Adolescent Cough Medicine Abuse: What Adults Should Know

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Posted: Monday, October 22, 2012 1:30 pm | Updated: 9:01 pm, Mon Oct 22, 2012.
With the onset of cooler weather, many are turning to over-the-counter medicines to keep cold symptoms at bay. But this increased demand can also escalate the misuse of such medications among adolescents—just by making the drugs more accessible. According to the 2011 Monitoring the Future survey conducted by the University of Michigan's Institute for Social Research, 5.5 percent of 10th graders and 5.3 percent of 12th graders in the U.S. have abused cough and cold medication.

David Shurtleff, Ph.D., acting deputy director at the National Institute on Drug Abuse, spoke to us about the dangers that teens face when it comes to abusing cold and cough medicine—like dextromethorphan—and what parents, physicians, and educators ought to do to prevent it.

Why do children and teens abuse cold medicine?People are looking for this euphoria, hallucinations, distorted visual perceptions—they're looking for a high. And unfortunately, around flu season, there's increased availability to these cough syrups in the homes and medicine cabinets and in schools so there's an increased likelihood of abuse particularly among teenagers.

How hard is it for teens to obtain over-the-counter drugs?Certain states do have requirements [to purchase cough or cold medicine], or people have to show ID, but again a lot of these drugs are available in the home, purchased by adults for legitimate use and then of course diverted for abuse. That goes for not only dextromethorphan but other prescription drugs such as the opiate prescriptions. We know that 50 percent of the people get [prescription] drugs from a relative or friend, who doesn't necessary have to be from a pharmacy. It could just be something that's available in the medicine cabinet that's already been purchased, but then abused.
In general that's the pattern. A lot of times, people won't go out and buy these drugs, but actually get them from a friend or family member. And primarily these are drugs that are in the medicine cabinet and easily accessible.

What are the short- and long-term effects of cough medicine misuse?To abuse, you really have to ingest 10 to 75 times the normal amount, so anywhere from 4 to 8 ounces of the drug—of the cough syrup. And when you do that, you can get all kinds of effects: hallucinations that can be frightening or distorted visual perception, loss of motor coordination, and impaired motor function so it's hard to even walk or sit up at times. This could be particularly dangerous if teens or others are attempting to drive or operating machinery.It can also can produce numbness, nausea, vomiting, increased heart rate and blood pressure. So in some cases, if too much is taken, it can be life-threatening because of the increase in blood pressure and heart rate.

Is it harder to abuse dextromethorphan pills than the syrup?I think it can be abused no matter what. The typical dose is 10 to 30 milligrams, every four hours. [In] extreme cases, to get the hallucinations, you're talking 400 to 600 milligrams. Instead of 1 or 2 teaspoons, you're talking 25 or 30 or 40 teaspoons to get that effect.A problem is that teens think, in general, if it's a medication, it must be a safe high. If its perceived risk is low, abuse will be higher. Sometimes people equate a medicine with being safe but of course, in these high doses, it's not safe. So people need to be aware that just because it's a medication it can be abused and it can be dangerous, if used inappropriately.

How big is the risk for addiction?There have been cases of people getting addicted and having to take more and more dextromethorphan to get the same effect. There's a tolerance that can build up. As people continue to use, they need to take more and more of this drug to get the same high or same effect that they had in the past. And over time, for some individuals, that can lead to a craving or chronic taking of dextromethorphan. And if they stop using, some can experience withdrawal symptoms, not too dissimilar from the flu, actually, with sleep disturbances, nausea, night sweats, muscle aches, diarrhea, restlessness and anxiety. In some cases, some people may have acute psychosis that may require hospitalization for some time, in a psychiatric unit, for example.

What do parents need to know to prevent abuse among children?I think it's not just not parents, it's physicians and educators as well—they need to be aware of the symptoms, they need to know what this drug can do in high doses, they need to be aware of the signs such as empty bottles of cough syrup or empty packages for the tablets. Primary care physicians don't think about this problem. Certainly, they should be asking teenagers about their drug use habits. Particularly, they think about marijuana and alcohol, but they should also be thinking about dextromethorphan and prescription drugs as well—Vicodin and others. It's a multi-pronged approach—educators as well need to be aware. Maybe talk about this in the classrooms, particularly now during cold and flu season.

At what age should children be warned of the risks?Our Monitoring the Future Survey [sponsored by the National Institute on Drug Abuse] monitors 8th, 10th, and 12th graders and we're seeing a prevalence in all of those grade levels, so the sooner the better. Certainly, by 7th or 8th grade, we should be talking about these and the data suggests that 15- to 19-year-olds, particularly, boys, are the highest use category for dextromethorphan. So that's certainly the age we should be targeting: the mid-teens, 15 to 19. But certainly educating kids sooner would be a good idea.

What should parents do if they suspect abuse?If [their children] are using and they are experiencing these symptoms for any period of time, obviously, if the parent becomes aware of the problem, they need to talk to the child about the dangers and potential harm of abusing dextromethorphan.If in fact there's acute psychosis or visual perception and the child is agitated or upset, it may require medical intervention of going to the hospital emergency room or their primary care physician for treatment and referral to drug counseling—it really depends.But I think the first step is parent awareness of the problem and if they become aware—and they know, obviously, the first step is to educate the child about the dangers—but if it's an extreme case, it may require counseling or medical help.

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[darklife]

For once a good job on reporting by the media with factual information. Not every day that happens.

[_shameless_]

i agree, its not every day you see something on drugs that isn't packed full of groundless accusations.

[CruelPleasure]

Not a bad article for once.