An increasing number of young people in Japan are being taken into emergency care after overdosing on over-the-counter medicines. Even if they aren't taken to hospital, there are also many young people suffering from addiction to over-the-counter drugs. To find out about the current situation and measures that families can take, the Mainichi Shimbun interviewed Yoshito Kamijo, 65, who established the Clinical Toxicology Center at Saitama Medical University Hospital in Moroyama, Saitama Prefecture, and is engaged in treatment for drug poisoning.

Mainichi: Is the number of patients addicted to or overdoing on over-the-counter drugs increasing?

Yoshito Kamijo: During the COVID-19 crisis, there was an increase in the number of patients in their teens and 20s who were taken in for drug poisoning. Each year about 90 people from the western part of the prefecture including the cities of Chichibu and Tokorozawa are brought in to our center. About 80% of the cases involve drug poisoning. Middle-aged and older people often become addicted to sleeping pills, but with youths, most of the cases involve addictions to over-the-counter drugs. Many young people are relying on such drugs on a daily basis and abusing them, but have not gotten to the point of being taken to the hospital for emergency treatment.

Previously when junior high and high school students had bad experiences, they would discuss the problems with their friends at school and solve them. But during COVID-19, even when they were at school they were told, wear masks, stay at least a meter apart, don't talk too much. And so, when they revealed their problems online, people introduced them to addictive over-the-counter drugs, telling them, "You can get this medicine (to relieve stress)." And they relied on them. Patients tell me stories like this. Many of them are female.

MS: If they're taken to hospital, can they be helped?

YK: On average, patients arrive at hospital three to 3 1/2 hours after taking the medicine. Even if they consume a large amount, if there are signs of life when they arrive (such as a heartbeat and breathing), usually they can be saved. Even if the heart stops temporarily, there are machines that can remove and oxygenate the blood and return it to their bodies. We encourage people not to give up but to call for an ambulance and take the person to the hospital.

MS: What kind of treatment is given?

YK: First is resuscitation and monitoring the patient's body. We attach them to a ventilator and if their blood pressure is low, we use a vasopressor. There are three special treatments for poisoning: The first is inhibiting absorption. We have them drink activated charcoal to absorb the drugs remaining in their stomach and intestines, which is then excreted from the body. The second is promotion of excretion, where the drugs in the blood are removed from the body. One way to do this is through blood dialysis. This is quite effective for caffeine poisoning, and even in serious cases, there is a dramatic improvement after about four hours. The third is using antidotes.

MS: Which drug ingredients are problematic?

YK: One is dihydrocodeine, which is used in cough suppressants. Only tiny amounts are used so it is permitted, but the constituents are similar to morphine. Another cough medicine is methylephedrine, whose constituents are similar to stimulant drugs. Both are addictive. That's why people abuse over-the-counter medicines containing them. Other drugs such as diphenhydramine, which is found in medicine to improve sleep, can cause people to fall into a coma when taken in large doses.

Particularly problematic is caffeine. We examined 101 patients who were brought to hospital after ingesting large amounts of caffeine. Seven of them suffered cardiac arrests and three of them died. The cause was not tea or coffee, but tablets that enabled them take a large dose at once. These are toxic and we would like to see restrictions on their sale.

Additionally, bromovalerylurea, an ingredient found in headache medications and other drugs, can cause respiratory arrest if taken in large quantities. This is contained in some over-the-counter drugs in Japan, but it is not included in medicine people receive at hospitals and it is not used overseas. We want these ingredients that can kill people if they take too much to be regulated.

MS: What countermeasures are needed?

YK: Drugs that are harmful or that can even cause death when taken in large quantities can be obtained at drugstores and online. People that are addicted to over-the-counter drugs often want a large amount of medicine at once, so they rely on drugstores rather than going online. I think regulations at that point are important.

MS: Do you have a message to young people who abuse or take large doses of over-the-counter drugs and their parents?

YK: Unfortunately, there are few places where parents can go for consultation if they suspect their child might be abusing drugs. But the fact that the number of patients increased during the COVID-19 pandemic offers a clue. One preventative measure is to talk (with young people) and communicate with them. It's important to have an environment in which they can talk about their stress when it occurs. Having places where they can gather and talk freely would be beneficial.

(Interview by Shogo Takagi, Tokorozawa Local Bureau)