Ellen Campbell-Grizzle
ALMOST ANY substance can be misused. However, major concern revolves around those over-the-counter (OTC) agents that have a direct action of the central nervous system and cause a stimulant or depressant effect on mood. This includes painkillers, antidiarrhoeals, cough and cold preparations, travel sickness tables and hay fever preparations. There are also laxatives and inhalants that are frequently misused by adolescents. Many of these products were formerly prescription items and still need to be used with care.
The misuse of drugs in sport receives widespread media coverage, particularly after an elite athlete fails a drug test and is banned. Many pharmacists are faced with questions of how to treat specific conditions without exposing the athlete to the prospect of banning. The widely-publicised classes of substances consist of stimulants, narcotic analgesics, anabolic steroids and diuretics. In several cases, OTC preparations containing stimulants, such as caffeine, ephedrine and alcohol must be monitored. Selected vitamins and mineral supplements and some herbal remedies contain banned substances such as ephedrine and steroid.
Several other types or categories of OTC preparations are targets for drug misuse. These are:
Volatile solvents or propellants for inhalation. Solvents are also used for purification of street drugs.
Analgesics containing multiple constituents with caffeine or codeine. Irreversible and progressive destruction of the kidney can result after years of prolonged use.
Stimulant laxatives with which mostly some older females are obsessed. Despite the fact that they have no symptoms of constipation, they ensure a daily bowel movement through the use of products such as senna or bisacodyl. A younger group of females assumes that these laxatives reduce the caloric intake in food. This belief is often associated with underlying eating disorders such as anorexia and/or bulimia.
Nicotine replacement therapy (NRT) offers major benefits to cigarette addicts. It is not yet clear whether long-term use of NRT will also become a real issue. Pharmacists are advised to recommend counselling support along with these products to assist the smoker to quit. No NRT is yet licensed for pregnant women.
Some effective proprietary cough and cold remedies contain compounds that are structurally related to the amphetamine class and in high doses are stimulants and appetite depressants. Excessive doses lead to euphoria and changes in perception. A component in many of these preparations, pseudoephedrine, is used as a precursor chemical in the manufacture of methamphetamine. Vigilance must be exercised regarding the safe use of pseudoephedrine-containing products.
Citric and ascorbic acid. These are used to make some hard drugs more water-soluble.
Cooling rubs that cause vasodilation of the peripheral blood vessels and lead to rapid cooling. Some drug abusers use these substances to prevent overheating.
Powders and wrappers. In some countries, drug dealers are using these powders to 'cut'
their supplies and repackaging the street drugs in the original wrappers.
Most persons use OTC preparations without negative consequences. However, it is possible for persons who have used medicines legitimately, in high doses, to become dependent on one or more constituents. There are those who deliberately experiment with OTC preparations for 'kicks'. Others are dependent on 'harder' drugs but use OTC preparations as substitutes when other drugs are unavailable.
Please, talk to your pharmacist about:
1. Potential drug interactions between OTC preparations and your prescribed medication.
2. OTC preparations that may contain the prohibited class of substances for athletes.
3. The safe use of all medicines.
Ellen Campbell-Grizzle, president, Caribbean Association of Pharmacists; director, Information & Research, National Council on Drug Abuse; email: yourhealth@gleanerjm.com.
