Stay Alert for Abuse of OTC and Prescription Meds

Misuse of over-the-counter (OTC) and prescription meds continues to result in emergency department visits.

Meds are often abused for euphoria and other CNS effects.

Some aren’t surprising...oxycodone and other opioids, alprazolam (Xanax) and other benzos, or stimulants such as methylphenidate (Ritalin).

But stay alert for others that may not immediately come to mind.

Dextromethorphan is the “DM” in OTC cough medicines such as Robitussin DM. You’ll hear it called “robo,” “skittles,” “poor man’s PCP”...or “triple C” when Coricidin HBP Cough and Cold is abused. Watch for altered mental status, seizures, or ataxia.

Loperamide (Imodium A-D) is well known as an OTC antidiarrheal. But high doses can cause opioid-like euphoric effects...leading to its nickname, “poor man’s methadone.” Be on the lookout for arrhythmias, fainting, urinary retention, and constipation.

Bupropion (Wellbutrin) is an antidepressant called “poor man’s cocaine” due to its stimulating effects after snorting or injecting. Stay alert for seizures and tachycardia that could be fatal.

Quetiapine (Seroquel) is known on the street as “quell,” “Suzie-Q,” or “baby heroin”...or “Q-ball” when used with illicit drugs such as cocaine. Be aware that this antipsychotic is misused for its antianxiety effect...and can lead to low BP, tachycardia, coma, or respiratory arrest.

Gabapentin (Neurontin) is gaining popularity as “gabbie,” since it can cause a high in large doses...or enhance opioid euphoria. Look for drowsiness, slurred speech, or diarrhea with overdose.

Plan to start supportive care for patients who present after misusing these meds. Suggest naloxone for respiratory depression with loperamide or dextromethorphan.

Reach out to Poison Control at 800-222-1222 for help.

Keep in mind that OTCs often contain multiple abuse of one ingredient may lead to toxicity with others, including acetaminophen.

Get our Drugs of Abuse chart for more examples of med misuse, such as albuterol to stay alert...or levothyroxine for weight loss.

Key References
  • Ann Emerg Med 2017;69(1):83-6
  • Pharmacoepidemiol Drug Saf 2017;26(9):1083-6
  • J Addict Med 2014;8(3):195-8
Nurse’s Letter. Feb 2018, No. 340240

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