Over-The-Counter (OTC) Opioids: Risks And Side Effects

Over-the-counter opioids are opioid-containing medications available to the general public without a prescription, typically used to treat mild to moderate pain or suppress a cough. While they contain lower doses of the active opioid ingredient than prescription medications, they are not without risk, and in some ways their easy accessibility makes them more prone to misuse than stronger opioids that require a prescription.

The most common opioid ingredient found in OTC medications is codeine, which must be combined with at least two other medicinal ingredients and kept below a certain dosage threshold to qualify for over-the-counter sale. Availability varies by state, and some locations require an ID to purchase these products.

What Are Over-The-Counter (OTC) Opioids?

Over-the-counter (OTC) opioids are opioids that are available to the general public without a prescription. They are not always available in every state, however, and may require an ID in order to purchase.

Medicinal ingredients found in over-the-counter opioids include:

• caffeine
• acetaminophen
• aspirin
• carisoprodol
• promethazine

The opioid ingredient that you most often see in OTC opioid medications is codeine. In order to be sold over the counter, the dose of codeine must below and it must be combined with at least two other medicinal ingredients.

Risks Of Over-The-Counter Opioids

OTC opioids may contain a much lower dose of the active opioid ingredient than the prescription options, but that does not mean they are without risks. In some ways OTC opioids could be considered even more dangerous than prescription opioids because they are so readily available. The real danger starts when one of these medications starts being misused.

Ways to misuse a medication include:

• taking more than the recommended dose
• taking it when not medically necessary
• mixing multiple products together
• taking it in ways not intended (for example, crushing up and snorting a pill that is meant to be taken orally)

When taken in high enough doses, OTC opioids produce the same euphoric effects that both prescription and illicit opioids are known for. For this reason, addiction is highly possible, and unfortunately, the product is relatively easy to obtain.

Side Effects Of Over-The-Counter Opioids

The side effects of OTC opioids will be much milder than those with prescription opioids, and will oftentimes depend on the other active medicinal ingredients. Side effects will be stronger if the medication is misused or abused.

Side effects of over-the-counter opioids include:

• headache
• difficulty urinating
• stomach pain
• constipation
• nausea and/or vomiting
• dizziness
• lightheadedness
• sleepiness
• euphoria

The side effects of OTC opioids will become stronger with higher doses, at which point the individual can develop slow and shallow breathing and potentially lose consciousness.

Is It Possible To Overdose On Over-The-Counter Opioids?

While it would take a much larger amount to overdose on an OTC opioid than on a prescription opioid, it is possible. These medications are never meant to be taken in high doses or long-term.

It is also important to note that OTC opioids are often misused in combination with other substances, most commonly alcohol, marijuana, and other OTC medications. Complications are more likely to arise when these substances interact with each other.

Find Treatment For An Opioid Addiction

OTC opioid misuse can escalate into full addiction more quickly than many people expect, particularly because these products are so easy to obtain and are often not perceived as serious drugs of abuse. When misused in high doses or in combination with alcohol or other substances, OTC opioids can cause the same dependence and withdrawal as prescription opioids, and stopping without support can be genuinely difficult.

Treatment options include medically supervised detox, medication-assisted treatment, and behavioral therapy through inpatient or outpatient programs.

Written by the Addiction Resource Editorial Staff