Examination of Over-the-Counter Drug Misuse Among Youth1 Erin J. F.docx

Examination of Over-the-Counter Drug Misuse Among Youth1
Erin J. Farley and Daniel J. O’Connell
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Examination of Over-the-Counter Drug Misuse Among Youth
by Erin J. Farley and Daniel J. O’Connell
Prepared by: Mary H. Maguire, California State University,
Sacramento Article Kim Schnurbush, California State
University,Sacramento
Examination of Over-the-Counter Drug Misuse Among Youth1
Erin J. Farley and Daniel J. O’Connell
Learning Outcomes
After reading this article, you will be able to:
• Discuss the factors that contribute to the prevalence of over-
the-counter drug misuse by teens.
• Analyse the contribution of gender to over-the-counter drug
misuse by teens.
• Discuss possible policy or practice efforts to decrease over-
Introduction
Potential harm from the intentional misuse of over-the-counter
(OTC) medicines among youth has become an area of increased
concern among medical practitioners and researchers (Bryner et
al. 2006; Lessenger et al. 2008; Substance Abuse and Mental
Health Services Administration (SAMHSA) 2006). Although the
likelihood of death from overdose is rare, research has revealed
an increase in dextromethorphan (a key ingredient in numerous
cough and cold medicines) abuse cases reported to poison
control centers (Bryner et al. 2006). Equally important is the
suspicion that OTC use may be a stepping stone to other forms
of drug misuse and abuse.
While OTC misuse has garnered increased media coverage, it

has not yet attracted an equivalent interest among researchers.
Further, it is possible that research to date has inappropri- ately
specified the relationship between OTC and other drug misuse.
Extant research has examined the relationship between OTC
misuse and illicit drug use by utilizing a single construct,
limiting the ability to completely flesh out the dimensions of
this relationship between drug use. One area that needs further
attention is if and how OTC misuse among youth is associated
with other types of drug use. By combining all categories of
drugs under a single construct, the nuances of how particular
drugs relate to OTC use is diminished. This paper examines the
current state of knowledge on OTC misuse by examining the
prevalence of OTC misuse and its relationship with other types
of drug use among a specific cohort to expand the current
understanding of the problem.
Prevalence of OTC Misuse
OTC cough and cold medicines (e.g., Coricidin and Nyquil) can
be easily purchased from pharmacies and drug stores.
Adolescents typically ingest OTC medicines for the ingredient
dextromethorphan (DXM). DXM is a synthetic drug related to
opiates, which has the ability to produce effects similar to
psychotropic drugs (Bobo et al. 2004; SAMHSA 2006). These
effects include sensory enhancement, perceptual distortion, and
hallucinations. DXM can be found in as many as 140 different
cold and cough medications (Bobo et al. 2004; SAMHSA 2008).
Misuse of these types of OTC drugs often involve youth seeking
inexpensive and easily accessible substitute for other drugs that
are more difficult to obtain.
Misuse of OTC drugs, especially in combination with other
types of drugs, can lead to a variety of serious health problems,
including confusion, blurred vision, slurred speech, loss of
coor- dination, paranoia, high blood pressure, loss of
consciousness, irregular heartbeat, seizure, panic attacks, brain
damage, coma, and possibly death (Bobo et al. 2004; Food and
Drug Admin- istration 2005). Yet, there is a growing concern
that youth who intentionally misuse OTC drugs misperceive that

