August 22, 2025

OTC vs. Prescription: Understanding the Risks for Teen Health

Learn the risks of OTC and prescription drug misuse among teens, including health dangers, addiction potential, and drug use prevention strategies for parents

Gary R Hazy

August 22, 2025

According to the National Center for Drug Abuse, around 442,000 teens report misusing non-illicit drugs. Non-illicit drugs means that they are legal to sell, manufacture, and possess, and are sold either over-the-counter (OTC) or as a prescription (RX)[1].

Many teens mistakenly perceive OTC and prescription drugs as being safer alternatives to illicit drugs because they are legal and often FDA-approved for medical use. However, abusing either leads to significant risks to the health of teens.

Read on to understand the differences between OTC and prescription drugs, common ones abused by teens, and how to prevent medication misuse in youth.

What Are OTC Drugs and How Are They Different from RX Drugs?

Over-the-counter drugs are medications sold without a prescription. They can be bought in drugstores, pharmacies, or grocery stores. RX drugs are only distributed in pharmacies and require a prescription. Some of the key differences between OTC drugs and RX drugs include [2]:

Drug Class	RX Prescription	Over-The-Counter (OTC)
Availability and Accessibility	Requires a prescription from a medical professional and is sold only at pharmacies	Available without a prescription and can be purchased in stores, pharmacies, or online
Intended Use	Prescribed for specific, often more serious medical conditions and under medical supervision	Self-care use, relief of symptoms from minor problems, such as colds, allergies, or headaches
Safety and Potency	Higher potencies require strict medical oversight, a higher risk of addiction, and overdose with certain classes (opioids)	Lower potency, although it can still be dangerous if taken too much
Cost	Higher priced, but often covered by insurance	Not usually covered by insurance, but at a much lower price
Examples	Xanax (benzodiazepine), Oxycodone (opioid), Adderall (stimulant)	DXM cough syrup, Benadryl, Sudafed, Nyquil, Laxatives

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Are OTC and RX Drugs Safe? Health Risks to Consider

When taken as prescribed or as instructed on the packaging, both OTC and RX drugs are safe and medically beneficial. However, when misused, abused, or taken incorrectly, they can impact the brain's reward system and quickly lead to addiction.

Commonly Abused OTC Drugs

Below are some of the most commonly used OTC drugs, their effects, and health risks to consider [3][4].

OTC Category	Common Drugs	Effects	Risks to Consider
Cough Medication	Dextromethorphan (DXM)	Mild stimulant effects, increased euphoria, hallucinations, dissociations in higher doses	Most commonly abused OTC drug, around 25% of 9th graders reported using DXM to get high, known as “robotripping”.
Allergy Medication	Diphenhydramine (Benadryl)	Sedation, anxiety relief, mild hallucination in higher doses	Commonly abused for sedative effects, or teens who struggle to sleep
Stimulant OTC Cold Medications	Pseudoephedrine (Sudafed)	Increased alertness and energy	Abused for its stimulating and energy-producing effects
Pain Relievers and NSAIDS	Acetaminophen, Ibuprofen, Naproxen	Can relieve pain, but is not sedating, euphoria-inducing, or addictive. Taking too much can quickly lead to overdose and a medical emergency	May be misused for pain relief, but low risk of abuse in teens.
Sleep Aids	Nyquil	Sedation and mild euphoria in high doses	May be abused
Laxatives	Miralax	Increase bowel movements, but over time, can lead to dehydration and gastrointestinal damage	Abused in teens with eating disorders or low self-esteem and weight-related issues

Commonly Abused RX Drugs

Below are some of the most commonly used RX drugs, their effects, and risks to consider.

RX Category	Common Drugs	Effects	Risks to Consider
Opioids	Oxycodone, Vicodin, Hydrocodone	Sedation, muscle relaxation, pain relief (many use it as an attempt to cope with psychic pain masked as physical pain)	High risk of addiction, respiratory depression, overdose, and a difficult, intense withdrawal period
Benzodiazepines	Xanax, Valium, Klonopin	Sedation, anxiety relief, increased euphoria, similar to some people feeling drunk	High risk of addiction and overdose, withdrawal can be dangerous if unsupervised
Stimulants	Adderall, Ritalin, Vyvanse	Increased energy, alertness, and a boost in productivity	Abused as a study drug, can increase the risk of anxiety, paranoia, mood swings, and heart problems

Why Teens Misuse Medication

Teens misuse medication for a variety of reasons. Some to relieve symptoms of underlying mental health disorders, others to cope with academic stress, and many just to get high. Below are the top 5 most common reasons why teens report misusing medication and abusing drugs:

To get high and feel good. Many teens abuse these as an attempt to experience the mind-altering effects, euphoria, and stress relief when taken in high doses.

