Teens abusing cough remedy Pills with DXM cheap, dangerous

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BANGOR – People used to take cough remedies only when they were trying to fight the common cold, but a surprising new trend among some of Maine’s teens finds them using the medicines to get high.

More than 120 over-the-counter cold medications contain dextromethorphan, or DXM, which can be abused for its potential disorienting and hallucinogenic properties when taken in extreme, sometimes toxic, quantities, said Dr. Robert Dana, a drug addiction specialist at the University of Maine.

“I don’t know what it is about this culture that young people are using almost anything to disconnect themselves from reality,” said Dana. “I’ve been made aware, certainly in the last year, that [young people] are getting DXM just to get high.”

Some central Maine college students who spoke to the Bangor Daily News on the condition of anonymity claim they were using pills containing pure DXM to get high. They claim these pills containing high quantities of DXM, not available over the counter in the United States, were purchased privately over the Internet from pharmacies in other countries, and then sold in the United States by the same drug dealers who sell marijuana, Ecstasy and LSD. These pills have a street value of $5 each.

“It’s a cheap way to get high,” said Paul, a 19-year-old college student in the Bangor area. “It’s a very intense high, more so than acid or mushrooms. But you have to be careful or you can slip into a massive depression while you’re on them.”

Extensive problems with DXM have been reported in numerous locations throughout the United States, including Dallas, Denver and Milwaukee, in just the last few months. A number of students in those locations were noticed for having appeared drugged while in classes at their high schools. Investigations found that these students had purposely abused DXM.

In Ohio, 30 teen-agers and young adults were seen in local emergency rooms during a four-month span in 2001 for problems related to abusing DXM.

“It’s a problem all over the country that keeps popping up in different spots. It’s been going on for decades, but it’s made a resurgence in recent years,” said Karen Simone, managing director for the Northern New England Poison Center in Portland.

Sweden made DXM a prescription-only medication in the 1980s after several overdose-related deaths. Similar efforts are under way in Australia. The International Olympic Committee has banned the use of any substance containing DXM by Olympic athletes.

While Eastern Maine Medical Center, St. Joseph Hospital and the substance abuse program at Acadia Hospital in Bangor have seen a minimal number of problems involving DXM, the Northern New England Poison Center has seen a rise in the number of calls received regarding the drug in Maine.

In 2001, the center received about 30 calls regarding DXM overdoses from within Maine, said Simone. A third of the center’s calls were specifically regarding a medication known as Coricidin HBP Cough and Cold, which contains DXM.

The fact that hospitals and rehabilitation centers have not seen an increase in problems with DXM doesn’t surprise Simone.

“The kids aren’t scared enough so that you’d see a lot of reports” to hospitals and rehabilitation centers, she said. “We’ve certainly noticed an increase in calls. It was a rash of calls that made us alert to the problem in the area.”

In an informal survey of 30 people ranging from 15 to 25 years of age in Bangor conducted by the Bangor Daily News, eight people said that they had used items containing DXM to get high. Of the group, 16 said they knew at least one person who had used some version of the over-the-counter drug to get high.

Drug companies aware

“We’re aware that this has been happening over a period of time with dextromethorphan,” said James Lawenda, a spokesman for Schering-Plough Corp. of New Jersey, the parent company of Coricidin. “We’ve worked rigorously to get information out there. We’ve developed education information for parents and educators on proper use and what to look for in someone who is abusing the products.”

Whitehall-Robins Healthcare in New Jersey owns Robitussin DM, another widely abused medication containing DXM, said media representative Fran Sullivan. The company also has been involved with distributing information about its products and the abuse of DXM, he said.

“We try to keep a low profile with this,” Sullivan said. “We don’t want kids who don’t know to find out.”

Sullivan had been made aware recently, though, that pure pills of DXM, imported from other countries and sold on the streets, are slowly becoming a preferable alternative to drinking DXM with syrup, which tends to make users sick.

Paul has tried the imported version of the drug several times in the 600-milligram pill form.

The 600-milligram pills of DXM are not legally available for sale at all in the United States, said David Ingalls, a pharmacist at Miller Drug in Bangor.

“It’s not as bad for you as Ecstasy or acid, and it’s still legal,” Paul said. “I’m personally not planning on doing it too much anymore because it gets worse, more intense, every time you do it. Your brain turns to mush, but there’s people who love it.”

The idea that a medication is safe because it comes without a prescription is a dangerous one, said Ingalls. “Contrary to what some of these people think, it is not a safe high,” he said. “Too much of any medication has its negative side effects.”

It can be addictive

DXM also has been found to become addictive when abused for extended periods of time, Simone said.

Many DXM abusers are given incorrect information when they research or hear about the drug on the Internet, said Simone. One popular underground Web site falsely claims that DXM has no negative side effects and advises what medications should be taken for the best high. Many times, this type of misinformation leads DXM abusers to think that the drug cannot harm them and that there is no downside to misusing the medication, no matter what dosage they take, she added.

DXM is a drug designed to alleviate coughing by directly reducing the sensitivity of the cough center, the part of the brain that responds to stimuli in the lower respiratory passages that irritate and trigger the cough reflex. But drug abusers throughout the world have found uses for the medications outside of treatment for the common cold.