they are safe because these types of drugs are legal and
prevalent (Johnston et al. 2006). If this misperception is
contributing to the misuse of OTC drugs, the consequences can
be serious. On the other hand, this same misperception also
points toward potentially efficacious prevention programs
focused on educating youth to the harm posed by these drugs.
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· Prevalence by Age
The abuse or misuse of OTC drugs appears to be mostly a
problem among younger persons. A Drug Abuse Warning Net-
work (DAWN) report revealed that 12,584 emergency depart-
ment visits were associated with DXM use in 2004 (SAMHSA
2006). Among these, 44% (5,581) were associated with the
nonmedical use of DXM products among patients aged 12 to 20.
Findings from this report highlight that negative consequences
associated with OTC misuse are more likely to occur among
youth and young adults. For example, the rate of visits to the
emergency department resulting from nonmedical use of DXM
was 7.1 per 100,000 youths ages 12 to 20. For older age groups
the rate was 2.6 visits or fewer per 100,000 (Bobo and Fulton
2004). In addition, a recent National Survey on Drug Use and
Health (NSDUH) report highlighted OTC misuse as a significant
problem among youth and young adults (SAMHSA 2008).
According to this report, respondents age 12 to 17 years were
more likely than those age 18 to 25 years to report past year
misuse of OTCs (SAMHSA 2008).
One signal that OTC misuse is becoming of greater concern
among researchers is the addition of an OTC measure (to get
high) by both the Monitoring the Future and the National Drug
Use and Health in 2006 into their annual surveys. The 2007

Mon- itoring the Future (MTF) survey revealed that 4% of
eighth graders, 5% of tenth graders and 6% of twelfth graders
report past year use of OTCs to get high (Johnston et al. 2008).
For eighth graders in particular, self-report misuse of OTCs was
lower than past year marijuana (10%), inhalant (8%), and
alcohol (32%) use. However, OTC misuse was higher than past
year hallucinogen (2%), ecstasy (2%), Oxycontin (2%), Vicodin
(3%), Ritalin (2%), and tranquilizer (2%) use.
Prevalence by Gender, Race, and Ethnicity
Extant research reveals significant gender differences in OTC
misuse. A 2008 NSDUH report found an interaction of age and
gender on self-report OTC misuse. While females age 12 to 17
years were more likely than males in the same age group to
report past year OTC misuse, males age 18 to 25 years were
more likely to report past year OTC misuse in comparison to
females in the same age group (SAMHSA 2008). Other research
has found significant gender differences in OTC misuse. For
instance, both Steinman’s (2006) analysis of 39,345 high school
students from Ohio and Ford’s (2009) examination of the 2006
National Survey on Drug Use and Health data (ages 12 to 17)
revealed significant gender differences with females more likely
to report OTC misuse than males (Ford 2009; Steinman 2006).
Research on racial and ethnic differences in OTC misuse is less
clear. While Steinman’s (2006) findings revealed Native
Americans were more likely to report misuse, followed by
white, “other/mixed,” Hispanic, Asian, and African-American,
the national survey conducted by SAMHSA (2008) revealed
whites were more likely to report OTC misuse, followed by
Hispanic and African-American. Misuse by Native Americans
may be an additional area of concern, but the extant data indi-
cate that whites and females are particularly at risk.
OTC Misuse Association with Prescription and Illicit Drugs
While the existing literature of OTC misuse is scant, there are
key observations to be noted from research on the nonmedical
use of prescription drugs (NMUPDs). Prior research on the
NMUPDs has repeatedly highlighted the strong relationship

between illicit prescription drug use and cigarette, alcohol,
marijuana, and other drug use (Boyd et al. 2006; McCabe et al.
2004; McCabe et al. 2005; Simoni-Wastila et al. 2004). These
findings suggest that nonmedical users of prescription drugs
may not be a qualitatively different category of drug users, but
are in fact part of well- established group of poly-drug users. It
is unclear from available research whether the relationship
between OTC and street drugs is the same as prescribed drugs.
Current research suggests there is reason to be concerned about
the phenomena of youth mixing cough and cold medicines
with other types of drugs. A 2006 DAWN report revealed that
among those emergency department visits that involved DXM,
13% of 12 to 17 year old visits and 36% of 18 to 20 year old
visits involved combinations of DXM and alcohol. In addition,
Steinman’s (2006) research on OTC misuse in Ohio high
schools revealed OTC misuse was associated with alcohol,
cigarette, marijuana, and other illicit drug use (e.g., cocaine,
LSD, and ecstasy). Research by Ford (2009) also found a sig-
nificant relationship between OTC misuse and binge drinking,
marijuana use, prescription drug use, and other illicit drug use.
Steinman (2006) emphasized the strong association between
OTC misuse with alcohol and other illicit drugs suggesting that
OTC misuse is not a “gateway” drug, but only one of a number
of substance utilized by adolescents.
OTC as the Gateway?
The gateway drug concept suggests that there are lower tiered
drugs that open the way towards other drugs, and that drug use
itself is responsible for opening the gate (Kandel 1975; Kandel
et al. 1975; Kandel et al. 2002). Other studies have attempted to
refute this concept, suggesting that more serious drug users may
in fact use harder drugs prior to drugs like marijuana (Mackesy-
Amiti et al. 1997). Early teen drug use may largely be dictated
by what drugs are available to adolescents, as well as a desire to
alter one’s consciousness. Access to most drugs, however, is not
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evenly distributed. Marijuana use by older youth may provide
access to a small group of marijuana users, while another group
might have access to prescription drugs, and another, access to
drugs like cocaine. Unlike these other substances, almost all
youth have access to OTC drugs.
While it has been shown empirically that “drug users use
drugs,” that is, using any substance increases the probability of
using any other substance, this pattern may not be exclusively
based on availability. In our modern consumer culture, adoles-
cents are faced with multiple choices, and increasingly, the type
of drug is one of them. Recognizing that the choice of drug is
related to both availability and preference, it is important to
understand the pattern of correlation between different drugs.
Just as there are more choices in terms of which drugs, there are
also more choices regarding where to obtain drugs. Those
involved in traditional street drugs like marijuana and ecstasy
are getting drugs from those who sell them, necessitating some
link to a criminal element. Those using OTC drugs and pre-
scription drugs can sidestep this path, which has important con-
siderations for prevention policy.
The Current Study
This study intends to tease out the relationship between OTC
misuse and the use of different types of drugs. Previous
analyses have tended to lump “other illegal drugs” together in
one category. If early teen usage is related to drug choice and
availability, combining drugs may mask relationships that exist
among individual drugs. The current study utilized a large
enough sample to examine drugs both individually and in

groups, and attempted to investigate which drugs are associated
with OTC use.
The objective of the current study is twofold: First, the prev-
alence of OTC misuse among a sample of eighth grade public
school students is examined, including gender and race differ-
ences in OTC misuse; second, the relationship between OTC
misuse and other substance use is examined to identify patterns
of use, with a specific focus on whether estimating the effects
of other illegal drugs individually provides more insight than
using a single construct.
Methods
Data for the current study are from the 2005 Delaware School
Survey. Data was collected by The Center for Drug and Alco-
hol Studies (CDAS) at the University of Delaware. CDAS has
conducted an annual survey of eighth grade public school stu-
dents since 1995 (the annual survey also measures fifth and
eleventh graders). In order to ensure confidentiality and foster
honesty, survey administrators are University personnel and not
teachers. Passive parental and active student consent is solicited
before administrating the survey. The purpose of the survey is
to track prevalence rates of drug use among Delaware public
school students.
A single question, “how often do you use OTC drugs (cough &
cold meds, Nyquil) to get high?” measured eighth grade self-
reports of OTC misuse. Response options included “never,”
“before, but not in past year,” “a few times in past year,” “once
or twice a month,” “once or twice a week,” and “almost every-
day.” This measure was recoded into a dichotomous variable (0
= not in past year, 1 = in past year).
Other substance questions included past year cigarette, alco-
hol, and marijuana use. Binge drinking was also measured and
defined as three drinks at a time in the last two weeks. Other
drug use (with the intent of getting high) questions included:
uppers (speed, meth, crank, diet pills), sedatives (tranquilizers,
barbiturates, Xanax), heroin, inhalants, ecstasy, hallucinogens,
pain relievers, stimulants (Ritalin, Adderall, Cylert, etc.),

