Those of you who work in supermarkets and drugstores interact with customers every day and are in an advantageous position of getting to know consumer behavior. You observe our buying patterns—what we purchase and how often.

While you undoubtedly know about the abuse of prescription medicines, what may not be on your radar screen is the latest trend by teenagers to take excessive amounts of OTC cough preparations containing dextromethorphan (DXM) to get high. We need your help in educating consumers—parents and their children—about the importance of taking these medicines as directed and on informing them about the serious side effects if abused. 

While we want to ensure that OTC cough and cold medicines containing DXM remain accessible to those who need them, we also must recognize the potential for abuse among youth demands our immediate attention. This fact sheet gives you information about this growing trend as well as tools for suggested action. Here’s what you’ll learn about:

• The Cough Medicine Abuse Subculture
• Methods of Abuse
• Why Get Involved?
• Things You Can Do

 

 

 

The Cough Medicine Abuse Subculture

Recent studies tell us that an estimated one out of 10 people aged 12–17 nationwide —that’s 2.4 million kids from all backgrounds and geographic areas—say that they have taken cough medicine to get high. Further underscoring this trend, the National Institute on Drug Abuse’s “Monitoring the Future” study estimates the intentional abuse of cough medicine among eighth, tenth, and twelfth graders is roughly at four percent, five percent, and seven percent, respectively—on par with cocaine.

There are well over 100 OTC medicines that contain DXM, either as the only active ingredient or in combination with other active ingredients. Examples include Alka-Seltzer Plus Cold & Cough Formula, Coricidin HBP Cough and Cold, some Delsym products, Dimetapp® DM, some Mucinex® products, PediaCare cough medicines, certain Robitussin® cough products, Sudafed cough products, TheraFlu® Cough products, Triaminic® cough products, Tylenol Cough and Tylenol Cold products, Vicks 44 Cough Relief products, certain Vicks DayQuil and NyQuil LiquiCaps, and Zicam. There also are a number of store brands that contain dextromethorphan, as well. Kids have code-names for DXM and the cough preparations. While nicknames vary by product and region, the most common are “Dex, DXM, Robo, Syrup, Tussin, Triple-C, CCC, or Skittles.” Popular expressions for abusing DXM are “Robo-tripping, Dex-ing, Robo-fizzing, Smurfing (buying cough medicines from multiple retail stores), and Skittling.” Users are sometimes called “syrup heads or robotards.”

Young people who abuse OTC cough medicine may purchase (or shoplift) multiple quantities of the medications and/or frequently return to your store to buy more. Some retailers report that kids guzzle down the syrup or pills in their stores, simply leaving the empty packages behind. In addition to buying these products off-the-shelf, some are visiting web sites and online communities that promote the abuse of DXM. These sites provide guides on how to achieve a high based on a user’s height and weight; how to combine it with other drugs; and what effects are to be expected based on the amount consumed.

 

Methods of Abuse

A normal dose of cough medicine is 15–30 milligrams. Mind-altering effects can occur at doses of 100 milligrams, but many consume enough pills or syrup to equal 240–360 milligrams. In fact, some kids take up to 80 pills daily, or as much as 25–50 times beyond the recommended doses. Some users prefer pills over syrups because tablets are easier to conceal and consume. Alternately, others prefer the cough syrup and drink it undiluted, while still others mix it with sodas or even alcohol. They call this “Robo-fizzing.” An equally dangerous option is that they consume the pure, unfinished DXM ingredient which can also be purchased over the Internet.

Presciption and OTC medicines may also be used for a worrisome activity kids call “pharming.” With their friends, they amass pills—including DXM-containing medicines they’ve collected from home or elsewhere. