> SOUTHERN INDIANA — Over-the-counter drugs are medicines sold directly to the public, as opposed to drugs that require a prescription by an authorized health care provider. They probably should be called “off-the-shelf” drugs instead, since it is prescription drugs that are actually sold over the counter.

There are a few drugs that fall in the middle. These don’t require a prescription, but the buyer must sign for the purchase and there may be quantity restrictions, like with pseudoephedrine — which can be used in the manufacture of methamphetamine.

Until it became a prescription drug, the antidiarrheal analgesic paregoric — tincture of opium — was also one of these medications. In the past, some parents would put a few drops of paregoric in their children’s milk to calm them down or help them sleep. Maybe that’s why there were fewer cases of hyperactivity diagnosed back then.

Once there were very few over-the-counter commercial drugs, but now they account for about 80 percent of all medications used in the United States. Americans buy well more than 5 billion such drug products each year. With today’s economy, high unemployment and the inability to afford health insurance, the number of people who are treating themselves is growing.

The last time my wife, Diane, went for a check-up, we were surprised that her doctor recommended several over-the-counter drugs. One of the medications that Diane is now taking is a dietary supplement made from krill, a small marine creature. Like fish oil, this substance is reputed to help lower cholesterol. The bottle smells like a shrimp boat in August, but they say it is manufactured in a special way so there is no fishy aftertaste or burps. So far so good.

The krill oil reminds Diane of the cod liver oil her mother spooned in her mouth as a child. Cod liver oil was once given to young children as a tonic and to prevent rickets, because it contained a lot of vitamin A and D. It was formerly made by fermenting barrels of cod livers and seawater for about a year and then extracting the oil; I’m not kidding.

According to the Consumer Healthcare Products Association, retail sales of OTC products in 2009 were more than $16.9 billion, a 14 percent increase in the last 10 years. There are more than 80 different classes of OTC medications and well more than 100,000 products on the market today. The biggest sellers in 2009 were cough and cold remedies, pain medicines, heartburn drugs, toothpaste and laxatives, in that order.

Like Diane’s mother’s affection for cod liver oil, people often develop strong loyalties to the over the counter drugs they use. Comedian Chris Rock talked about how money was so tight when he was a child that he had to be almost dead in order to go to the doctor. Instead, his father thought he could use Robitussin cold medication to treat literally everything. It didn’t matter if it was asthma, cancer or a broken leg. “Just let the Tussin sink in,” he said.

My own father was a firm believer in a product called Sal Hepatica. According to him, a little of this saline laxative, made by Bristol-Myers, was enough to cure whatever ailed you. I think he was especially impressed by Sal Hepatica because its television commercial came on during “Gunsmoke” on Saturday nights. He was convinced that a good dose of Sal Hepatica was all Chester really needed to be cured of that limp.

Today there are more than 700 OTC drugs that formerly were prescription only. Since 1976, more than 73 drugs or dosages have switched from prescription only to OTC. I remember being thrilled when Benadryl became an over-the-counter drug.

With all my children’s ear infections, I had high hopes for Amoxicillin. It seemed like my kids were constantly taking this pink liquid that tasted like bubble gum. I suppose making that an OTC drug wasn’t such a great idea, since the misuse of antibiotics seems to have resulted in the antibiotic-resistant strains of bugs that are hard to fight off today. Still, I dreamed of a nice economy-sized bottle.    

There are, of course, many risks involved in using OTC drugs to self medicate. First of all, you may have misdiagnosed the problem and the resultant delay in getting the proper treatment could negatively effect the overall outcome.

Second, contrary to conventional wisdom, when it comes to medicine, more is not necessarily better. Many people take OTC medicines longer or in higher doses than the directions would indicate.

As Jerry Seinfeld said in one of his routines, we all want the “maximum strength” possible when it comes to medicine. He said that what we really want is for the manufacturer to first determine what dose would kill us and then back off just a little bit. Why mess around with some puny dose that won’t do any good?

If your symptoms continue, experts say you should take that as a clear sign that you should see your health care provider.

I have just started taking a probiotic over the counter medication to help “balance my digestion.” I am not sure what that means. It reminds me of that infomercial for garlic pills that emphasizes their “garlicky goodness.” Actually, I am testing these pills out for Diane, who wanted to ease into these suggested remedies, one at a time, so she can determine if any of them bother her. She’s a scientist, at heart, and required a test subject.

Each one of these pills promises to have several billion live bacteria that are good for your digestion. I’m not about to count them, but I’m hoping they can compensate for my bad eating habits. I think they might actually be helping. The only problem is that every time I take one, I think I can feel all those bacteria swimming around, tickling my throat.

— Terry L. Stawar, Ed.D., lives in Georgetown and is the CEO of LifeSpring, the mental health center in Jeffersonville. He can be reached at tstawar@lifespr.com. Check out his Welcome to Planet-Terry blog and podcast at http://planetterry.wordpress.com