albuterol, and crack/cocaine. All drug measures were recoded
into dichotomous variables (0 = not in past year, 1 = in past
year).
First, univariate and bivariate analyses were utilized to examine
the prevalence of OTC use and the relationship with other sub-
stances; second a series of logistic regressions were used to
demon- strate the difference between using a single construct
“other illicit drug use” differs from utilizing each drug measure
individually.
Results
A total of 7,815 eighth graders completed the 2005 survey (50%
female and 50% male). The racial and ethnic distribution of
students sampled consisted of 53% (3,975) white, 28% (2,065)
black, 8% (632) Puerto Rican or Mexican, 2.6% (198) Asian,
1.9% (142) American Indian/Native Alaskan, and 6.8% (509)
“Other.” With Steinman’s (2006) findings that Native Ameri-
cans reported the highest levels of OTC misuse, we conducted a
crosstabulation as an initial examination into racial variation.
While American Indians/Native Alaskans represented only 2.5%
of the students reporting OTC misuse in the past year, this
represented 13% of American Indians/Native Alaskans
students, this being the highest rate of use in comparison to the
other racial categories. This finding lends support to Steinman’s
(2006) findings. Due to small cell counts the race categories for
Puerto Rican, Mexican, Asian, American Indian/Native Alaskan,
and “other” were collapsed into one encompassing “other” cat-
egory. Subsequent crosstabulation analysis revealed no signifi-
cant variation between White, Black, and “other” students. As a
result, the race variable was collapsed into white and nonwhite
(0 = white, 1 = nonwhite) for use in the multivariate models.
The past year OTC misuse prevalence in eighth grade Dela-
ware sample was 10% (n = 704). Table 1 displays the break-
down of student self-reports: 86% of eighth graders reported
never misusing OTCs, 9% report past year use, and 4% report
misusing OTC in the past month.

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Table 2 demonstrates a significant difference between male and
female past year misuse of OTC drugs but no significant
difference between white and nonwhite students.
Crosstabulations of OTC and other drugs are presented in Table
3. The percent of people using OTC drugs is given for those
who used and did not use each substance in the past year. For
example, the first substance column alcohol is interpreted as
5.6% of those who did not use alcohol in the past year used
OTC drugs, while 15.1% of those who did use alcohol used OTC
drugs. The distribution is not uniform across drug types. There
is a clear distribution of the type of adolescents most likely to
be misusing OTC drugs. There appear to be four steps in the
distribution in Table 3. First, youth who do not report using a
given substance remain below 10% across all substances. Sec-
ond, those youth who used alcohol and marijuana used OTC
drugs at the lowest rate among users, hovering between 15%
and 22% (Binge drinkers). Third, those using the more
traditional street drugs such as ecstasy, hallucinogens,
inhalants, heroin, and cocaine formed a middle tier, reporting
OTC use on the 25% to 30% range. Fourth and final, there is a
group of persons using prescription drugs who are more likely
to use OTC drugs as well. Those youths who used sedatives,
amphetamines, pain
Table 1 Eighth Grade Self-Reports of OTC Abuse to Get High
Percentage
Never 86% Before, but not in past year 5% Few times in past
year 5% Once or twice a month 3% Once or twice a week 1%
Almost everyday 0%*
*Note: Less than one-half of one percent.