Some are just simply curious or bored and want a new experience. These drugs are also often available in the home.

Influence from friends or social media that normalize or glamorize drug use. These include social media trends such as the Benadryl challenge, cooking food with Nyquil, or making “sleepy time” cocktails (lean) using cough medicine and Sprite.

Teens with unresolved mental health challenges such as anxiety, depression, or trauma may misuse medication as a desire to escape or a form of self-harm.

Many teens wrongly assume that prescription and OTC medications are safer, carrying little to no risks compared to illicit drugs, because they are legal and used by doctors.

How to Protect Teens from Medication Misuse

Protecting teens from medication misuse begins with education. Unlike illicit drugs, OTC and RX meds can’t always be avoided. Have open conversations with your teen about the importance of taking prescription medications as prescribed, and OTC meds as instructed on the bottle.

Let them know that even OTC medications, often perceived as safe, can cause severe health problems such as stomach ulcers, liver toxicity, and overdose. A few other ways to protect teens from medication misuse include:

Keep medications safely stored where teens cannot easily access them. Put prescription medications in locked cabinets and limit access to OTC drugs as necessary.

Encourage teens to think critically about what they see on social media or hear from their peers. Build up their self-esteem so they don’t fall prey to senseless trends.

Model healthy drug-taking behaviors. Take your prescription medication as prescribed. Only use OTC medication as instructed.

If you recognize the signs your teen is abusing OTC or RX drugs, reach out to a mental health professional who can provide clinical support. Some common signs of OTC and prescription drug abuse in teens include:
- Mood swings, anxiety, depression, angry or aggressive outbursts
- Isolation, secretive behavior, lack of motivation, or sudden academic decline
- Medication is missing from the home medicine cabinets, or you find empty packages of OTC drugs in their room
- Nausea, vomiting, dizziness, slurred speech, flu-like symptoms, in serious cases, seizures or loss of consciousness

Substance Abuse Counseling for Teens at Lotus Behavioral Health in FL

Lotus Behavioral Health is a residential treatment facility for teens located in Florida. Our programs are designed to support teens and their families with the tools they need to recover from substance abuse and co-occurring mental health disorders.

We offer a blend of comprehensive recovery services such as individual therapy, group therapy, medication management, and skill-building workshops to help teens recover from prescription and OTC drug abuse. Contact our admissions team today to find support for your family.

Sources

[1] National Institute on Drug Abuse. 2024. Reported use of most drugs among adolescents remained low in 2024.

[2] Over-the-Counter (OTC) Medications. Updated 2025. Drugs.Com.

[3] Gupta, L. et al. 2024. Dextromethorphan: A double-edged drug – Unveiling the pernicious repercussions of Abuse and forensic implications. Journal of Emerging Trends in Drugs, Addiction, and Health.

[4] Chmielinski, J. (2018). Adolescents' Misuse of Over-The-Counter Medications: The Need for Pharmacist-led Intervention. Innovations in pharmacy, 9(3), 1–7.

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About the Author

Gary R Hazy

Gary Hazy serves as the Executive Director of Lotus Behavioral Health. With a career spanning 20+ years in the behavioral health field, Gary has dedicated his efforts to transforming the lives of kids and families facing challenging situations. He is fueled by a passion for making a positive impact and has tirelessly advocated for accessible, compassionate, and evidence-based care. His experiences across several states, in diverse roles, allows him to not only have a deep understanding of the mental health care field but also the kids he serves. Known for his exceptional interpersonal skills and ability to inspire others, Gary fosters a collaborative environment where team members are challenged, accountable and thrive. He values the expertise of Lotus Behavioral Health's dedicated staff and believes in empowering them to make a difference in the lives of the kids in their care. Gary remains steadfast in his mission to transform lives and improve the overall well-being of the community. Through his visionary leadership, compassionate approach, and commitment to excellence, he continues to make a lasting impact on the lives of youth in need.

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