Latest trend in drug abuse: Youths risk death for cough-remedy high

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Reprinted with permission. All rights reserved.
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Reprinted from USA TODAY 2003
Latest trend in drug abuse: Youths
risk death for cough-remedy high
Hospitals, schools report
a wave of overdoses on
non-prescription medicine
By Donna Leinwand
USA TODAY
Emergency rooms and schools across
the nation are reporting that waves of
youths are overdosing on nonprescription
cough and cold medicines
that are widely available in drugstores
and supermarkets.
The dozens of overdoses in the past
two years — including at least five
deaths in which the abuse of over-thecounter
medicines was a factor —
reflect how medicines such as
Robitussin and Coricidin are becoming
more popular as recreational drugs
for kids as young as 12, police and
doctors say.
The incidents represent a dangerous
turn from past decades, when some
youths would guzzle cough syrup to try
to get a buzz from alcohol and codeine,
authorities say. Most cough and cold
medicines no longer contain alcohol,
and those with codeine, an addictive
opiate, are available only by
prescription. But more than 120 overthe-counter
medicines include
dextromethorphan, or DXM, a cough
suppressant that when taken in heavy
doses can produce hallucinations and a
loss of motor control, much as PCP does.
By H. Darr Beiser, USA TODAY
On the label: Dextromethorphan is a common
cough suppressant in over-the-counter medicines.
Kids don't have to drink entire bottles
of goopy cough syrup to go
"Robotripping" or "Dexing." Pills such as
Coricidin HBP Cough & Cold tablets —
known as "Triple C's" — offer far more
potent doses of DXM with less hassle.
Youths can buy the medicines easily,
then go to Web sites to learn how much
someone of their weight should take to
get high.
Whether in cough syrup or pills, DXM
costs just a few dollars, is "easy to get . . .
and there's a lot of information about
how to get high on it on the Internet,"
says Charles Nozicka, medical director of
pediatric emergency medicine at St.
Alexius Medical Center in Hoffman
Estates, Ill., west of Chicago. He says that
he began seeing DXM overdoses among
teens three or four years ago, and that
lately he has seen as many as four cases
a week.
Authorities say DXM overdoses
typically occur in clusters, as word of the
drug spreads in a community's middle
schools and high schools. This fall,
parents and school officials in Naples,
Fla., who had known little about DXM
were shocked when several kids in their
early teens suddenly passed out in class
after overdosing on the drug.
At Pine Ridge Middle School in Naples
in September, a 13-year-old girl brought
about 80 Coricidin pills to campus one
day and gave some to six friends,
authorities there say. Each of the friends
took at least five pills — the
recommended dosage for adults is no
more than one pill every six hours —
and soon the school was in chaos. Two
students lost consciousness in their
first-period classes; they and one other
overdosed youth were treated at a
local hospital.
The girl who distributed the pills
thought it would be "fun to feel messed
up and act . . . drunk," says Cpl. Joseph
Scott of the sheriff's office in Collier
County, which is in southwestern
Florida on the Gulf Coast.
Another round of overdoses occurred
on Nov. 6 at Immokalee High School,
which also is in Collier County. A 15year-old
girl and two of her friends took
five Coricidin pills each before school. By
10:45 a.m., the girl "couldn't remember
her own name," Scott says. When
paramedics could not stabilize her
heartbeat, they called for a helicopter to

take her to a hospital. Authorities
learned later that she had obtained the
pills from a boy who had taken them
from his home. The girl's friends did not
have to be hospitalized.
Scott says that many parents in Collier
County were shaken by the idea that
youths could buy large amounts of such
a potentially dangerous drug at a local
store, and then consume the drug,
without breaking any laws. "It's
something people aren't really informed
about yet. The parents we've dealt with
so far are pretty much in shock," Scott
says. "It seems right now it's mostly the
younger kids" who are taking DXM.
Scott says his office is compiling
information packets about DXM that
will be distributed to local pharmacies
and schools.
Restricting access
Elsewhere, growing concerns about
DXM have led some drugstores to
restrict access to cough and
cold medicines.
After two teenage girls and two 20year-old
men in Merrill, Wis., overdosed
on medicines containing DXM this year,
some drugstores in the city of about
10,000 people 160 miles north of
Madison began to stow such remedies
behind their counters. At the Aurora
Pharmacy, customers now must request
Coricidin tablets, and they aren't
allowed to buy several boxes at once.
Pharmacist Jim Becker says he wants
the drug "where we can keep an eye
on it."
Drug manufacturers say they
sympathize with concerns about drug
abuse, but they have resisted efforts to
restrict consumers' access to Coricidin,
Robitussin and other remedies
containing DXM.
"The vast majority of people take
Latest trend in drug abuse
them responsibly," says Fran Sullivan,
spokesman for Wyeth Consumer
Healthcare in Madison, N.J., which
makes Robitussin products. "As a
medicine, it works hands-down, so we
want people to be able to use it if they
need it."