Table 2 Crosstabulation of OTC Abuse by Gender and Race
Past Year OTC Abuse
Gender* Male 8% Female 12%
Race White 10% NonWhite 10%
*Note: Significant at the .001 level.
Table 3 Percent of OTC Use or Nonuse of Other Substances
Alcohol Binge Drink Marijuana Ecstasy Hallucinogen Sedatives
Albuterol Amphetamines Inhalants Pain Relievers Ritalin
Heroin Crack/Cocaine
Did Not Use Drug
5.6% 8.1% 7.8% 9.3% 9.2% 9.0% 7.8% 8.9% 8.3% 7.1% 8.8%
9.4% 9.1%
Used Drug
15.1% 22% 17.3% 31.0% 31.0% 48.3% 28.2% 44.0% 35.2%
56.2% 45.8% 25.4% 32.5%
relievers and stimulants were substantially more likely to use
OTC drugs, with all categories reporting over 40% OTC users
and 56% of those who use pain relievers using OTC drugs as
well. In order to further investigate how these relationships
func- tion, we next employed regression techniques to control
for the effect of other drugs.
The multivariate analyses begin in Table 4, with findings from
the initial logistic regression (Model 1). This model tested the
traditional means of measuring the effects of other illicit drugs
by utilizing a single construct. Of the 7 variables, three did not
reach significance (nonwhite, past year binge drinking, and past
year marijuana use). The odds of females misusing OTC drugs
are 1.6 times greater (OR = 1.603, p = .000) than their male
counterparts, holding all other variables constant. The odds of
past year cigarette users misusing OTC drugs is 1.4 times
greater (OR=1.385, p = .011) than nonusers. The odds of past
year alcohol users misusing OTC drugs is 1.8 times greater (OR
= 1.779, p = .000) than nonusers. Using the single construct
other illicit drugs category produced the largest effect,
returning an odds ratio of 7.7 (OR = 7.685, p = .000), indicating
that youth who reported using any of the other drugs reported in

Table 3 increased the odds of using OTC drugs in the past year
by 7.7 times.
The suggestion is that combining all other drugs into one
construct misses variation among individual drugs. In order to
tease out this concept, a logistic regression analysis examining
the effect of other illicit drugs measured individually is pre-
sented as Model 2 in Tables 4A (Model 1) and 4B (Model 2).
When compared to Model 1, there are no major differences in
the effects of the lower tiered drugs on OTC misuse, when other
variables were accounted for. The exceptions to this are the
4
Table 4A Reduced Logistic Regression Predicting Past Year
OTC Misuse (Model 1)
B
S.E. Wald Sig. OR
95% CI
1.339, 1.918 .910, 1.301 1.077, 1.780 1.441, 2.197 .924, 1.549
.673, 1.114 6.390, 9.243
- - - - - - - - - -
Constant −.316
Female NonWhite Past Year Cigarette Use Past Year Alcohol
Use Binge Drinking Past Year Marijuana Use Other Illegal Drug
Use Past Year Ecstasy Past Year Hallucinogens Past Year
Albuterol Past Year Sedatives Past Year Amphetamines Past
Year Inhalants Past Year Pain Relievers Past Year Ritalin Past
Year Heroin Past Year Crack/Cocaine
.108 1122.595 .000 .027 .472 .092 26.451 .000 1.603 .085 .091
.806 .354 1.088 .325 .128 6.446 .011 1.385 .576 .108 28.653
.000 1.779 .180 .132 1.859 .173 .197
−.144 .129 1.259 .262 .866 2.039 .094 469.024 .000 7.685 - - - -

-
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - -
Table 4B Full Logistic Regression Predicting Past Year OTC
Misuse (Model 2)
B
Constant −3.502
S.E. Wald Sig.
.110 1008.918 .000
OR
.030 1.497 1.151 1.333 1.766 1.167
.899 - .736
.587 4.071 1.336 1.148 2.302 9.920 1.964
.321 2.560
95% CI
1.234, 1.816 .959, 1.395 1.011, 1.757 1.415, 2.205 .870, 1.565
.682, 1.185
- .338, 1.600 .276, 1.248
3.205, 5.170 .714, 2.499 .624, 2.113
1.643, 3.227 7.418, 13.267 1.218, 3.169
.112, .917 1.306, 5.019
Female
NonWhite
Past Year Cigarette Use
Past Year Alcohol Use
Binge Drinking
Past Year Marijuana Use
Other Illegal Drug Use
Past Year Ecstasy
Past Year Hallucinogens
Past Year Albuterol
Past Year Sedatives
Past Year Amphetamines
Past Year Inhalants
Past Year Pain Relievers
Past Year Ritalin

