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

19 December 2025 10 Comments Joe Lindley

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 fun, or mixing them with other substances can land you in serious trouble - even in the hospital. You don’t need to be a drug addict to be at risk. Sometimes, it starts with just one extra pill to help you sleep, or a few extra spoonfuls of cough syrup to get high. And before you know it, your body is changing, your behavior is shifting, and your health is slipping away.

You’re Taking More Than the Label Says

The instructions on the bottle aren’t suggestions. They’re limits. For example, dextromethorphan (DXM), the active ingredient in many cough syrups, is safe at 15-30 mg every 4-6 hours. But some people take 200 mg or more to feel spaced out, hallucinate, or numb their emotions. At 300-600 mg, you lose coordination. At 500 mg or higher, you might feel like you’re floating outside your body. That’s not a party trick - it’s a medical emergency.

When you regularly take more than the recommended dose, your body builds tolerance. That means you need more and more to get the same effect. Studies show 63% of people who misuse DXM need 3 to 5 times the normal dose within just 4-6 weeks. And if the product also contains acetaminophen (like Tylenol), you’re risking liver failure. The FDA says 4,000 mg of acetaminophen per day is the max. Some people abuse cough syrups and hit 10,000 mg in a single day. That’s enough to cause permanent liver damage - or death.

Your Body Is Sending Red Flags

Your body doesn’t lie. If you’re misusing OTC meds, it will show you signs - and they’re not subtle.

Dilated or pinpoint pupils: Seen in 78% of DXM abuse cases. Your eyes react to the drug’s effect on your nervous system.
Slurred speech: Your words get fuzzy, slow, or hard to understand. At abusive doses, speech errors jump from 2% to 68%.
Unexplained weight loss: Losing 12-13 pounds over a few months without dieting or exercise is a warning sign.
High body temperature: Fevers above 103°F can happen. This isn’t a cold - it’s your body overheating from drug toxicity.
Racing heart: Your pulse might spike from 70 bpm to over 160 bpm. That’s not excitement - it’s your heart struggling.
High blood pressure: Normal is 120/80. Abusive use can push it to 160/100 or higher, straining your heart and blood vessels.

These aren’t random symptoms. They’re the direct result of your brain and organs being overloaded by chemicals meant for much smaller doses.

Your Behavior Has Changed

It’s not just your body. Your mind and habits change too.

You’re hiding it: You start locking your cabinet, changing phone passwords, or lying about where you’ve been. One study found misusers increased locked-door behavior by 400%.
You’re spending money you can’t explain: $100-$150 a month vanishes on cough syrup, cold pills, or loperamide (Imodium). That’s not normal.
You’re withdrawing from friends and family: Social interactions drop from 5+ per day to 1-2. You stop texting, skip gatherings, and isolate yourself.
Your grades or work performance slips: A GPA drop from 3.4 to 2.1 in one semester is common among teens misusing OTC drugs.
You’re taking risks: Driving after taking DXM? That’s 3.2 times more likely to lead to a traffic violation. You’re not thinking straight.

These aren’t personality changes. They’re chemical changes. The drugs are rewiring your brain’s reward system, making you crave more - and care less about consequences.

Teen with physical symptoms of OTC drug misuse: dilated pupils, racing heart, and high fever.

You’re Feeling Emotionally Numb or Paranoid

OTC drugs don’t just mess with your body - they mess with your mind.

Emotional numbness: You feel nothing for hours after the high wears off. Sadness, joy, even hunger - it all feels distant. This lasts 12-24 hours and gets worse with repeated use.
Paranoia: You think people are watching you, talking about you, or out to get you. These episodes last 2-4 hours after taking DXM and happen in 44% of chronic users.
Mood swings: One minute you’re laughing, the next you’re crying or angry. Studies show these mood swings happen 5.7 times more often than in non-users.
Visual disturbances: Some users report “visual snow” - tiny dots or static in their vision - that lasts for weeks after stopping.

Dr. Nora Volkow from the National Institute on Drug Abuse says high-dose DXM abuse creates brain changes similar to ketamine. After six months, users show an 8.3% reduction in hippocampal volume - the part of the brain that handles memory and emotion. That’s not temporary. That’s lasting damage.

You’re Buying from Multiple Pharmacies

If you’re running out of your cough syrup before the bottle should be empty, you might be visiting multiple stores. That’s called “pharmacy hopping.”

A rehab center in Sydney tracked 15 teens misusing DXM. All 15 hid pills in vitamin bottles. All 15 visited 3 or more pharmacies each month. That’s not coincidence. That’s a pattern of addiction. Pharmacists in Australia and the U.S. are trained to spot this. They can flag suspicious purchases - especially when someone buys 5-10 bottles of cough syrup in a week.

