Can you get hooked on over-the-counter drugs? Diet pills, laxatives - even cough drops - can be habit forming.

Can You Get Hooked on Over-the-Counter Drugs?

More and more medicines that were once available by prescription only are now approved for over-the-counter (OTC) sales. You may save on visits to the doctor by purchasing these medications, but what are the risks?

It is commonly agreed among medical experts that one can become addicted to medications that don't even require a prescription! Many studies show that this becomes a reality in a startling number of cases!

You don't have to get high on a drug to become addicted to it. Joe Graedon, pharmacologist and noted author, tells us, "If you experience physical or psychological withdrawal symptoms after you stop using a substance, you are addicted." And the problems you encompass when you become addicted to these supposedly harmless OTC drugs can prove far more debilitating than the ailment for which you took them. Graedon, author of a series of People's Pharmacy books, adds, "It is possible for people to become psychologically dependent on practically anything, even aspirin."

Many people think anything available "off the shelf" must be fairly harmless. Are they right? They are wrong. Medical experts say many OTC drugs not only hurt you if taken incorrectly, but can also lead to physical as well as psychological dependency.

DIET PILLS. Over-the-counter diet drugs are prominently displayed in stores across the United States. The bright packages beckon seductively, and the tantalizing slogans seem to promise much: "Control Your appetite From Morning to Night," "Give Your Diet a Fighting Chance," and "Lose Weight Today." Today, thin, is in, and Americans spend an estimated $110 million each year on OTC diet aids.

Right in the middle of the diet controversy is phenylpropanolamine (PPA), which is found in many top-selling diet drugs such as Dietac, Appedrine, PVM, Control, Dexatrim, Prolamine, etc. PPA, one of the less potent "sisters" of the amphetamine family of drugs, acts on the central nervous system to speed the heart rate. It is also thought to act on the brain in such a way as to reduce the sensation of hunger.

Some rather alarming research indicates that for a number of peole, PPA is not safe! Many people experience temporary increases in blood pressure after taking PPA; and some report such annoying symptoms as dizziness, headaches, heart palpitations, and chest tightness. However, most often, a feeling of euphoria results.

"Medications containing PPA used to be sold on the streets as a substitute for amphetamines, or 'speed,'" says Sorrell L. Schwartz, Ph.D., a professor of pharmacology at Georgetown University School of Medicine, in Washington, D.C. "I don't feel that there is any sound reasoning for their support as diet aids," he adds.

As long ago as 1972 the FDA began investigating PPA along with other OTC drugs. In 1979, an advisory panel concluded that PPA was effective as a dietary aid. Since then, scores of researchers as well as the American Medical Association and the influential Medical Letter--an authoritative and well-respected newsletter that keeps doctors abreast of the latest developments in drugs--have criticized it, but without effect in marketplace.

Bambi Batts Young, Ph.D., associated with the Center for Science in the Public Interest, a Washington, D.C., consumer and research group, says, "Consumers assume that because a drug is sold over the counter, it must be safe. But this is just not true." Though the FDA is continuing to investigate claims regarding PPA, it has made no move to restrict its sale.

An article in the Journal of the American Medical Association also warrants that people taking diet pills for prolonged periods risk "psychic dependence and other undesirable side effects." Dr. Michael H. M. Dykes, author of the article, said the pills should be continued only as long as weight loss continues without side effects or the need for increased dosages, usually four to six weeks.

"The use of any diet pill will usually result in suppression of appetite and weight loss over a period of a few weeks," he said. Dykes, a member of the American Medical Association's Department of Drugs, also said the extent to which tolerance for the drug may develop and lead to psychic and physical dependence is still unknown, so diet pills should not be taken by persons susceptible to alcoholism or any form of drug abuse. Some patients have developed severe depression after being taken off the diet pills, he said.

COUGH DROPS WITH PPA. The use of PPA is not restricted to diet pills. More than 100 OTC medications, including cough syrups, cold remedies, and decongestants, contain this substance. The same mood shifts can occur with these substances as with diet pills, but the danger is oftentimes doubled. In addition to PPA, these medications may also contain ephedrine or pseudoephedrine, substances that relax air passages and constrict blood vessels, not only in the swollen air passages but also in the brain, affecting the nervous system.

COUGH SYRUPS WITH CODEINE. In most areas of the country you can get cough syrup containing codeine by simply asking the pharmacist for it and signing a register. This is legal in about two thirds of the states, says Jacob Miller, pharmacist and manager of professional relations at A. H. Robins Company.

Pharmacists tell us that "people who get hooked can get very sick, just like a street junkie, when they try to withdraw." The best treatment for codeine addiction is a tapering-off schedule of detoxification under a physician's care.

SLEEPING PILLS. OTC sleep aids are approved by the FDA "for occasional use only." However, Gerald Rachanow, deputy director of the FDA's Division of Over-The-Counter Drugs, says, "Using them for longer periods of time is probably safe. But you could get into a dependency problem." Studies show these dependency problems abound.

The experts tell us most of these pills are actually antihistamines, an allergy medicine that produces sleepiness as a side effect. People can depend psychologically on that side effect to get to sleep. The problem with taking these pills on a nightly basis is that discontinuing the practice can have an adverse affect on your sleep.

How can you kick this habit? By getting more exercise and by foregoing caffeine and naps.

CAFFEINE AND STAY-AWAKE PILLS. Pharmacologists tell us that caffeine can be an addictive drug: the main ingredient in those stay-awake pills is caffeine. When you stop taking them abruptly, the most common and well-documented symptom is a rather severe frontal headache.

