Growing drug abuse threat: over-the-counter medication
The use of non-prescription cold medication for recreational purposes is rising, as are the instances of overdosing and physical harm.
By AMANDA STRINDBERG and HEATHER IGNATIN
The Orange County Register PREVENTING ABUSE AT HOME
• Be suspicious if you find new packages of Robitussin or Coricidin in the house.
• Talk to your child if you suspect he or she is abusing medications.
• Be suspicious if your child is acting secretive or irresponsible
• Look for changes in friends or falling grades.
• Monitor your teens' Internet use
• Avoid stockpiling over-the-counter medications in the house
Source: Positive Action Center at Chapman Medical Center, and Mission Hospital
"The majority of parents are completely floored when their kids winds up in the ER. They have no idea they are doing this."
Mike RitterAssistant director of Mission Hospital’s emergency room.
CALIFORNIA’S DXM CASES
In people 9-17: 1999: 23 2000: 79 2001: 114 2002: 152 2003: 286 2004: 375 Source: California Poison Control System
Q: What is Dextromethorphan (DXM)?A: It is a cough suppressant ingredient, in use since the 1950s. However, it is safe when taken properly. Q: What is a normal dose? A: 30 milligrams every six to eight hours, up to 120 milligrams a day. However, abusers can take at least 100 milligrams at one time to get high. Q: What are some of the symptoms of an overdose?A: Dizziness, blurred vision, slurred speech, rapid heart rate, drossiness and hallucinations.Q: Can you die from an overdose? A: There have been no deaths reported to the California Poison Control System. However, it has the potential to be lethal.Q: What are some of the slang terms teens are using?A: DXM, Robo, Skittles, Syrup, Triple C and Tussin.Source: Partnership for a Drug-Free America, KidsHealth.org, California Poison Control System.
Getting high can be as cheap as $7 and a trip to the local drug store.
At least three Orange County teens have been hospitalized from over-the-counter cold remedies in the past two weeks.
The teens arrived at Mission Hospital hallucinating with owl-like eyes and racing heartbeats.
"One kid was grabbing in the air for his math text book," said Dr. Mike Ritter, assistant director of Mission Hospital's emergency room. "He was seeing school books flying around the room." None of the cases were fatal.
Experts say teens and young adults are increasingly buying over-the-counter cough syrups and cold medications to get high from one of its main ingredients – Dextromethorphan or DXM. The ingredient is found in about 200 products, including Robitussin DM and DayQuil.
"It causes dissociate hallucinations and out of body experiences," said Dr. Ilene B. Anderson, a clinical professor at the University of California San Francisco's School of Pharmacology, who compared the fix to "a PCP-like high."
This week the Consumer Healthcare Products Association, which represents nonprescription drug makers, launched a national campaign to educate the public about cough medication abuse through Web sites, television and radio spots and educational brochures.
Efforts to impose state legislation have failed.
State Sen. Joe Simitian (D-Palo Alto) introduced two bills within the last three years – one in the Assembly and the second in the Senate – to ban the sale of products containing DXM to any person under 18 without a prescription. Both bills met strong opposition from drug manufacturers, retailers and other lawmakers.
"I may re-introduce it as a way to increase awareness," said Simitian, who pulled the bills back before they reached a floor vote. "There are things in the Legislature that take a decade to do. Sometimes you are ahead of the curve."
But growing concern about DXM has led some drug stores, such as Walgreens, to voluntarily prohibit teens from purchasing any product containing the substance. A spokeswoman for Walgreens said the restriction came last year after the company noticed teens buying up to ten packages at a time. Rite Aid limits the number of such products on store shelves. But for many kids getting the products is as easy as opening the home medicine cabinet.
DANGER ON THE RISE
According to the California Poison Control System, the number of DXM overdoses reported in patients ages 9 to 17 has increased more than ten-fold – from 23 cases in 1999 to 375 cases in 2004.
High doses of DXM can cause serious medical complications, such as a coma. However, no deaths have been reported to the California Poison Control System – or Orange County Coroner's Office since at least 2001 – where DXM is the solo cause.
Still, poison control experts said kids run other health risks from ingredients mixed with DXM, such as antihistamines and acetaminophen (the main ingredient in Tylenol).
"It's always contained with something else, which is usually more toxic," said Dr. Lee Cantrell, director of the California Poison Control System's San Diego Division, which oversees Orange County. Toxic levels of acetaminophen can damage or destroy a liver. Antihistamines and pseudoephedrine can cause an increased heart rate, high blood pressure and seizures.
The cough suppressant has been around for decades, but experts say the Internet is fueling its abuse.
"Kids have more access now to what other kids are doing," Ritter said. "One kid in one city can use a drug and the next thing you know 10,000 other kids are aware of it."
In the past year, Ritter estimates Mission doctors have treated three to five cases a month. This month they've already seen at least three cases. Teens ages 14 to 17 have arrived unconscious, seizing and psychotic.
Some Web sites the Register reviewed detail teens swapping stories of "skittling" or "robotripping."
"I got caught in a nasty time loop...That stuff makes pure LSD seem like ginger beer. There is no comparison," blogged a girl on www.erowid.com.
Dr. Gary Goodman, director of the pediatric intensive care unit at Children's Hospital of Orange County's Mission Viejo campus – where the teens who recently overdosed were kept overnight – said he had a case where one patient took 35 Coricidin pills to get stoned. The teen had read online it took 36 to die. The hospital requires all such patients to meet with a social worker before being released. They also recommend counseling.
"We look at this as drug abuse," he said.
"Kids go and eat the whole box. They have no idea how dangerous it is," Goodman said. "They are fearless at that age."
CHEAP AND AVAILABLE
All three recent Orange County overdoses involved Coricidin HBP Cough & Cold, which contains DXM.
"It's the newest fad out there," said Duane Durst, program director of Chapman Medical Center's substance-abuse program, called Positive Action Center, about the over-the-counter drug.
"It's available. It's cheap. No prescription is necessary," Durst said.
In virtually all cases patients at PAC are abusing cold remedies with other drugs. Julie Lux, a spokeswoman for the manufacturer of Coricidin, said the drug-maker has begun using anti-theft tags in packaging to prevent teens from stealing the products.
"We recognize abuse of it is a problem," she said.
"I'd heard about it before from other friends, and they said it was fun," said Christina Pearce, 17, of Coto de Caza, who experimented with Coricidin once – when she was a * high school freshman. "You buy it over the counter, so you figure it's not Heroin, like it can't be that bad."
But the effects – delusions, heart racing and swollen eyes – lasted for three days. She vowed never to try it again. "I was scared to death."
Her message to other teens: "There are affects to your actions that aren't worth it... It's never worth your life."
Later that year, her mother Beth became involved in drug education after a Laguna Niguel girl overdosed on ketamine, a tranquilizer. She read the story in the newspaper and decided something had to be done.
Today the mother has made two educational films warning parents about the dangers of illegal drugs, including DXM.
"The pharmacies have started to put them behind the counter, but kids can still buy it," said Beth Pearce. "Kids think there is nothing wrong with it, that it is safe... It's not illegal to buy."