OSAKA - The growing abuse of over-the-counter drugs among young people in Japan reflects not only easy access to medicines but also loneliness, social media influence and a shortage of places where troubled youths can be safely seen and heard, according to a discussion among an addiction specialist, a former overdose user and a recovery worker with experience of drug and alcohol dependence.
Psychiatrist Toshihiko Matsumoto, who specializes in drug addiction, Shun Nakazawa, 24, who has experienced overdosing and now supports young people around Osaka’s Glico sign area known as Gri-shita, and Yojiro Watanabe, a staff member at an addiction recovery facility, discussed why overdosing, or OD, has spread and how adults should respond.
Nakazawa said he began overdosing at age 19 after spending time around young people in Gri-shita, where the practice felt ordinary. He said over-the-counter drugs and sleeping pills were easy to obtain and were often readily available among those around him. At the time, he was working at a restaurant without being late or missing shifts, but said he now thinks he may have been lonely or struggling with feelings he could not clearly identify.
Watanabe, now 50, said his experience began in a different era, after he entered psychiatric care around age 20 for problems involving alcohol and mental health. He said he encountered prescription drugs in hospital settings, where other patients told him psychiatric medication could make him feel good. During repeated hospitalizations, he said patients saved up prescribed pills and used them together, creating a sense of belonging less tied to the effect of the drugs than to the relationships formed around them.
Matsumoto said Japan’s strict controls on illegal drugs have contributed to a distinctive pattern in which prescription and over-the-counter medicines are more commonly abused than in some other countries. He said abuse of such medicines has increased over the past two to three decades, while over-the-counter drugs have become especially accessible to teenagers because they can be bought with pocket money and do not require health insurance cards or prescriptions.
According to Matsumoto, clinical cases involving over-the-counter drug abuse began rising gradually around 2018, before the COVID-19 pandemic, then increased sharply during the pandemic. He said school closures and stay-at-home requests may have left some children trapped in tense home environments, leading them to use overdosing as a way to "disappear" from that situation by losing consciousness.
The problem has not faded since the pandemic, he said. A rapid increase in drugstores has made medicines easier to obtain, while some cough medicines that previously required prescriptions became available over the counter during the pandemic. Matsumoto said these factors combined to accelerate overdose abuse among young people.
Nakazawa said access is still easy even when stores limit purchases to one box per person, because young people can simply visit several drugstores. He said prescription drugs such as Silece, which should be available only through medical channels, are also being supplied to teenagers by irresponsible adults, with discarded packages sometimes found in Gri-shita.
He also pointed to the role of social media, saying overdosing has become stylized or fashionable on platforms such as TikTok, where images of drugs are presented as part of a dark-cute aesthetic. He said even young people who do not gather in Gri-shita or Tokyo’s Toyoko area in Kabukicho sometimes adopt cultural markers such as a blue tongue after taking medicine.
Nakazawa said cost is another factor. While stimulants and other illegal drugs are expensive, he said some over-the-counter medicines can be bought in quantities of around 300 tablets for about 3,000 yen to 4,000 yen.
Matsumoto warned that tightening sales restrictions alone is unlikely to solve the problem. He noted that limits on the number of high-risk over-the-counter drugs sold online had already been in place since 2014, yet abuse continued to rise. A new system introduced in May restricted sales of certain abuse-prone drugs to people under 18, but Matsumoto said young people may simply visit multiple stores or turn to adult resellers.
He said excessive restriction could create new dangers if young people buy medicine from predatory adults, encounter products mixed with illegal drugs or are forced to raise money through exploitative relationships or activities that expose them to sexual violence.
While street gathering spots such as Toyoko and Gri-shita receive public attention, Matsumoto said they represent only a small part of the problem. Many young people he treats for over-the-counter drug dependence have never been regulars in such places. Historically, he said, many abused medicines alone, often after histories of self-harm such as wrist-cutting. Some shifted from self-harm to overdosing, and if drugs were forcibly removed, they returned to cutting.
Matsumoto said the pandemic and media attention around Toyoko and Gri-shita helped some isolated young people find others like themselves, including through social media. He said that connection can encourage and glamorize overdosing, but it also means people who had been suffering alone are finally visible to others.
Watanabe said he has heard from students at schools and universities who privately disclosed that they were taking over-the-counter drugs or self-harming, even though their classmates did not know. He said drug use can become tied to identity for people who have long lacked a place to belong or the ability to express what they feel.
Both Watanabe and Matsumoto said overdosing can become a way to communicate distress when words have failed. Watanabe said he had once wanted people to see his damaged body because he could not express his pain verbally and felt ignored when he tried. He said simply cutting off the behavior can feel to the person as though they are being told to disappear.
