Each generation of young people looks for new ways to get high. A dangerous and growing trend among that population is medicine abuse—both prescription and over-the-counter. This troubling trend includes taking extreme amounts of cold medicines that contain dextromethorphan (DXM) to get high. For most parents and their children, the dangers of this practice is not yet on their radar screens.

While we want to ensure that these medicines remain accessible to those who need them, we also must recognize that the potential for abuse among teenagers demands our immediate attention. We are turning to you as healthcare providers to help combat this problem. Because you are on the frontlines, we need your assistance in educating parents, other caregivers, and young people about the importance of taking OTC cough medications as directed. They need to know that if these drugs are abused, the side effects can be dangerous.

Our goal, therefore, is to give you an insider’s look at the cough medicine abuse subculture and suggest ways you can help. We will be discussing:

• The Problem
• Decoding Cough Medicine Abuse “Language”
• Methods of Abuse
• The “Highs” and “Lows” of Cough Medicine Abuse
• Cough Medicine on the Internet
• Things You Can Do

 

 

 

The Problem

It’s estimated that one out of 10 teens nationwide—that’s 2.4 million people from all backgrounds and geographic areas—say that they have taken cough medicines to get high. Further underscoring this trend, the National Institute on Drug Abuse’s “Monitoring the Future” study estimates the intentional abuse of cough medicine among eighth, 10th, and 12th graders is at roughly four percent, five percent, and seven percent, respectively—on par with cocaine.

There are well over 100 OTC medicines that contain DXM, either as the only active ingredient or in combination with other active ingredients. Examples include Alka-Seltzer Plus Cold & Cough Formula, Coricidin HBP Cough and Cold, some Delsym products, Dimetapp® DM, some Mucinex® products, PediaCare cough medicines, certain Robitussin® cough products, Sudafed cough products, TheraFlu® Cough products, Triaminic® cough products, Tylenol Cough and Tylenol Cold products, Vicks 44 Cough Relief products, certain Vicks DayQuil and NyQuil LiquiCaps, and Zicam. There also are a number of store brands that contain dextromethorphan, as well.

Most kids and their parents are in the dark about the hazardous risks of abusing these popular medicines. In fact, a recent survey conducted by the Community Anti-Drug Coalitions of America (CADCA), in partnership with the Consumer Healthcare Products Association (CHPA), indicated that only eight percent of parents are aware of cough medicine abuse, and 75 percent don’t talk to their children and teens about the problem. Another study reports that only 45 percent of teens believe that abusing cough medicine to get high is risky, which means that over half believe it is not.

 

Decoding Cough Medicine Abuse “Language”

Kids have code names for OTC cough medicines, and it’s important for you to know what they are. Among them are “Dex, DXM, Robo, Skittles, Syrup, Tussin, Triple-C, and CCC.” Popular expressions for abusing OTC cough medicines are “Robo-tripping, Roboing, Robo-fizzing, Smurfing (buying cough medicines from multiple retail stores), and Skittling.” Users are sometimes called “syrup heads” or “robotards.”

 

Methods of Abuse

As you are well aware, a normal dose of cough medicine is 15–30 milligrams. Mind-altering effects can occur at doses as low as 100 milligrams, but many consume enough pills or syrup to equal 240–360 milligrams.

Some users prefer pills over syrups because tablets are easier to conceal and consume. Alternately, others prefer the cough syrup and drink it undiluted, while others mix it with sodas or even alcohol. They call this “Robo-fizzing.” An equally dangerous option is that they consume pure, unfinished DXM powders which can be purchased “in bulk” over the Internet.

One of the most worrisome party activities kids participate in is called “pharming.” With their friends, they amass pills—including DXM-containing medicines they’ve collected from home or elsewhere. Often in one sitting, they randomly take handfuls of pills, not caring what they are ingesting, and oblivious to the consequences of taking excessive amounts of medication or the potential danger of combining one drug with another. Of major concern, of course, is combining DXM-containing medicines with non-drowsy
antihistamines, SSRI anti-depressants, and MAOI inhibitors.

 

The “Highs” and “Lows” of Cough Medicine Abuse

DXM abusers say that a cough medicine high is similar to an ecstasy-like high. They may experience mild distortions of color and sound, strong visual hallucinations, “out-of-body” sensations, confusion, slurred speech, and the loss of motor control. Other serious side effects can include:

—  Delusions
—  Panic attacks
—  Memory problems
—  Blurred vision
—  Stomach pain, nausea, and vomiting
—  High blood pressure and rapid heart beat
—  Numbness of fingers and toes
—  Drowsiness and dizziness
—  Fever and headaches
—  Rashes and itchy skin
—  Loss of consciousness

The effects can be worsened if the DXM-containing cough medicine being abused also include other ingredients to treat more than just coughs, and, as described above, if used in combination with other medications, or taken with alcohol and illegal drugs.

 

Cough Medicine on the Internet

Web sites and online communities that promote the abuse of DXM-containing products are pervasive on the Internet. These Internet predators are putting children at risk by encouraging the abuse of cough medicine and giving detailed instructions on how to abuse these medicines. Some sites provide guides on how to achieve a high based on a user’s height and weight; how to combine DXM with other drugs; and what effects or “plateaus” to expect based on the amount consumed. Other web sites provide access to raw, unfinished DXM, thus serving as dangerous online drug dealers. The frightening reality is that kids can log-on to these sites, purchase large amounts of pure DXM with only a credit card or PayPal account, and a shipping address, and packages arrive at their door.

 

Things You Can Do

There are many actions you can take to help combat this growing drug problem:

• Educate young people and their parents/guardians: Your expertise is invaluable in helping to discuss the hazardous side effects of cough medicine abuse. Parents need to be advised to not stockpile their OTC medicines, and to be on the alert for the warning signs of cough medicine abuse, including: Disappearing bottles or packages of cough medicine from the medicine cabinet; cough medicine bottles or unusual pills in their child’s room; unexpected arrival packages; changes in a child’s eating or sleeping patterns; declining grades; loss of interest in friends and activities; changes in physical appearance and behavior; unusual chemical or medicinal smells on a child or in his/her room; and any of the side effects listed above.
• If you are a first responder, be aware of a possible connection between a patient’s symptoms and cough medicine overdose or abuse: As you do with all patients, when you ask drug-related questions, always include OTC cough medicine in the discussion.
• Continue to be a diligent observer: If you suspect that a patient has a cough medicine abuse problem, take appropriate action—connect the user and family to appropriate intervention options in your community.

Whenever possible, partner with your local community anti-drug coalition as they create and implement prevention and intervention measures: Your input as an advisor, speaker, or facilitator would be a significant contribution as the community tackles this drug problem.

 

Want to Learn More?

Stop Cough Medicine Abuse Programs
Consumer Healthcare Products Association
www.StopMedicineAbuse.org

A Dose of Prevention Toolkit
Community Anti-Drug Coalitions of America, Consumer Healthcare Products Association:
www.doseofprevention.org

What Every Parent Needs to Know about Cough Medicine Abuse
Partnership for a Drug-Free America and Consumer Healthcare Products Association:
http://www.OTCsafety.org/publications

FDA Talk Paper on DXM
Food and Drug Administration:
www.fda.gov/bbs/topics/ANSWERS/2005/ANS01360.html

Make Up Your Own Mind About Cough Medicine
Partnership for a Drug-Free America: 
www.dxmstories.com