Past Year Heroin Past Year Crack/Cocaine
.403 .098 .141 .098 .297 .141 .569 .113 .154 .150
−.107 .141 - -
−.307 .396 −.533 .365 1.404 .122 .290 .320 .138 .311 .834 .172
2.295 .148 .675 .244 −1.137 .536 .940 .344
16.794 .000 2.058 .151 4.139 .042
25.248 .000 1.059 .303 .573 .449
- - .600 .439 1.916 .166 132.464 .000 .821 .365 .197 .657
23.449 .000 239.336 .000 7.662 .006 4.505 .034 7.487 .006
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smokeable substances, cigarettes and marijuana, both of which
lose significance in Model 2.
The odds of females misusing OTC drugs remained
approximately 1.5 times greater (OR = 1.497, p = .000) than
their male counterparts, holding all other variables constant.
Modest effects were again found for cigarettes smokers (OR =
1.333, p < .05) and alcohol users (OR = 1.766, p = .000). The
largest effects, however, were among users of pain relievers.
The odds of students who reported past year use of illicit pain
relievers reporting OTC drug misuse were over 9 times more
likely than those who did not report pain reliever use (OR =
9.920, p = .000). Similarly, albuterol (or other asthma medicine)
misusers were 4 times more likely to report OTC misuse in
comparison to nonusers (OR = 4.071, p = .000). In addition,
inhalant misusers were approximately twice as likely to report
OTC misuse (OR = 2.302, p = .000). Similar effects were found
for cocaine use (OR = 2.560, p < .01), and Ritalin use to get
high (OR = 1.964, p < .01). Finally, heroin use significantly
declined among those students who reported past year OTC drug
misuse (OR = .321, p < .05).

Discussion and Conclusion
This study questioned whether combining all drugs into one
construct is an appropriate measure in the current drug envi-
ronment in which youth have more choices in terms of type of
drug and routes of acquiring the drugs. While the current study
replicates the findings of prior research indicating that OTC use
is correlated with other drug use, the study demonstrated that
this relationship is by no means uniform, and that combining
drugs other than marijuana and alcohol into a single “other
drug” construct misses the nuanced variation between drugs.
The objective of this study was to examine the relationship
between past year OTC misuse and other drug types including
other illicit drugs and the NMUPDs. Bivariate analyses revealed
that nonmedical users of prescription drugs were more likely to
use OTC drugs, and users of drugs like alcohol and marijuana
were least likely to misuse OTC drugs. Our full model (Tables
4A and 4B) revealed that modeling drugs individually and
allowing them to essentially “fight it out” in a regression analy-
sis showed that past year nonmedical use of pain relievers and
albuterol were by far the strongest predictors of OTC misuse.
Unlike Steinman’s (2006) findings which led him to explore
answers to the question of why is OTC misuse associated with
more serious drug use, our findings lead us to ask the ques-
tion, why is OTC misuse significantly associated with the
NMUPDs? The significant association between OTC misuse and
the NMUPDs (i.e., pain relievers, albuterol, and Ritalin) may be
due to the similar accessibility or mode of acquisi- tion for the
two types of drugs. For example, both OTC drugs and
prescription drugs may be easily accessible from friends
at school, at home in the medicine cabinet, or, in the case of
OTC drugs, from their local drug store. Acquiring OTC or pre-
scription drugs does not require contact with a traditional drug
dealer which some students do not have access to and others
might find discomforting.
The widespread and growing prevalence of OTC misuse is
partially facilitated by its easy accessibility and the perception