Matsumoto said adults often fail to notice a child’s distress until self-harm or overdosing occurs. When the behavior stops, adults may assume the child has recovered and pull away, even though continued support is most important after the crisis appears to pass. If adults grow tired of repeated incidents and stop reacting, he warned, young people may escalate in order to be noticed again, sometimes with fatal results.
Nakazawa said he stopped overdosing after taking around 300 tablets and falling into a coma for two days. He said the hospital told his family he could die. He said he has seen young people in Gri-shita collapse, foam at the mouth or become violent after taking drugs, making him question how safe over-the-counter medicines really are.
Matsumoto said many over-the-counter drugs are older medicines that doctors no longer use as commonly, and some contain ingredients derived from opium or substances with similarities to drugs such as LSD or MDMA. While the public often assumes over-the-counter drugs are weaker and safer than prescription medicines, he said specialists see real risks in them.
He said the danger can increase when groups form around overdosing. In such communities, those who take the most extreme overdoses or appear to have the most serious problems may attract the most attention and rise in status, creating group pressure that pushes behavior further.
Nakazawa said support should not focus only on stopping drug use. Young people need other exciting, rewarding experiences and opportunities to be praised, he said. Some who find work, events or new activities gradually move away from overdosing without being forced.
Matsumoto agreed but said some young people have no past experience of excitement or success to revive. For them, support must begin from scratch by helping them discover something other than overdosing that gives them a sense of identity and possibility.
Nakazawa said forced separation rarely works. He has seen young people placed away from Osaka only to search for nearby drugstores or escape back to Gri-shita. Some run away from child consultation centers and return to Toyoko. He said suppressing or physically removing young people does not address the underlying need for connection.
The participants said support systems must be sustainable for adults as well. Nakazawa said he once answered every late-night call and went wherever he was summoned, but that exhausted supporters. He said his group has since learned to maintain a pace that allows long-term involvement, with younger staff providing peer-like support and older volunteers acting more like parental figures.
Matsumoto said support should begin at an intensity that can be maintained for a long time, rather than starting at full energy and later pulling back in a way that young people may interpret as abandonment. He said teams are necessary, including peers close in age, experienced adults and professionals who may not be visible at the front line but can advise from behind.
Nakazawa said local hubs are needed across Japan, involving private groups, medical professionals, volunteers and specialists. He said young people in Gri-shita are not necessarily from Osaka, just as many in Toyoko are not from Tokyo, meaning the issue is rooted in regional communities as much as in big-city gathering spots.
Matsumoto said many young people arrive in cities after being effectively pushed out of their homes or isolated in their schools and communities. Some have already briefly accessed psychiatric care in their hometowns, yet the hole in their lives remained unfilled until they found connection in places such as Gri-shita or Toyoko. He said Japan needs to examine what is happening to children in local areas, not just in major entertainment districts.
The speakers also warned against simply shutting down gathering places. Matsumoto said when Toyoko was blocked off and made harder for young people to gather in, some moved into business hotels around Kabukicho, where their activities became less visible and some were drawn further into predatory adult networks. Nakazawa said similar displacement has occurred around Gri-shita, with young people moving into nearby facilities or hotels, where risks such as managed prostitution or exploitation may increase.
Matsumoto said public support spaces can also fail if they ban those who self-harm or overdose, because the very people who most need help are then excluded. He said systems must be able to tolerate some difficult behavior so that support can reach young people at the edge.
Asked what should be said to people currently overdosing, Nakazawa said there is no simple phrase that works in every situation. He said anyone who feels trapped should reach out to a trusted adult if possible, though he acknowledged that many overdose precisely because they find that difficult. He said young people can contact him and that he will not immediately tell them to stop, but will listen and help them gradually find other enjoyable things.
Watanabe said he wants to hear the feelings behind the behavior rather than dismiss it. He said overdosing is dangerous and that danger must be discussed honestly, but he also said many people use it as a form of expression when they are too cornered to explain themselves in words.
Matsumoto said when someone tells an adult they have overdosed, that should be understood as a sign they still value themselves. Many people hide overdosing completely, he said, so disclosure means the person does not believe the situation can remain as it is.
He urged young people who cannot quit suddenly to first aim for slightly safer behavior, such as avoiding reckless use and reducing the amount even by one tablet. He also advised them to find an adult who will not scold them or immediately demand that they stop, and to use that person almost like a diary by regularly sharing what they took and what happened that day.
For parents, Matsumoto said anger, confiscating drugs or repeatedly scolding children can worsen the cycle when families try to handle the issue alone. He urged parents to seek their own support through mental health and welfare centers, which are available in prefectures and ordinance-designated cities, including Osaka Prefecture, Osaka City and Sakai City. Adults supporting young people, he said, also need supporters of their own.
Source: KTV NEWS
