Last night … well, late last night, I saw a commercial for an over-the-counter sleep aid. It promised to help me fall asleep quickly and to stay asleep waking refreshed the next day. It touted a breakthrough system of dual release -– the quick-release portion for rapid relief and then the time-released component for a full night’s sleep. We’ve all seen these commercials, nothing surprising here. What did make me "tsk" was the last comment, “Now you can sleep through the night without drugs.”
Huh? If this isn’t a drug, then what is? This is misleading to say the least and a bit dangerous. It is, unfortunately, common for people to confuse various terms –- drug, medication/medicine, prescription, over the counter, herbal remedy, dietary supplement –- thinking that some words inherently mean a substance is safe. These misconceptions are knowingly played up by marketing campaigns so I thought it would be helpful to define these words.
- Drug – The American Heritage Dictionary presents two distinct definitions for this term. First, it is a “chemical substance, especially one prescribed by a medical provider, that is used in the diagnosis, treatment, or prevention of a condition or disease. The second definition references the street use of substances, “A chemical substance such as a narcotic or a hallucinogen that affects the central nervous system and is used recreationally for perceived desirable effects on personality, perception, or behavior.”
As you can see, this is a broad term and encompasses many things we do not generally consider as drugs such as caffeine (yes, our beloved coffee and chocolate), vitamins, herbal remedies and, you guessed it, the sleep aid from the commercial.
Medication/Medicine – This is another generalized term referencing any agent, such as a drug, used to treat disease or injury.
Prescription – This is a written order from a doctor for the preparation and administration of a medicine or other treatment. We tend to think of prescriptions as only those items we pick up from the pharmacy. However, doctors write prescriptions for many things that are not controlled such as vitamins, nutritional supplements or other over-the-counter items. Prescriptions can also be written for devices like crutches or additional treatments like physical therapy.
Over the Counter – This is a phrase referencing any substance (vitamin, ointment, supplement, etc.) available without a doctor's prescription but legal.
Herbal Remedy – This is a drug or preparation made from a plant or plants and used to prevent and treat diseases and ailments or to promote health and healing. We generally think of herbal remedies to be available over the counter, but many are controlled and available only through prescription. An example is ephedra, a plant substance often used for weight loss. Previously this drug had been widely available and legal. It is now controlled.
Dietary Supplement – Also known as nutritional supplements, these can be any of a number of minerals, vitamins or herbs that are taken as a supplement to regular food.
In reading through these definitions, I am hoping it is apparent that there are rather blurry lines between the various categories of agents used to treat and aid the aspects of our health. Case in point, lithium. Lithium is actually a mineral on the periodic table of elements. Over-the-counter formulas are available as dietary supplements. However, it is also a powerful drug used in the treatment of bipolar disorder. This type of lithium is available only through prescription. Lithium is known to have interactions with a number of other over the counter and prescription drugs: ibuprofen (Advil, Motrin), naproxen (Aleve), diuretics, SSRI antidepressants (Prozac, Luvox, etc.).
Substances presented as innocuous in advertising, or in common understanding, have the potential to be dangerous most especially when taken in combination with other agents. Two points you’ve heard us say over and over: Know the details about the drugs (prescriptions and over the counter) you take and always discuss any changes, additions or deletions to your drug regimens with your doctor.