You’re staring at a row of bright plastic bottles in a CVS aisle at 2:00 AM. Most people are just looking for a way to stop coughing so they can sleep, but there’s a subculture—mostly younger, often desperate, or just plain curious—looking for something else entirely. They’re looking for over the counter drugs that get you high. It sounds convenient. It sounds "safer" because, hey, the FDA approved it, right?
That logic is flawed. Deeply.
The reality of OTC drug abuse is messy, physically taxing, and sometimes permanent. We aren't just talking about a little buzz. We are talking about hallucinations, liver failure, and heart arrhythmias that can kick in before you even realize you’ve messed up.
Why Dextromethorphan (DXM) is the most common culprit
Most people know it as "Robo-tripping." Dextromethorphan is the active ingredient in over 120 cough and cold medicines. At the recommended dose—usually 15 to 30 milligrams—it’s a godsend for a dry cough. It works by signaling your brain to stop the coughing reflex. But when someone chugs an entire bottle? Everything changes.
At high doses, DXM acts as a dissociative anesthetic. It’s chemically related to ketamine and PCP.
Users describe "plateaus." The first plateau is a mild stimulant effect. The fourth plateau? That’s a full-on out-of-body experience where you might lose contact with reality entirely. Dr. Edward Boyer, a toxicologist at Brigham and Women's Hospital, has noted in various medical journals that the "high" is often accompanied by something called the "robo-walk," where your coordination is so shot you look like a glitching android.
It isn't fun. It's terrifying for the people watching you, and it’s brutal on your kidneys. Many of these syrups also contain acetaminophen. If you take enough syrup to get high on DXM, you might accidentally take enough acetaminophen to destroy your liver. Acute liver failure is a slow, painful way to go.
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The Diphenhydramine "Shadow People"
Then there’s Benadryl. Or rather, diphenhydramine.
It’s an antihistamine. It’s meant for hay fever or itchy hives. But in the dark corners of the internet—think Reddit’s r/DPH—people talk about taking 20, 30, or 50 pills at once. This isn't a euphoric high. It’s a delirious nightmare.
High doses of diphenhydramine block acetylcholine, a neurotransmitter vital for memory and muscle control. The result is "anticholinergic toxidrome." You get a racing heart, bone-dry skin, and vivid hallucinations of spiders or "the hat man." It’s a state of temporary psychosis. Honestly, most people who try this once never want to do it again because the "high" feels like a fever dream where you’re being hunted by your own furniture.
Loperamide: The "Poor Man's Methadone"
This one is particularly scary because it’s so under the radar. Loperamide is the active ingredient in Imodium. It’s an opioid.
Wait. Don’t get excited.
It’s an opioid that is specifically designed not to cross the blood-brain barrier under normal circumstances. It stays in your gut to stop diarrhea. However, some people discovered that if you take massive, "mega-doses"—we are talking 50 to 100 pills—some of it can force its way into the brain.
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The price is astronomical. Loperamide is cardiotoxic at those levels. The FDA issued a safety communication because people were literally dropping dead from "Torsades de Pointes," a specific type of fatal heart rhythm. You’re trying to catch a cheap high and your heart just... quits. It’s a gamble with zero upside.
What about Pseudoephedrine and Laxatives?
Pseudoephedrine is the "D" in Sudafed. It’s a stimulant. It’s also why you have to show your ID and get tracked by the DEA when you buy it. While it can cause jitters and a racing heart, it’s more commonly used as a precursor to manufacture methamphetamine rather than being abused on its own.
Then you have the "lifestyle" abuse. Laxatives and diet pills. These aren't about "getting high" in the traditional sense, but they are frequently abused for the "high" of weight loss or control. The damage here is long-term: electrolyte imbalances that lead to cardiac arrest.
The Physical Toll Nobody Mentions
It’s easy to focus on the brain, but the body pays the bill. OTC drugs are often "combination" medicines.
- Guaifenesin: Often found in cough meds. Too much will make you vomit uncontrollably. It also causes kidney stones.
- Alcohol: Many liquid medicines are up to 10% ethanol.
- Phenylephrine: Found in sinus meds. It can spike your blood pressure so high you risk a stroke.
The National Institute on Drug Abuse (NIDA) points out that OTC abuse is especially dangerous because it's often mixed with alcohol or prescription drugs. This "poly-drug" use creates a chemical cocktail that emergency room doctors struggle to treat because they don't know what's causing the seizure or the respiratory depression.
Realities of Regulation
Lawmakers aren't blind to this. In many states, you have to be 18 to buy DXM products. Retailers like Walmart and Walgreens have "hard stops" at the register.
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But you can’t regulate everything. You can’t ban Benadryl. It’s too useful.
This places the burden on parents and individuals. If you see someone with "brain fog" that won't go away, or if you find empty blister packs of cold medicine in the trash, it’s a red flag. The "high" from these drugs is a sign of toxic overload. It is the brain malfunctioning under chemical stress.
How to Handle OTC Concerns
If you or someone you know is experimenting with over the counter drugs that get you high, the first step isn't a lecture. It’s understanding. Often, this behavior is a bridge to other substances or a way to self-medicate for untreated anxiety or depression.
- Check the labels: If a medicine has more than one active ingredient, the risk of overdose on the secondary ingredient (like Tylenol) is extremely high.
- Monitor the heart: Tachycardia (fast heart rate) is a common side effect of almost all OTC abuse. It is a precursor to more serious cardiac events.
- Seek help for the "why": Substance use disorder doesn't care if the drug came from a dealer or a drug store.
The myth of the "safe" legal high is just that—a myth. These chemicals are designed to be used in milligrams, not grams. When you cross that line, you aren't a casual user anymore; you’re a patient in waiting.
If you suspect an overdose, call the Poison Control Center (1-800-222-1222) immediately. They are anonymous, free, and they have seen it all. Don't wait for the person to "sleep it off." With drugs like loperamide or high-dose Benadryl, sleeping it off might mean never waking up.
Practical Next Steps
- Clean out your medicine cabinet. Dispose of expired or unneeded medications at a local pharmacy "take-back" kiosk.
- Educate younger family members about the specific dangers of acetaminophen poisoning—it’s the "silent killer" in many OTC abuse cases.
- If you find yourself reaching for these pills to cope with stress, look into local outpatient counseling or support groups that specialize in non-traditional substance abuse.
OTC drugs are tools for health, but when used as a shortcut to a high, they become some of the most unpredictable poisons available to the public.