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Information for Retailers

Those of you who work in supermarkets and drugstores interact with customers every day and are in the position of getting to know consumer behavior. You observe our buying patterns—what your customers purchase and how often.

While you undoubtedly know about the abuse of prescription medicines, what may not be on your radar screen is a substance abuse trend: teens who take large amounts of OTC cough preparations containing dextromethorphan (DXM) to get high. We need your help in educating consumers about the importance of taking these medicines as directed and on informing them about the serious side effects if abused.

While we want to ensure that OTC cough and cold medicines containing DXM remain accessible to those who need them, we also must recognize the potential for abuse among youth demands our immediate attention. This fact sheet gives you information about OTC cough medicine abuse as well as tools for suggested action. Here’s what you’ll learn about:

• The Cough Medicine Abuse Subculture
• Methods of Abuse
• Why Get Involved?
• 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 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.
• 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 kids who purchase multiple cough syrup bottles and pills; notice empty bottles and pill packs in bathrooms and other places where someone would go for privacy.
• Educate employees and consumers about this drug abuse problem.
• Get involved and stay engaged in this community-wide effort.

Serious Side Effects of DXM Abuse:

• 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
• Headaches
• Rashes and itchy skin
• Loss of consciousness

Some DXM Web Sites to Watch for:

• erowid.org
• dextroverse.org
• lycaeum.org
• myspace.com/dextromethorphan

The Cough Medicine Abuse Subculture

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

Young people who abuse OTC cough medicine may purchase (or shoplift) multiple quantities of the medications or frequently return to your store to buy more. Some retailers report that kids guzzle down the syrup or pills in their stores, simply leaving the empty packages behind. In addition to buying these products off-the-shelf, some are visiting web sites and online communities that promote the abuse of DXM. These sites provide guides on how to achieve a high based on a user’s height and weight, how to combine it with other drugs, and what effects are to be expected based on the amount consumed.

Methods of Abuse

A normal dose of cough medicine is 15–30 milligrams. Mind-altering effects can occur at doses of 100 milligrams, but many consume enough pills or syrup to equal 240–360 milligrams. In fact, some kids report taking up to 80 pills daily, or as much as 25–50 times beyond the recommended doses. 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 still others mix it with sodas or even alcohol. They call this Robo-fizzing. An equally dangerous option is that they consume the pure, unfinished DXM ingredient which can also be purchased over the Internet.

Prescription and OTC medicines also may be used for a worrisome activity kids call “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, of course, is combining DXM-containing medicines with non-drowsy antihistamines, SSRI anti-depressants, and MAOI inhibitors.

Why Get Involved?

Most users and their parents have no idea about the dangers of taking excessive amounts of DXM-containing cough medicines. Nor do they have a clue that other active ingredients in these preparations can be extremely dangerous if taken in large doses. They do not understand that the side effects can be worsened if used in combination with medications as explained above or taken with alcohol or illegal drugs.

We’re sure that as a retailer you are committed to the community where your store is located, and to the customers who walk through your doors. Because of your unique relationship with your consumers, we hope you will educate your community to help stop abuse.

Things You Can Do

• Move OTC medications to visible and observable places in your store: This action may prevent shoplifting and over-purchasing of cough medicines.
• Educate your employees: Provide training to your loss prevention personnel, stockers, pharmacy technicians, and others to be on the look-out for young people purchasing large amounts of cough and cold medicines that contain DXM. Also work with your local community colleges or other institutions that are responsible for training pharmacy technicians and ask for continuing education units (CEUs) for training in this area.
• Create posters and other materials to remind employees about this problem: Post these materials in staff and break rooms.
• Become a diligent observer: Notice if there is a run on cough medicine and who is purchasing it.
• Educate your pharmacists, if applicable, and don’t be afraid to share what you know about the side effects of taking too much cough medicine: Advise parents not to stockpile their OTC or prescription medicines—it creates greater accessibility to these drugs. Tell them to be on the alert for the warning signs of abuse, including disappearing medications, empty bottles or multiple pill packs in a child’s room or trash can, and a child’s strange or unusual behavior. If you’re talking to teens, give them the straight story: Tell them the truth about the hazardous side effects of abuse. A free brochure for parents, Preventing Teen Cough Medicine Abuse: A Parent's Guide, can be ordered through the CHPA Educational Foundation.
• Talk with your customers and distribute brochures. Tell them about the hazardous risks of combining DXM-containing medicines with other medications.
• Get involved, stay engaged: Your local community anti-drug coalition welcomes your participation in its prevention and intervention activities. Don’t hesitate to contact your local coalition for more information, on this, and other forms of drug abuse.

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

The Real Truth
A Newspapers in Education Supplement made possible by CADCA, CHPA, and PhRMA
OTCsafety.org/publications/

 

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