How much caffeine is in one of the pills? We are told it is usually 100 to 200 milligrams, equivalent to one or two cups of coffee. However, if you use a bottle of pills a week, it amounts to fairly substantial quantities.

How to kick the habit? The experts agree the best way is to have a little less caffeine each day, to avoid withdrawal symptoms.

LAXATIVES. Even when laxatives have clear warnings on the packages that "frequent or continued use may result in dependency," experts say that millions of people are "hooked" on laxatives. Some of these abusers do so intentionally -- they include misinformed people who are trying to lose weight via the laxative method. However, most abusers are people who falsely believe that normal bowel function means one movement a day. Gastroenterologists throughout the country say that "normal" can vary from three a day to three a week.

Dr. Marvin M. Schuster, gastroenterologist at Johns Hopkins School of Medicine, says the most habit-forming laxatives contain phenolphthalein. How do they work? They irritate the lining of the intestine, which in turn irritates the nerves that cause intestinal muscles to contract. Doctor Schuster further warns, "Eventually, these nerve cells can permanently degenerate. The intestine actually becomes partially paralyzed, making constipation worse than it was before you took the laxatives."

As with all addictive medications, people who use laxatives too often discover they must take more and more to get the same effect. Yet the more they take, the more constipated they become. They eventually become convinced they can't have a normal movement without the laxative drug.

How can you kick the habit? Doctor Schuster advises substituting a bulk-type laxative, which works more naturally, for the stimulant type. However, he adds that adhering to a high-fiber, low-fat diet with plenty of fluids and getting regular, moderate exercise is very important. Trying to make a habit of at least attempting to have a movement at the same time every day also helps.

EYE DROPS. Why can constant use of eye drops be addictive? They contain vasoconstrictors that constrict the blood vessels in the eyes, making them smaller so that the eyes look whiter. The experts say that if you use them several times daily over a period of a week, a rebound phenomenon can occur.

Ophthalmologists tell us that using eye drops occasionally is all right, but if you abuse them you may find you have to use them every few hours to get rid of the redness. And when you try to stop using eye drops, your eyes get redder than they were before you started.

The only way to curb this addiction is to stop abruptly, say the ophthalmologists. If you are really worried about chronic eye redness, see an ophthalmologist.

NASAL SPRAYS. Habitual users of nasal spray oftentimes find it is very difficult to stop. And it doesn't take long to get hooked. That's why instructions on nasal sprays warn not to use them for longer than three days. If you get addicted to them, you will find you can't breathe through your nose without them, a terrifying discovery. (There are records of hard-core users of 20 years and longer who consume several bottles of nasal spray daily.)

Another risk of perpetual use is ever-worsening congestion, constant sneezing, and constant runny nose.

Why does this happen? Atlanta allergist/immunologist Dr. Donald C. McLean says this is a reaction known as rebound phenomenon. Nasal spray works by shrinking blood vessels in the nose. If the spray is used to often or for too many days in a row, those blood vessels become so tired out they can no longer shrink. Instead, they dilate, and the surrounding nasal tissues swell with fluid, causing more congestion than ever. You can make the vessels shrink, but the doctor says it takes more spray more often to do it. The end result isn't just discomfort; you can suffer permanent damage to nasal membranes, excessive bleeding, infected sinuses, even partial or complete loss of smell.

If this ever happens to you, consult your doctor at once! He/she will most probably give you cortisone nasal spray or another prescription spray containing cromolyn sodium. Doctor McLean says oral antihistamines are sometimes sufficient.

To wean yourself from nasal spray addiction, Dr. C. Edwin Webb, pharmacist and clinical affairs associate of the American Pharmaceutical Association, advises switching from long-lasting 12-hour brands of spray to short-acting forms, then going on to children's formula.

Or you might use the spray in just one nostril so you will be able to keep breathing through one side while the other gradually clears.

USING OTC DRUGS WITHOUT BECOMING

"HOOKED":

* If you suspect you are taking too much of an OTC drug, or taking it too often, make it less readily available. Store it in an out-of-the-way place. Don't keep a supply in your purse or pocket, or in the glove compartment of your car. If you're having a dependency problem with an OTC drug, don't keep that medication around the house.

* Limit use to the dosage and amount of time specified on the label. Gerald Rachanow of the FDA says, "For self-medication you should always follow the package guidelines. However, occasionally you may use a specified OTC drug longer than the packaging recommends if you are under a doctor's supervision."

* Even if you have taken the drug before, be sure to read the label on a new bottle or package. Manufacturers are constantly changing formulas and updating ingredients, warnings, and other instructions.

* If you don't fully understand the instructions, or if you are wondering about taking the OTC drug with prescription drugs you may also be taking, ask your pharmacist's advice.

* Having trouble kicking the OTC habit? Ask your physician for help. You needn't be embarrassed, because you surely won't be the first he/she has encountered.

OTC drugs aren't harmless. They can be exceptionally helpful--but only if they are taken strictly according to the directions on the package. There is no reason to become addicted to OTC drugs. They didn't choose you--you chose them. And only you can choose to stop them.

Jean E. Laird, mother of five (now in their 20s and 30s), has sold 900 articles to major publications like Ladies' Home Journal, Good Housekeeping, Parents, Better Homes and Gardens, Parade, Catholic Digest, and many others. She is also the author of several books and teaches a journalism course at a college in Chicago.