Aware that teens might be tempted to
abuse its newest DXM product, anticough
gel-tabs, Wyeth made its
packaging large enough so that it is
difficult to stash in a backpack or pocket,
Sullivan says. The company advertises
on TV shows geared to adults, he says.
"We've noticed that the abuse comes
and goes in waves," he says. "It gets
really popular in a small area for a short
period of time and then it dies out.
Teens end up in the emergency room, it
makes the local newspaper, and the area
goes on alert."
Schering-Plough, which makes
Coricidin, is working with the
Partnership for a Drug-Free America to
create an educational Web site on DXM,
company spokeswoman Mary-Fran
Faraji says. Company representatives
also are meeting with pharmacists,
parents, schools and retailers to discuss
ways to prevent drug abuse.
But Faraji says Schering-Plough
doesn't plan to eliminate DXM from its
non-prescription cough and cold
medicines. She notes that most of the
potential alternatives to DXM as a cough
suppressant are opiates that carry more
potential for abuse. "Reformulating our
product is not going to make the abuse
issue go away," Faraji says. "Our product
is safe and effective when used
as directed."
DXM approved decades ago
DXM, a synthetic drug that chemically
is similar to morphine, was approved by
the Food and Drug Administration as a
cough suppressant in 1954. Drug
Reprinted with permission. All rights reserved.
About DXM
Dextromethorphan, also called DXM,
is found in more than 120 nonprescription
cough and cold medicines,
including Robitussin, Coricidin HBP,
Vicks NyQuil and Vicks Formula 44.
Other facts:
v Youths' nicknames for DXM:
Robo, Skittles, Triple C's, Rojo, Dex,
Tussin, Vitamin D. DXM abuse is called
"Robotripping" or "Tussing." Users
might be called "syrup heads" or
"robotards."
v Symptoms of abuse: They include
sweating; high body temperature; dry
mouth; dry, itchy or flaky skin; blurred
vision; hallucinations; delusions;
nausea; stomach pain; vomiting;
irregular heartbeat; high blood
pressure; numbness in toes and fingers;
red face; headache; loss of
consciousness.
v How much is too much: A normal
dose of DXM is 15 to 30 milligrams.
Mind-altering effects can occur at doses
as low as 100 milligrams, but many
abusers consume enough pills or syrup
(say, half a 12-ounce bottle) to result in
a dose of 240-360 milligrams.
v Its status: The Drug Enforce-ment
Administration classifies DXM as a
"drug of concern" because of its
potential for misuse, but there are no
legal restrictions on buying the drug.
Sources: National Institutes of Health, Drug
Enforcement Administration
manufacturers began putting it in cough
syrups in the 1970s as a replacement
for codeine.
DXM is sold legally without a
prescription because it does not make
users high when taken in small doses.
The recommended dose, about onesixth
to one-third of an ounce of an
extra-strength cough syrup, contains 15
to 30 milligrams of DXM, according to

the National Institute on Drug Abuse. At
doses of 4 or more ounces of cough
syrup, DXM produces effects similar to
those of PCP or the anesthetic ketamine,
the institute says. DXM can produce
hallucinations, depressed breathing,
elevated blood pressure and an irregular
heartbeat. Overdoses can cause seizures,
comas and death.
It can be particularly dangerous when
taken with other drugs.
Lee Cantrell, interim director of the
California Poison Control System's San
Diego division, says that Robitussin and
some other cough and cold remedies
containing DXM have additional
ingredients that can be fatal to abusers if
taken in huge doses. For example,
antihistamines, which often are
combined with DXM in cough and cold
remedies, can be toxic and cause
respiratory distress, Cantrell says. He
says cough medicine abuse emerged as
a problem in California about three
years ago.
During what officials called a "minioutbreak"
of DXM overdoses in New
Jersey two months ago, a 15-year-old
boy had to be treated for
acetaminophen poisoning after he drank
two bottles of Robitussin and took some
Coricidin. Acetaminophen is a pain
reliever/fever reducer that, over time,
can cause liver damage if taken in
large doses.
The federal government does not keep
statistics on DXM abuse, but drug
specialists say anecdotal evidence
suggests that its use does not approach
that of methamphetamine or the club
drug Ecstasy. DXM abusers, drug
specialists say, typically are young teens
who are seeking a cheap alternative to
drugs that are more expensive and more
difficult to get.
Still, "what we see in the emergency
department is probably the tip of the
Latest trend in drug abuse
iceberg," Nozicka says of DXM abuse in
his community near Chicago. "There's
probably a lot more going on, but most
(overdose cases) don't end up in the
emergency room."
Some drug counselors and doctors say
young adults have begun using DXM
with alcohol, Ecstasy and other drugs.
