Just when you thought you were on top of the latest drug abuse trends, guess again. “Skittles, Robo, Dex, and Vitamin D” are among the code words for the current practice among young people getting high by taking large doses of over-the-counter (OTC) cough and cold medications containing dextromethorphan (DXM).

As men and women on the frontlines, your help is needed to raise awareness about this growing problem. We also ask that you put OTC cough preparations on the list of drug abuse or overdose possibilities when you evaluate crime or motor vehicle crash scenes. If OTC cough medicines are involved, you need to know that the side effects can be extremely dangerous.

This fact sheet gives you an insider’s look at cough medicine abuse
and its subculture; provides information about possible signs of abuse;
and suggests ways you can help. It addresses:

• 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

So now you know that OTC cough medicine should be considered a priority, along with other drugs of abuse. What may be news to you is that one out of 10 people—or 2.4 million kids from all backgrounds and communities—say they have taken cough medicine to get high. And a federally funded university survey estimates the intentional abuse of cough medicine among eight, tenth, and twelfth graders is at roughly four percent, five percent, and seven percent, respectively—on par with cocaine.

There are three factors that make this drug problem different from others you’ve encountered:

1. OTC cough medicines play an important role in addressing many families’ healthcare needs. 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. 
2. Youth can obtain these medicines legally and easily from their home or a friend’s home, a local retail store, and the Internet. 
3. There is also a lack of awareness among people of all ages, particularly teens and parents, about their dangerous side effects when taken in excessive amounts.

As a first responder, you may be the first person on a crime or accident scene to say “If drugs are involved, maybe it’s cough medicine.” You may be the one to educate family members, the user, and others about the hazardous risks of abusing OTC cough medicines, which is why learning more about the abuse of these medicines is important.

 

Decoding Cough Medicine Abuse “Language”

In addition to those previously mentioned, kids have code names for DXM and the cough preparations. While nicknames vary by product and region, the most common are “Dex, DXM, Syrup, Tussin, Triple-C or CCC.” If a person is abusing DXM, popular expressions you may hear are “Roboing, Dex-ing, Robo-fizzing, Smurfing (buying cough medicines from multiple retail stores), and Skittling.” Users are sometimes called “syrup heads or robotards.”

 

Methods of Abuse

Remarkably, kids are taking excessive amounts of pills or cough syrup, sometimes as much as 25–50 times beyond the recommended doses. 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 still others mix it with sodas or even alcohol. They call this “Robo-fizzing.” Another dangerous method is to consume pure, unfinished DXM powders and pills which can be purchased “in bulk” over the Internet with no questions asked.

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 serious concern is combining DXM-containing medicines with non-drowsy antihistamines, alcohol, SSRI anti-depressants, and MAOI inhibitors. Combining DXM with these drugs is extremely dangerous and can send young people to the emergency room.

 

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. 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 includes 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.

Web sites promoting DXM abuse are not the only online sources providing dangerous content to kids. Social networking sites such as MySpace, YouTube, LiveJournal, and Facebook are filled with detailed instructions, user conversation, and videos of DXM abuse. Users blog and post videos about specific plans to take DXM, how and when they will take it, and even recounts of the abuse itself. Through these outlets, users actively compare notes, exchange approaches, and promote abuse. For more information, see the Internet Alert at www.doseofprevention.org and visit the web sites listed below to see the type of information accessible to kids.

Things You Can Do

There are many actions that law enforcement officials can take to help combat this growing problem:

• Educate youth and their parents: Discuss the hazardous side effects of cough medicine abuse with teens and their care givers whenever you do school outreach programs. Parents need to be advised not to 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;
• Empty cough medicine bottles or unusual pills in a child’s room;
• Unexpected arrival of 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; and
• Unusual chemical or medicinal smells on a child or in his/her room.
• If you are a first responder, be aware of a possible connection between a person’s symptoms and cough medicine overdose or abuse: When you ask drug-related questions, be sure to include OTC cough medicine in the discussion.
• When you go on party patrols, remember that pharming parties may be taking place: Kids might be abusing DXM in combination with other medications.
• If you test drivers for alcohol and/or other drugs, keep in mind that drivers may be abusing an OTC cough medicine: These medicines may not necessarily show up on standard drug screens.
• Integrate OTC cough medicine abuse into the department’s drug abuse training: Work with your local community anti-drug coalition to create targeted materials that police officers can use.
• Be a diligent observer: If you suspect that someone has a cough medicine abuse problem, don’t hesitate to take action—connect the user and family to appropriate resources in your community.
• Get involved, stay engaged: As a first responder, your local community anti-drug coalition welcomes your participation in its prevention and intervention activities. Don’t hesitate to contact them for more information on this, and other, forms of drug abuse.

 

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

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