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Parents: Learn about teen medicine abuse

Information for Educators

While educators are familiar with a full range of drug problems among students, perhaps the abuse of prescription and over-the-counter (OTC) cough and cold preparations may not be on your radar screen. If this is true, you are not alone. According to a recent survey conducted by the Community Anti-Drug Coalitions of America (CADCA), in partnership with the Consumer Healthcare Products Association (CHPA), less than one-third (30 percent) of coalitions believe that parents are aware of cough medicine abuse, and over half (55 percent) do not think parents are having conversations about this form of abuse with their kids..

The National Institute on Drug Abuse’s Monitoring the Future 2008 study estimates the intentional abuse of cough medicine among eighth, 10th, and 12th graders is at 3.8 percent, 6 percent, and 5.9 percent, respectively. Yet another study indicates that only 47 percent of teens believe that abusing cough medicine to get high is risky, which means that over half believe it is not.

Our goal, therefore, is to give teachers, guidance counselors, school nurses, psychologists, and administrators an insider’s look at the cough medicine abuse subculture, help you understand the facts, and give you the tools you need to prevent and stop this latest trend. Here’s what you’ll learn about:

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

At-a-Glance

While over-the-counter (OTC) medicines provide millions with relief from cold and cough symptoms, the potential for abuse among youth of cough medicines demands our immediate attention.
5% of teens have abused cough medicine to get high in the past year.
There are over 100 OTC cough medicines that contain DXM, either as the only active ingredient or in combination with other ingredients. These products are easily obtained from home medicine cabinets, in retail stores, and on the Internet.
When these remedies are taken in large amounts, users can experience an ecstasy-like high along with extremely dangerous side effects.
Be on the look-out for students who have cough medicine bottles, pills, or strange-looking tablets in their possession; or hide cough medicine bottles or pills in lockers or backpacks. Like with other forms of drug abuse, you may also notice declining grades, loss of interest in activities and friends, changes in physical appearance and mental outlook, and/or unusual chemical or medicinal smells on a student.
Include OTC cough medicine in your drug abuse prevention unit.
Work with your local prevention coalition to create and disseminate materials.
Craft and implement staff training.
Continue to be a diligent observer.

Some DXM Web Sites to Watch for:

The Problem

“Skittles, DXM, Dex, Vitamin D” — You might have heard these terms in the hallways, the bathrooms, and in your classrooms. While these expressions sound innocent, they represent the latest practice among young people to get high by taking dangerously large doses of OTC cough medications. These are the same remedies that families commonly have in their medicine cabinets, and are readily available in retail stores everywhere.

The cough medicine high is caused by dextromethorphan (DXM). 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, Dimetapp® DM, Mucinex® DM tablets, 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, and certain Vicks DayQuil and NyQuil LiquiCaps. There also are a number of store brands that contain dextromethorphan, as well.

While the problem of medicine abuse isn’t new, what’s alarming is the fact that parents and kids don’t know the harm that cough medicine can cause when taken in excess. This, coupled with how accessible the medications are, is catching adults by surprise—especially once they learn that this kind of abuse can be extremely dangerous.

Decoding Cough Medicine Abuse “Language”

Kids have code names for DXM and the cough preparations. While nicknames vary by product and region, the most common are Skittles, Syrup, Tussin, Triple-C, or CCC. Popular expressions for abusing OTC cough medicines are Robo-tripping, Dex-ing, and Skittling. Users are sometimes called syrup heads or robotards.

Methods of Abuse

Cough medicine abuse is serious, with some kids reporting taking large amounts of pills (even up to 80 per day) or cough syrup, sometimes as much as 25–50 times beyond the recommended doses. Some users prefer pills over certain 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. An equally dangerous option is that they 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 participates in and which you are probably aware of, 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 large amounts of medication or the potential danger of combining one drug with another. Of major concern is combining DXM-containing medicines with non-drowsy antihistamines, 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 heartbeat
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 contains 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 wait for packages to arrive at their door.

Web sites containing DXM abuse information 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 conversations, 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. Essentially, they are actively comparing notes, exchanging approaches, and promoting abuse.

Warning Signs of Cough Medicine Abuse

Authorities say DXM overdoses typically occur in clusters, as word of the drug spreads in a community's middle schools and high schools. People who have a problem with cough medicine abuse may experience the following, some of which as an educator, you may or may not see. A student may:

Have cough medicine bottles, pills, or strange-looking tablets in his/her possession.
Hide cough medicine bottles or pills in a locker or backpack.
Exhibit one or more of the signs in the “Highs” and “Lows” of Cough Medicine Abuse.

You may also notice declining grades, loss of interest in activities and friends, changes in physical appearance and mental outlook, or unusual chemical or medicinal smells on a child.

Things You Can Do

Schools are ideally positioned to identify and prevent OTC cough medicine abuse. You can not only raise awareness about the tragedies caused by this drug abuse problem, but also, as you have always done, intervene when you see potential warning signs. Here are things you can do right now:

Include OTC cough medicine in your drug abuse prevention unit: Stress the message “If these medicines are not taken as directed, the side effects could be extremely dangerous.” Your local community anti-drug coalition can provide you with in-service training and materials that can be integrated into staff and student programs.
Partner with your prevention coalition to create and disseminate materials: Ask for help in creating targeted PowerPoint presentations, flyers, and other materials, or use prepared materials available on StopMedicineAbuse.org. CADCA and CHPA, along with the Pharmaceutical Research and Manufacturers Association, also created a Newspapers in Education supplement on teen substance abuse. Contact CADCA’s Natalia Duncan Martinez for information on how to make use of it.
Craft and implement staff training: Emphasize the importance among your teachers, school nurses, school security, and others about what to look for in cases of OTC cough medicine abuse. Give them the heads-up on the potentially dangerous side effects so they can be prepared.
Ask your PTA to address the topic during one or more of its meetings: Ask them to provide a speaker and materials on the topic by putting them in touch with your local coalition.
Become a diligent observer: As you have done so excellently in the past, don’t hesitate to take appropriate intervention measures as you do with all students if you suspect that someone in your school may be abusing OTC cough medicine.

Want to Learn More?

StopMedicineAbuse, an effort by the leading makers of OTC cough medicines
Consumer Healthcare Products Association
StopMedicineAbuse.org

Preventing Teen Cough Medicine Abuse: A Parent’s Guide
Partnership for a Drug-Free America and Consumer Healthcare Products Association
OTCsafety.org/publications

Battling The Over-The-Counter High
Substance Abuse and Mental Health Services Administration
http://ncadistore.samhsa.gov/catalog/mediaDetails.aspx?ID=371

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

Stay Smart, Don’t Start: The Truth About Drugs and Alcohol (download only)
A Newspapers in Education Supplement made possible by CADCA, CHPA, and PhRMA
nieteacher.org/staysmart.pdf