The FDA now requires all DXM products to have a bold warning: “Misuse may cause serious injury.” Since this rule started, adolescent misuse dropped by 14.3%. But people still find ways around it. That’s why knowing the signs matters more than ever.

Family supporting a loved one with recovery path leading from locked cabinet to therapy.

What to Do If You Recognize These Signs

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

Stop immediately: Quitting cold turkey can be dangerous. Withdrawal from DXM can cause anxiety, insomnia, and depression. Don’t try to handle it alone.
Call a professional: SAMHSA’s National Helpline (1-800-662-HELP) is free, confidential, and available 24/7. In Australia, call Lifeline at 13 11 14.
Get medical support: Detoxing from OTC drugs often requires monitoring. For DXM, 5-7 days of medical care is typical. For loperamide abuse, heart monitoring is critical - some cases cause fatal arrhythmias.
Start therapy: Cognitive behavioral therapy (CBT) combined with family therapy has a 68% success rate at 6 months for teens. That’s far better than going it alone.
Secure your meds: Lock your medicine cabinet. If you’re not using it, don’t keep it out. Homes with unlocked cabinets have 3.2 times higher misuse rates.

It’s Not Too Late

You might think, “I’m not addicted. I’m just using it to cope.” But addiction doesn’t start with a binge. It starts with a small compromise. One extra pill. One night you didn’t tell anyone. One time you thought, “I’ll stop tomorrow.”

The good news? Early intervention works. Studies show that if someone gets help within 72 hours of showing signs, their chance of entering treatment increases by 63%. Recovery is possible. Your brain can heal. Your relationships can mend. Your life doesn’t have to be defined by a bottle you thought was harmless.

Prevention Starts With Awareness

Schools in 32 U.S. states now run “Know the Dose” programs. Since 2021, first-time DXM misuse among 8th graders has dropped by 29%. That’s because kids are learning the truth: OTC drugs aren’t safe just because they’re legal. They’re chemicals. And chemicals, when misused, can break your body - and your mind.

You don’t need to be a drug user to be at risk. You just need to believe the myth that OTC means harmless. It doesn’t. The bottle doesn’t lie. Your body doesn’t lie. And it’s never too late to ask for help.

Can you really get addicted to cough syrup?

Yes. Dextromethorphan (DXM), the main ingredient in many cough syrups, can cause physical dependence and psychological addiction. People who take high doses regularly develop tolerance and need more to feel the same effects. Withdrawal symptoms include anxiety, insomnia, and depression. Studies show 63% of users need 3-5 times the normal dose within 4-6 weeks.

Is it dangerous to mix OTC meds with alcohol?

Extremely dangerous. Mixing DXM with alcohol increases the risk of respiratory depression, liver damage, and overdose. Many OTC cold medicines already contain acetaminophen, which can cause fatal liver failure when combined with alcohol. The FDA warns that this combination is one of the top causes of emergency room visits related to OTC misuse.

Can loperamide (Imodium) really cause heart problems?

Yes. Loperamide is meant for short-term diarrhea relief at 16 mg per day. But some people take 5,000-10,000 mg to get high or manage opioid withdrawal. This can stretch the heart’s electrical cycle (QT interval) beyond 500 ms - far above the safe limit of 440 ms. This causes irregular heartbeats that can lead to sudden cardiac arrest. Since 2011, loperamide misuse has increased by 278%.

How do I know if someone is hiding OTC drugs?

Look for signs like unexplained spending on cough syrup, empty bottles in unusual places, locked medicine cabinets, or pills hidden in vitamin containers. Behavioral changes - like sudden secrecy, social withdrawal, or mood swings - often accompany physical signs like slurred speech, dilated pupils, or weight loss. If you notice three or more of these, it’s time to talk.

What should I do if I think my teen is misusing OTC meds?

Don’t panic. Don’t yell. Start by talking calmly and without judgment. Then, contact a professional. SAMHSA’s helpline or a local addiction counselor can guide you. Family therapy combined with cognitive behavioral therapy has a 68% success rate in helping teens recover. Locking up medications and monitoring purchases can also help prevent further use.

Are there any safe alternatives to using OTC drugs for stress or sleep?

Absolutely. For sleep, try melatonin (at 0.5-3 mg), consistent bedtime routines, and reducing screen time before bed. For stress, regular exercise, mindfulness apps, or talking to a counselor are proven, safe options. OTC sleep aids like diphenhydramine (Benadryl) can cause next-day drowsiness and dependency. There are better, healthier ways to feel better.