Cough syrup abuse rises
Center notes 20% increase in '03 reports; one '04 death
By Bill Scanlon, Rocky Mountain News
June 21, 2004
Calls to the Rocky Mountain Poison Center about cough and cold medicine abuse shot up 20 percent to 275 reports last year, topped only by calls about sleeping pills and painkillers.
And, in the past two months, attempts to get high on cough or cold medicine killed a 20-year-old Westminster man.
On May 1, Blair Worthley, of Westminster, died of an overdose of Coricidin HBP, an over-the- counter tablet form of cough medicine.
The medicine's active ingredient is dextrometh-orphan, or DXM or Dex, which can cause fanciful hallucinations but also seizures, agitation and permanent kidney and liver damage.
DXM is found in more than 120 nonprescription cough and cold medicines, including Robitussin, Vicks NyQuil and Vicks Formula 44.
Abuse of cough medicine has come in and out of popularity for at least 40 years, but now, in metro Denver, it is a growing, dangerous problem.
In the first five months of this year, the Rocky Mountain Poison Center recorded 53 overdoses from cough and cold medicines, said Dr. Alvin C. Bronstein, medical director of the center run by Denver Health Medical Center. "It's a problem, and it's popular. How popular, I can't tell you."
Bronstein said he believes the number of overdoses is underreported because hospitals don't have a quick lab test to detect dextromethorphan in the system. If a teenager comes in hallucinating and having seizures, dextromethorphan may be partly to blame, but kids may have combined it with other drugs including alcohol, Ecstasy or marijuana.
In addition, emergency rooms do not report all their cases to the poison control center. Nor do all teens having a bad trip seek medical help.
"It's well-known among the teen community," Bronstein added. Typically, a user will buy a 16-tab box of Coricidin and use the whole box at once. At $5 or $6 a box, "it's a cheap high."
Abuse of Coricidin is more dangerous than Robitussin and other DXM-only medicines, experts say. That's because Coricidin also contains a few milligrams of chlorphen-iramine maleate, which is metabolized by the same liver enzyme as DXM. The two drugs together are a dangerous combination.
At Wal-Mart stores, pharmacists now keep Coricidin and Sudafed products behind the counter and limit to three the number of packages a customer can purchase at one time. A pharmacist at the Brighton store who did not want to give his name said abuse and theft are the primary reasons that Wal-Mart chose to move the drug.
King Soopers stores still stock Coricidin on the shelves, but a pharmacist at a Golden store said the company might consider moving it if the trend toward abuse continues. That's what they've done with Sudafed, which can be used to make methamphetamine.
"I just don't sell it to teenagers," said the pharmacist, who asked not to be named.
"Just because it's over the counter does not mean it's safe. Anything in large quantities can be toxic," the pharmacist said. "If there's an underlying condition, such as a heart, liver or kidney problem, it could push them over the edge.
"If you start putting chemicals into the system, it might shut down."
Cough- and cold-medicine abuse is not unique to Colorado.
In Cheyenne, it has become one of the biggest problems in schools, according to Dawn Gay of the U.S. Drug Enforcement Administration.
Gay recently told 30 parents at Central High School that of 12 children in Southeast Wyoming Mental Health's intensive outpatient program for adolescents, three are over-the-counter-medicine abusers.
Gay outlined signs that children might be abusing drugs or alcohol, including a sudden increase in grades if the student is using a stimulant, or long periods of wakefulness, weight gain or loss, irritability, loss of interest in once-important activities and the disappearance of valuables from around the house.
Blair Worthley's family tried to help him when they noticed a change.
"Blair had always been a really good kid," said Michael Noel, his pastor at The Journey Christian Church. "He had his problems, but none concerned drugs or alcohol."
The family is too distraught to talk to the media, so they asked Noel to speak for them.
Worthley didn't handle his parents' divorce well, but it was his father's death that seemed to send him into deep depression. "Part of Blair died that day," Noel said.
Nine months later, the sadness got so bad that Worthley moved to Nebraska, where he tried to put together a band. He apparently started his cold-medicine use there.
By the time Worthley came back to Colorado for the first anniversary of his father's death, "he wasn't the same person," Noel said.
"His depression and sadness were at all-time levels." He would take the Coricidin to get up, but it seemed to just bring him down even worse.
Noel and members of Worthley's family took him to a specialist, who diagnosed a bipolar disorder and put him on medications.
"We did everything right, at least we thought we did," Noel said.
"But I didn't realize how addictive this stuff was," Noel added. Worthley started abusing the stuff again.
"He couldn't get a job; he couldn't hold onto anything," Noel said. "He was taking a ton of the tablets."
Still living in his father's house, he took too much one night and died.
"He told me it just gave him a sense of happiness, of euphoria," Noel said.
"He wanted to be a youth pastor, and he wanted to be a musician," Noel said, noting that Worthley helped Noel start the youth ministry at The Journey.
Worthley is the only young person Noel knows who has died or gotten very sick from DXM. But he's worried he won't be the last.
"Kids play games with this stuff, like the old drinking games. Instead of doing shots of tequila, they do shots of NyQuil or Robitussin.
"The family is going through a lot of emotions and difficulty right now," Noel added. "It's just so sad."
Colorado calls to the Rocky Mountain Poison and Drug Center, and the type of drug involved, in the past two years
Drug 2002 2003
Marijuana 92 100
Heroin 14 24
Cocaine 109 137
Methamphetamine 71 82
Cough medicines/ dextromethorphan 229 275
Codeine 153 188
Painkillers/ oxycodone 602 809
Sleeping pills, tranquilizers/ benzodiazepines 1,012 1,212
Methadone 87 97
Morphine 150 208
Ethyl alcohol 270 248
Total calls 68,245 67,463