Giant to limit access to DXM

Giant to limit access to DXM
Grocer joins effort to prevent abuse of cough medication
May 16, 2007

Joining other retailers and chain pharmacies, Giant Food announced yesterday that it won't sell certain types of cough medicine to customers under 18 because the products have been abused by teenagers.

Beginning Sunday, Giant and other grocery chains owned by Royal Ahold NV will limit sales of products containing dextromethorphan (DXM), a common ingredient in cough and cold syrups, lozenges and pills.

"It's similar to buying cigarettes - if the cashier has a question, we will ask for verification," said Jamie Miller, manager of public affairs for Landover-based Giant Food Inc., which has 186 supermarkets in Maryland and nearby states.

Among more than 100 products containing DXM are Robitussin Maximum Strength Cough Suppressant, Sucrets 8 Hour Cough Suppressant and Vicks 44 Cough Relief, according to the National Institutes of Health. Those brands also have products that do not contain DXM.

The Food and Drug Administration issued a warning in 2005 that five teenagers died in cases "that may be associated with the consumption of powered DXM," although it said the ingredient, when used as directed, is "generally safe and effective."

Concerns over DXM heated up this spring when drug counselors on Long Island reported nine teenagers hospitalized in one month after abusing over-the-counter cough medicines, according to Newsday.

The importance of the action against DXM is a reminder that legal drugs, even over-the-counter drugs, aren't safe if they're misused, said Michael M. Gimbel, director of substance abuse education for the Sheppard Pratt Health System. "When I go out to talk to parents, I have my bottle of cough medicine," he said. Pharmacies have also restricted sales of products containing pseudoephedrine, an over-the-counter decongestant that can be used in the manufacture of methamphetamines.

"It's a sad state of affairs," Gimbel said. "We're slowly but surely emptying the shelves of our pharmacies of over-the-counter medicines."

"As soon as we find out what the kids are up to and do something about it, three days later, they're onto something else," he said.

Gimbel, and state and Baltimore health officials, said there is no indication that DXM use is a particular problem in this area.

Dr. Peter Cohen, medical director of the state health department's alcohol and drug abuse administration, said the state did not have any figures tracking DXM abuse in Maryland and that it was "not high prevalence compared to other substances."

Dr. Joshua Sharfstein, Baltimore health commissioner, said he had talked to police, school health staff and drug abuse treatment providers, and "so far, in Baltimore, it's not hitting our radar screens."

Sharfstein added that the city health department, after consulting with pediatricians, doesn't recommend cough medicines containing DXM for children under age 6, even when used as directed, because "there is not an adequate margin of safety and they are not effective."

Nationally, a survey released in December by the University of Michigan reported that 4 percent of 8th-graders, 5 percent of 10th- graders and 7 percent of high school seniors said they had used cough or cold medicines to get high.

Abuse can occur either by concentrating DXM into powdered form or by taking large amounts of the cough syrups.

"It isn't someone taking a few more tablespoons or a couple more pills - it's 25 to 50 times the recommended dose," said Elizabeth Funderburk, communications director for the Consumer Healthcare Products Association, the trade association for manufacturers of over-the-counter medications.

Gimbel and Cohen said that in large doses, DXM can produce feelings of euphoria, but also disorientation and hallucinations. They said DXM can be particularly dangerous when combined with other drugs or alcohol or if used while driving.

Several states - including Maryland - have considered legislation this year limiting sales of DXM to adults, but none has yet done so, according to Kevin Nicholson, vice president for pharmacy regulatory affairs for the National Association of Chain Drug Stores. His trade association is also supporting similar federal legislation.

While DXM sales are not restricted by law, most large chain stores have imposed voluntary restrictions, Nicholson said.

Among the stores that restrict the sale of products containing DXM are Rite Aid, Wal-Mart, CVS, Target, Walgreens, Brooks, Eckerd and Costco, according to Nicholson, with most adopting the policies since the FDA warning two years ago. Safeway put DXM age restrictions in place in March, said spokesman Greg TenEyck.

Although there haven't been widespread reports of abuse in this area, "We were kind of taking the lead from the Food and Drug Administration," said Miller, the Giant spokesman.

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