DXM "looks innocuous enough, but if
you take enough of it, it can cause
serious problems," says Ed Bottei,
medical director of the Iowa Statewide
Poison Control Center in Sioux City. A
22-year-old college student in Ames,
Iowa, died of a DXM overdose in
October 2002. "Even though it's an overthe-counter
medicine, it can still hurt
you," Bottei says.
Authorities who have been more
focused on illegal drugs often have been
surprised by sudden outbreaks of
DXM overdoses.
After a series of overdoses in the
Detroit area in August, the U.S. Drug
Enforcement Administration issued an
alert that warned parents, schools and
local communities about an "escalation"
in DXM abuse.
The alert cited a "disturbing increase"
of overdoses in the Grosse Point area,
near Detroit.
DEA special agent David Jacobson,
spokesman for the agency's Detroit
office, says that federal drug
enforcement analysts usually can
forecast regional trends in drug use,
based on geographic patterns. But
"Robotripping" came out of nowhere,
he says.
"Law enforcement hadn't heard about
it, but all the kids had," Jacobson says.
As he and others in the community
asked around, they found that DXM
abuse "was not only out there, but it
was out there more than we thought."
Reprinted with permission. All rights reserved.
Internet fuels trend
Like others who monitor DXM abuse,
Jacobson says the Internet has fueled
the trend.
"Now (DXM cases) pop up
everywhere," he says. "If one kid is
doing it anywhere, kids here will know
about it."
At Michigan State University in East
Lansing, the student health center is
planning to include a question about
DXM abuse on its next student health
survey in the spring, says Dennis
Martell, the university's interim
coordinator for health education.
"We want to be proactive in
identifying the problem before it
becomes the rage," he says.
Meanwhile, as word of DXM spreads
among teens and young adults,
pharmacies are reporting more thefts of
cough and cold medicines, as well as
suspicious purchases.
Victor Vercammen, a pharmacist who
works in a drugstore north of Chicago,
says he recently watched two young
men try to buy six packages of Coricidin.
As the clerk rang up the purchase,
Vercammen confronted the pair.
"I could tell as the conversation went
on that they planned to misuse it, so I
asked if they realized that it could cause
a seizure, that it could be fatal," says
Vercammen, a spokesman for the
Illinois Pharmacists Association. "My
hope was that educating them at least
gets them to think about it. The popular
conception is that because it's over-thecounter,
it's safer."
The men left the packages on the
counter and walked out.

APPLICATIONS:
sociology, trends, problem solving,
knowledge, creative thinking,
cooperative learning
STANDARDS:
NPH-H.5-8.4
Influences on Health
Students will analyze the influence of
culture, media, technology, and other
factors on health.
NPH-H.5-8.5
Using Communication Skills to
Promote Health
Students demonstrate the ability to use
interpersonal communication skills to
enhance health.
NPH-H.5-8.7
Health Advocacy
Students demonstrate the ability to
advocate for personal, family, and
community health.
Source: Education World
Latest trend in drug abuse
DISCUSSION QUESTIONS:
Why are over-the-counter cough remedies becoming popular recreational drugs
for teens? What is DXM? What type of effects can it produce when taken in large
quantities? Why is this type of high popular among adolescents? What are the
dangers associated with overdosing on cough suppressants? How have manufacturers
of cough medicines and the pharmacies that stock them responded to this
trend? Why is DXM sold legally? How does the DEA forecast regional trends in
drug use? How has the Internet fueled the surge in cough suppressant use among
teens? What misconception exists about over-the-counter drugs? What are some
of the nicknames for DXM? What symptoms indicate it is being abused?
ACTIVITY:
Divide the class into small groups, and ask each group to answer the following
questions: Under what circumstances do teenagers begin to use alcohol, tobacco
and other drugs (legal or illegal)? Why are teens compelled to seek altered states
of mind? Do adolescents consider the potential consequences of their actions?
Next, using the information in the article and the sidebar, develop an informational
brochure or poster about the ill-effects of overdosing on DMX or using it for
unintended purposes (i.e., to get high). Create a unique catchphrase aimed at deterring
your peers from experimenting with over-the-counter cough remedies. Try to
incorporate one of the slang terms for DMX into your slogan. Distribute your
brochures or hang your posters in the halls around your school.
APPLICATIONS: health & behavior, cause &
effect, character education
According to the 2002 National
Youth Tobacco Survey, the prevalence
of smoking among high school
students declined about 18 percent,
from 28 percent in 2000 to 22.9
percent in 2002. The survey also
reported the following findings:*
uEvery day in 2001, 4,400
young people aged 12-17 tried their
first cigarette;
u2,000 began to smoke daily;
uOne-third of adolescents who
*2002 National Youth Tobacco Survey
smoke will eventually die of a
smoking-related disease.
For what reasons do adolescents
begin to experiment with tobacco,
alcohol and other drugs? How can
students serve as role models and
leaders in the fight against youth
tobacco use? Do anti-smoking
campaigns help students make
informed decisions about their health?
Why or why not?