that OTC drugs are not as harmful as more traditional drugs.
The relationship between these OTC and NMUPD may be due to
the misperception that OTC and prescription drugs are safer
than other types of drugs.
One relationship which appears counterintuitive to the finding
that OTC use is more prominently associated with the NMUPD
is the significant relationship between OTC misuse and
crack/cocaine use. Not only did crack/cocaine use have a larger
effect on OTC misuse than cigarette use, alcohol use, inhalant
use, and illicit Ritalin use, crack/cocaine use is also a notable
step into more serious types of drug use. One possible
explanation is that crack/cocaine users often use some type of
depressant to “take the edge off.” It may thus be that some
youth who are using crack/cocaine are also using OTC drugs to
ease the “crash” from crack/cocaine. Further research is needed
to explore the dimensions of this relationship.
What appears to emerge from this study is that misusers of OTC
drugs are more likely to be using pills (sedatives, stimulants,
pain relievers) and asthma drugs to get high than they are the
traditional marijuana, cocaine, and hallucinogens of earlier
eras (see Table 2). MTF data have already shown the new drug
users are more likely to initiate use through prescription drugs
rather than marijuana (Mackesy-Amiti et al. 1997). That
finding, coupled with those above lead us to question whether
there may be a shift in adolescent drug use on the horizon or
even occurring currently.
A general awareness about the misuse potential of OTC drugs
among adolescents already exists. This awareness can be seen in
the recent movement to place OTC drugs behind cashier
counters and also limiting the number of OTC drugs an
individual can buy at one time. The findings from this analysis
help to further our understanding of OTC misuse among youth.
Research limitations need to be acknowledged. The data uti-
lized for the current analysis was cross-sectional data and limits
our ability to examine directionality of drug misuse. The sam-
ple was drawn from a single state, thus limiting its generaliz-

ability. In addition, no survey data is available for students who
were absent the day the survey was administered. Further, the
OTC measure utilized represented one general question about
OTC drug misuse instead of a list of OTC drugs by type. This
general OTC measure limits our ability to interpret differences
in misuse by type of OTC drug.
Based on the findings from this study, the authors emphasize
continued education for adolescents on the dangers of misus-
ing OTC drugs. Combating misuse should involve educating
6
parents about the dangers of the drugs in their house and the
potential for misuse, especially among youth who may not
already be known for misusing or abusing drugs. OTC drug use
occurs among inexperienced drug users and traditional signs of
drug use among youth may not be successful in identifying
youth who are abusing OTC drugs.
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Hypothesis, edited by Denise B. Kandel. New York, Cambridge
University Press.
Lessenger, James E. and Steven D. Feinberg. 2008. “Abuse of
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Goldstein. 1997. “Sequence of Drug Use Among Serious Drug
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Journal of Substance Abuse Treatment 28: 225–230.

McCabe, Sean E., Christian J. Teter, and Carol J. Boyd. 2004.
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Among Middle and High School Students.” Substance Use and
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Steinman, Kenneth J. 2006. “High School Students’ Misuse of
Over- The-Counter Drugs: A Population-Based Survey in an
Urban Area.” Journal of Adolescent Health 38: 445–447.
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(SAMHSA). 2006. The New Dawn Report: Emergency
Department visits Involving Dextromethorphan. Office of
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Note
1. OriginalstudysupportedbyDelawareHealthandHuman
Services, Division of Substance Abuse and Mental Health,
through the Substance Abuse Prevention and Treatment Block
Grant from the Substance Abuse and Mental Health Services
Administration (SAMHSA), U.S. Department of Health and
Human Services. Support for this study also received from The
Delaware Legislature through the Delaware Health Fund.
Critical Thinking
1. Discuss the factors that contribute to the prevalence of over-
2. Are their gender differences in misuse of over-the-counter
misuse of drugs? If so, why do you think this is? If not, why
not?
Internet References
Stop Medicine Abuse
http://stopmedicineabuse.org/what-does-abuse-look-like

United States Army Public Health Command
http://phc.amedd.army.mil/topics/healthyliving/asm/Pages/Over
-the- CounterMedicationMisuse.aspx
Farley, Erin J. and O’Connell, Daniel J., (2010) “Examination
of Over-the-Counter Drug Misuse Among Youth” Sociation
Today 8(2) Copyright © 2010 North Carolina Sociological
Association. Reprinted by permission. All rights reserved.
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