Over-the-Counter Drug Abuse
Saturday April 1, 2006
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OTC drug abusers are likely to be white and young and slightly more likely to be male, according to a 2004 SAMHSA report. However, "any patient can abuse over-the-counter drugs because he or she wants to get high," says Carolyn Baird, CARN-AP (certified addictions RN-advanced practice), MBA, MEd, president-elect of the Inter-national Nurses Society on Addictions. Baird, who also is on staff at Isaly Counseling Associates in Pittsburgh, adds, "Or patients think that if they double up on the dose, they'll get better faster."
Young people are the biggest abusers
of OTC drugs, says Carol Essenmacher, CARN, who practices in Battle Creek, Mich. Even as the use of illicit drugs decreases among teenagers, one in 11 teens admits to taking an OTC cough medicine to get high, according to a national survey by the Partnership for a Drug-Free America. And results of a
Utah Poison Control Study conducted between 1990 and 1999 showed that 38% of recreational drug abuse among children and teens involved nonprescription drugs.
The OTC medications most often abused directly affect the brain and central nervous system. In high doses, OTC drugs such as cough and cold remedies that contain dextromethorphan - a synthetic derivative of morphine- can produce effects similar to those of the hallucinogen PCP. Other OTC medicines with psychoactive effects include caffeine-containing stimulants, analgesics, and cold preparations such as antihistamines and decongestants.
Laxatives also are frequently abused, especially among people with anorexia nervosa or bulimia, Essenmacher says. Usually female, these substance abusers think they can lose weight by habitually taking laxatives, but any weight lost returns after the body rehydrates.
Easy accessibility has fueled the problem of OTC drug abuse, but that's changing for some drugs. Nearly 40 states have passed laws that limit the sale of cold medicines containing the decongestants pseudoephed-rine and ephedrine, which illegal labs use to make methamphetamine. In some states, these products are locked behind barriers installed on store shelves or are available only behind the pharmacy counter. To
further thwart the problem, some cold
remedy manufacturers have introduced pseudoephedrine-free formulations.
The public misperception that medication that's available without a prescription cannot cause harm fuels OTC drug abuse, Essenmacher says. Prolonged use and
higher-than-recommended doses of OTC drugs, however, can cause death or adverse effects (see chart on left).
Despite the scope of OTC drug abuse, few nurses thoroughly screen for it, according to Essenmacher. Nurses may not be aware of the prevalence of OTC drug abuse, or they may feel too pressed for time to perform thorough assessments.
Just ask
Some nurses fear they will offend patients if they ask questions about drug use. The solution, Essenmacher says, is to project unconditional acceptance while asking the tough questions about OTC drug use.
Baird recommends nurses keep asking questions until patients stop giving information. To find out the patient's drug dosages, pattern of drug use, and any
consequences, ask primarily open-ended questions that build on each other as needed, such as -
· What types of over-the-counter medications do you take regularly?
· How much of this medication do you take? Do you take more today than you had to in the past?
· What else do you take with this
medication?
· When do you take this medication? Is this a recent change?
· How uncomfortable are you if you don't take the medication?
· Do you think you've ever had any harmful effects from this medication?
· Has anyone commented on your behavior when you use this medication?
Signs of abuse
If a patient answers OTC abuse assessment questions defensively or vaguely, this may indicate drug abuse. Other
warning signs of abuse include using a nonprescription drug often and exceeding the recommended dose frequently; believing the drug is necessary to function
normally; reporting increased tolerance
to the drug; continuing to use the drug even if its use creates problems at work
or home; and using the drug dangerously, such as by driving under the influence of a sedating drug.
In the absence of warning signs, Baird suggests nurses perform a thorough drug abuse screening when patients have chronic conditions such as joint pain, sinusitis, or eating disorders that could predispose them to OTC drug misuse.
Intervention
After identifying a pattern of OTC drug abuse, nurses should document the problem and refer the patient to a physician for intervention, Baird says. It's unlikely these patients will view their substance abuse
as a problem because the drugs they are abusing are legal, says Essenmacher.
Rather than trying to figure out why a patient is abusing drugs, a nurse should make it a first priority to help stop the abusive cycle, according to Essenmacher. As the primary patient educators, nurses can inform patients about how medication works and what are its effects.
Nurses also must educate their patients about how prolonged use of some nonprescription medications may lead to physical dependence. They may experience withdrawal symptoms after stopping their use of caffeine-containing alertness aids or some decongestant nose drops.
Kathleen Louden is a freelance writer.
Accidental acetaminophen
overdoses on the rise
In patients who met standard criteria for acute liver failure (ALF), the annual percentage of acetaminophen-related ALF rose from 28% in 1998 to 51% in 2003, reports a study published in the December 2005 edition of the journal Hepatology.
The rise in liver damage may be related to unintentional overdoses of the drug, which is a common ingredient in many OTC and prescription medications. Accidental overdoses can occur when patients are unaware acetaminophen is present in these drugs and take a combination of those medications.
To help prevent acetaminophen overdose, nurses can encourage patients to ask health care providers whether prescription medications contain acetaminophen and to read the ingredient labels on OTC drugs.
To read the study in full, visit: http://www3.interscience.wiley.com/
cgi-bin/fulltext/112161379/HTMLSTART.
More Clinical News was compiled by Jennifer Thew, RN, MSJ, an editorial director for Nursing Spectrum.
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