Anti-Cough Ingredient Abused

DXM's popularity among kids seeking a high has forced countermeasures

For decades, teenagers have found it easy to get high without buying drugs illegally: chug cough syrup or down a fistful of cold tablets, cope with the vomiting or other possible side effects, and await the hallucinations.

But in recent months, an apparent surge in abuse of dextromethorphan, the key ingredient in some cough suppressants and cold remedies, has sparked an unprecedented response among drug manufacturers, pharmacists and awareness groups.

Last year, poison control centers took 3,271 calls related to DXM, as the ingredient is also known -- twice the number in 2001, according to the American Association of Poison Control Centers. Cold medicine abuse was blamed for a handful of deaths in the past two years, several experts said.

While no precise statistics are available, a January report from the White House's Office of National Drug Control Policy said adolescents are "increasingly abusing" DXM, particularly in Portland, Ore., Detroit, Houston, Tampa-St. Petersburg, Fla., and Denver.

"It's something that's been around for a long time, but it seems to be coming back since at least 2000 among young adults," said Andrea Barthwell, the office's deputy director for demand reduction.

When the Phoenix Academy recently surveyed 40 youths in its Austin, Texas, drug rehabilitation program, it found that half of them had misused cold medicines, with the average starting age 11 1/2 years. "We've seen kids abuse over-the- counter stuff before, but I do think there are more products out there now, and they're much more accessible," said Laurie DeLong, the center's program director.

Drug makers and sellers say they want to change that.

Since January, Walgreen Co., the nation's largest drugstore chain, has limited purchases of Coricidin HBP Cough & Cold tablets -- a DXM product known to abusers as "triple Cs" -- to three packages per customer.

Meanwhile, one manufacturer based in New Jersey has embarked on education efforts, while another has changed packaging to discourage shoplifting and even cut back on the ingredient in some of its products.

"We recognize there's a role for us to play," said Mary-Fran Faraji, spokeswoman for Kenilworth- based Schering-Plough Health Care, which makes Coricidin.

Schering-Plough is distributing fact sheets to pharmacists and parents who buy dextromethorphan products. The guide for parents urges them to talk to their children about drug abuse and to know their children's friends and their parents.

Madison-based Wyeth Consumer Healthcare, which makes Robitussin cough syrup, recently enlarged the packaging of its newest DXM product, anti-cough gel tabs, while reducing the amount of the drug compared with the bottled version, spokesman Fran Sullivan said.

State lawmakers in New York and California want to go even further, introducing legislation that would ban sales of products containing DXM to minors.

Pharmacies in some of the areas cited in the White House report are stocking Coricidin and other products containing dextromethorphan behind the counter, selling them only upon request.

Dan Kennedy, manager of a Portland pharmacy, said he took action after hearing about problems with DXM in the area several months ago. "There were some high schoolers who were abusing it," he said. "At that point, we pulled Coricidin behind the counter and posted a sign saying that it's available with a pharmacist's assistance."

But some pharmacists are uneasy about that practice -- they note that more than 100 products contain the drug. "At a practical level, it raises a difficult set of issues," said Tom Holt, executive director of the Oregon State Pharmacy Association. "Take Robitussin: It's not one product, it's a couple of dozen."

Heavy dextromethorphan users describe the sensation as a series of "plateaus" that can range from a mild stimulation to a sense of complete disassociation from their bodies.

The Partnership for a Drug-Free America is using the Internet to launch a new educational effort about DXM. It has set up a site for parents (www.drugfree.org/dxm) and another for teenagers (www.dxmstories.com).

The teen site includes a photo of a youth passed out on a couch after vomiting, along with a cautionary essay by a former user, illustrated with a set of skulls that begins, "You gotta be sick in the head to drink cough syrup."

Partnership spokeswoman Lisa Merchant said the site has received more than 22,000 hits this year, a figure she called encouraging. Merchant compared the educational push to an initiative launched several years ago to warn about "huffing" spray paint and other household products.

"The idea was to get information to parents to realize that spray paint isn't something you should just keep lying around the house," she said. "It's the same with over- the-counter drugs."

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