Adolescent abuse of over-the-counter cold medicine soars

By Wallace Ravven

December issue of Archives of Pediatrics and Adolescent Medicine

Abuse of a drug found in popular over-the-counter cough and cold medicines has soared in recent years, particularly among adolescents, according to an analysis of phone calls received by the statewide California Poison Control System.

The drug, dextromethorphan, or DXM, is an active ingredient in such medications as Coricidin HBP Cough & Cold Tablets and Robitussin products, the CPCS reports. Taken in excess of recommended doses, it can produce euphoria, hallucinations and potentially dangerous responses. The drug goes by such slang terms as CCC, Triple C, Dex, Skittle and Robo.

CPCS, managed by the School of Pharmacy at the University of California, San Francisco, is a statewide 24-hour emergency telephone consultation service that offers treatment advice to the public and health care professionals regarding poisonings and overdoses. The system reported a 10-fold increase in calls concerning DXM abuse from 1999 to 2004, with abuse among youths from ages 9 to 17 increasing more than 15-fold. The highest frequency of abuse was among teens aged 15 and 16, according to CPCS calls.

The CPCS reports its analysis in the December issue of Archives of Pediatrics and Adolescent Medicine.

Adverse effects in cases called in to CPCS between 1999 and 2004 ranged from drowsiness and disorientation to rapid heartbeat, high blood pressure and brief seizures. No deaths were reported.

CPCS assessed 1,382 DXM abuse cases over the six-year period, and found that the frequency of reported cases increased almost 50 percent each year.  Actual abuse of the drug may be much higher, the report notes, since the data is based only on calls CPCS receives. The increased DXM abuse cases identified in California as reported to the CPCS mirrors national trends, the CPCS researchers report.

The increase in abuse likely stems from several causes, the authors write. Products containing DXM are sold over the counter at pharmacies and grocery stores, making them readily available and removing the stigma associated with illegal drugs. Children and teens also have increased internet access, where web sites promote abuse of the drug.

Preventive measures, such as placing DXM-containing products behind pharmacy counters, may limit this trend of increasing abuse, the report concludes.

“Teenage dextromethorphan abuse is a serious problem, and the incidence is rising not only in California, but nationally,” said Ilene B. Anderson, PharmD, senior author of the paper and a clinical pharmacist at the San Francisco division of CPCS. “It is important for parents, health care professionals and retail establishments selling DXM-containing products to be aware of this issue in order to educate, and to prevent dangerous health consequences.” Anderson also serves as a clinical professor in the UCSF clinical pharmacy department.

Lead author on the study is Jodi Bryner, Pharm D, a pharmacy resident currently at Kaiser Permanente, Walnut Creek. Co-authors are Uerica Wang, PharmD; Jenny Hui, PharmD; and Merlin Bedodo, PharmD, all pharmacy residents in the UCSF clinical pharmacy department. Conan MacDougall, PharmD, UCSF assistant professor of clinical pharmacy, is also a co-author.

The research was supported in part by the National Institute on Drug Abuse.

UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.

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