Rethinking responses to over-the-counter drug overdose among young people in Japan: Toward a low-threshold support architecture.

Over-the-counter (OTC) drug misuse and overdose among young people in Japan should be understood not only as a medication-safety issue but also as a public health and youth support issue situated at the intersection of psychological distress, self-harm, suicidality, help-seeking difficulties, digital environments, and fragmented care systems. Current responses, including emergency treatment for acute intoxication, psychiatric assessment, consultation services, school-based prevention, and retail regulation, remain important but often operate after crisis escalation or depend on young people's ability to present themselves through institutionally recognizable forms of help-seeking. In this Policy Forum article, we argue that Japan's response to OTC overdose should be redesigned as a low-threshold support architecture that connects early relational entry points with professional assessment, crisis escalation pathways, interagency collaboration, and safeguards for supporters. We also caution that peer support, while potentially valuable as an accessible first point of contact, should not be treated as a stand-alone intervention. Potential risks, including contagion-related concerns, exposure to distressing self-harm narratives, blurred role expectations, over-reliance on a single supporter, and safety-management failures, require explicit training, supervision, boundaries, and safeguarding protocols. We propose a three-zone framework comprising low-threshold entry points (Zone A), professional medical and interagency backup (Zone B), and sustainability infrastructure for supporters (Zone C). Rather than replacing clinical or regulatory responses, this architecture is intended to connect them with youth-accessible forms of support and to generate testable implementation models for future research.