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Parents: Learn about teen medicine abuse

Information for Healthcare Professionals

Each generation of young people looks for new ways to get high. A dangerous and growing trend among that population is medicine abuse—both prescription and over-the-counter. This troubling trend includes taking extreme amounts of cold medicines that contain dextromethorphan (DXM) to get high. And many parents may be unaware.

While we want to ensure that these medicines remain accessible to those who need them, we also must recognize that the potential for abuse among teenagers demands our immediate attention. We are turning to you as healthcare providers to help combat this problem. Because you are on the frontlines, we need your assistance in educating parents, other caregivers, and young people about the importance of taking OTC cough medications only as directed. They need to know that if these drugs are abused, the side effects can be dangerous.

Our goal, therefore, is to give you an insider’s look at the cough medicine abuse subculture and suggest ways you can help. We will be discussing:

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

At-a-Glance

While over-the-counter (OTC) medicines provide millions with relief from cold and cough symptoms, the potential for abuse demands our immediate attention.
5% of teens have abused OTC medicines to get high in the past year.
When these remedies are taken in large amounts, users can experience a hallucinogenic high along with extremely dangerous side effects.
Only eight percent of parents surveyed knew about cough medicine abuse, and 75 percent said they never talked about it with their teenagers.
It is vital that first responders be aware of possible connections between a person’s symptoms and cough medicine overdose or abuse.
The involvement of healthcare providers is essential in helping educate parents, children, and the general public about this problem.

Some DXM Web Sites to Watch for:

According to data collected in 2009 by the National Institute on Drug Abuse for its Monitoring the Future study estimate the intentional abuse of cough medicine among eighth, tenth, and twelfth graders is 3.8 percent, 6 percent, and 5.9 percent, respectively.

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.

Most kids and their parents are in the dark about the hazardous risks of abusing these popular medicines. In fact, a recent survey conducted by the Community Anti-Drug Coalitions of America (CADCA), in partnership with the Consumer Healthcare Products Association (CHPA), indicated that only eight percent of parents are aware of cough medicine abuse, and 75 percent don’t talk to their children and teens about the problem. Another study reports 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.

Decoding Cough Medicine Abuse “Language”

Kids have code names for OTC cough medicines, and it’s important for you to know what they are. Among them are Dex, DXM, Robo, Skittles, Syrup, Tussin, Triple-C, and CCC. Popular expressions for abusing OTC cough medicines are Robo-tripping, Roboing, and Skittling. Users are sometimes called syrup heads or robotards.

Methods of Abuse

As you are well aware, a normal dose of cough medicine is 15–30 milligrams. Mind-altering effects can occur at doses as low as 100 milligrams, but many consume enough pills or syrup to equal 240–360 milligrams.

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 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 which can be purchased in bulk over the Internet.

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 major concern, of course, is combining DXM-containing medicines with non-drowsy antihistamines, SSRI anti-depressants, and MAOI inhibitors.

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. Other 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 include 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 and purchase large amounts of pure DXM with only a credit card or PayPal account and a shipping address, and packages arrive at their door.

Things You Can Do

There are many actions you can take to help combat this growing drug problem:

Educate young people and their parents or guardians: Your expertise is invaluable in helping to discuss the hazardous side effects of cough medicine abuse. Parents need to be advised to not 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; cough medicine bottles or unusual pills in their child’s room; unexpected arrival 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; unusual chemical or medicinal smells on a child or in his or her room; and any of the side effects listed above.
If you are a first responder, be aware of a possible connection between a patient’s symptoms and cough medicine overdose or abuse: As you do with all patients, when you ask drug-related questions, always include OTC cough medicine in the discussion.
Continue to be a diligent observer: If you suspect that a patient has a cough medicine abuse problem, take appropriate action—connect the user and family to appropriate intervention options in your community.
Whenever possible, partner with your local community anti-drug coalition as they create and implement prevention and intervention measures: Your input as an advisor, speaker, or facilitator would be a significant contribution as the community tackles this drug problem.