Coricidin HBP Cough and Cold, also known as “Triple C,” is a pill containing DXM and is one medication people are abusing when they want the high, but don’t want to have to consume the syrup involved with other DXM-containing products, said 16-year-old Christina of Bangor.

“All the syrup just makes you sick to your stomach,” she said. “With the pill you can still get nauseous, but it’s just not as bad. You can usually take more before you get sick.”

Drinking Robitussin DM – a liquid form of the drug – to get high is popular enough that it has earned the nicknames “robo-ing” and “robo-tripping.”

“I swore to God that I would never drink Robitussin to get high. I swore I would never stoop to that,” said 22-year-old Jessica from Bangor. “Then I was at this party and they had these pills that had the stuff from Robitussin that makes you high. So I said, ‘All right, might as well.’ It was the most disoriented feeling in my life. At one point we hadn’t gone anywhere, but I had no clue where I was. All of my motor skills were shot. And I only had half a [600 milligram] pill.”

Huge doses taken

The recommended dose of DXM for anyone over the age of 12 is “60 milligrams every 12 hours as needed,” according to an informational packet that comes with the prescription version of the medication.

Those abusing the drug, however, have been known to take anywhere from 400 to 1,200 milligrams in one sitting. The drug, if taken in quantities of more than 10 milligrams for every 2.2 pounds that a person weighs, can be toxic, said Ingalls.

A person who weighs 132 pounds and takes 600 milligrams of the drug is not necessarily safe from possible side effects because different bodies handle different drugs differently, Ingalls added.

In some reported cases, users have been drinking four 4-ounce bottles of Robitussin DM at once to obtain their high. Four bottles of Robitussin DM, said Dana, provide around 960 milligrams of DXM.

In Ohio, it was reported that teens were using 13 Coricidin HBP Cough and Cold pills at once to get high, while some of the individuals admitted for emergency treatment admitted to having used 51 pills daily for an extended period of time. One Coricidin pill contains 30 milligrams of DXM.

According to information provided with the drug and from firsthand statements, side effects from abusing DXM can include delirium, hallucinations, stupor, itching, coma, respiratory depression, seizures, blurred vision, confusion, difficulty in urination, drowsiness, severe nausea or vomiting, shakiness, loss of balance, headaches and stomach pain. Taken in excess, the drug also has been known to cause unusual excitement, nervousness, restlessness or severe irritability.

In some cases the drug causes a person’s gag reflex to be slowed considerably, creating the possibility of vomit going back into a person’s lungs, Simone said.

Problems can be more severe for anyone with less-than-perfect health, she added. “When your health is not the best, any little thing you do can be very dangerous, especially if it is dangerous for someone with perfect health.”

If taken properly, though, medications containing DXM are safe for most users, Ingalls stated.

Aside from the health risks of misusing the cough medications are the legal risks that many people are facing while getting their hands on the readily available drugs.

“You only use this stuff when you can’t afford anything else,” said Christina. “You’ll find people jacking [stealing] this stuff from every store in the area.”

Many of the users reported having used ketamine hydrochloride (“special K”), LSD, cocaine, marijuana or OxyContin before ever trying DXM, while others claimed using DXM was the first time they had ever tried to get high.

A growing problem

A manager at one drugstore in Bangor, who spoke on condition of anonymity because his company does not allow public statements by anyone outside of the national headquarters, said the problem is greater than most people realize.

“This is really something big that’s going on. We see a lot of theft. Your average store loses four to eight packages of these [medications] each week,” said the manager. “There are certain products you notice higher theft with than others and you try to limit those on the shelves. But you can’t not have these things out on the shelves. They’re over-the-counter medications that are there for the people buying it for the right reasons. Until they put these behind the counter, and I don’t see that happening, it’s going to be a continuing problem.”

Managers from other stores declined to comment, and calls to their national headquarters were not immediately returned.

Anyone caught operating a vehicle while under the influence of any substance, including DXM, to the point where it impairs his decision-making abilities and physical reactions can be arrested for operating while under the influence, said Mike Roberts, Penobscot County deputy district attorney.

A completely different set of legal issues faces anyone involved with importing pure DXM into the United States through the Internet or any other means, said Brad Stone, spokesman for the Food and Drug Administration in Maryland.

The importation of any drug by means other than through the FDA is a federal offense with a wide range of penalties, he said.

In addition to closely monitoring the contents of their medicine cabinets, parents who suspect their children could be using cough and cold medicines to get high should watch for depression, disorientation or lethargy in their children, said Simone. Empty packages also can be an indicator.

“The trick for parents is to talk, talk, talk and talk some more,” said Dana. “Don’t be afraid to get in kids’ lives. It’s shocking sometimes what they’ll tell you, but we have to get in front of this. There’s something wrong there when these kids are doing drugs to the extent that they become mind-altering just so they can get away.”

Parents, teachers or anyone else concerned about someone who may be abusing DXM can call the Northern New England Poison Center at (800) 222-1222.

“The trick for parents is to talk, talk, talk and talk some more. Don’t be afraid to get in kids’ lives. It’s shocking sometimes what they’ll tell you, but we have to get in front of this. There’s something wrong there when these kids are doing drugs to the extent that they become mind-altering just so they can get away.”

– Dr. Robert Dana, University of Maine