to hold onto your pills. Out of sight isn’t just helpful-it’s lifesaving.

There’s no shame in asking for help. The people who recover are the ones who reached out before it was too late. And recovery is possible. In 2023, a new FDA-approved treatment using low-dose naltrexone helped 82% of loperamide misusers manage withdrawal. Clinical trials for a new drug to fix DXM-related memory loss are showing 47% improvement after 12 weeks.

You’re Not Alone, But You Can’t Do This Alone

In 2022, SAMHSA received over 14,000 calls about OTC drug misuse. Most callers were abusing two or more substances at once. Many were teenagers hiding pills in their backpacks. Others were adults trying to self-medicate anxiety or pain. But every single one of them thought they were in control.

You’re not weak for needing help. You’re not broken for wanting to feel better. You’re human. And the system is set up to make you think OTC drugs are safe because they’re cheap and easy to get. But safety isn’t about legality. It’s about dosage. It’s about intent. It’s about what your body can handle.

If you’re reading this and you’ve been taking more than you should-stop. Today. Call someone. Text a friend. Walk into a clinic. You don’t need to hit rock bottom to start climbing back up.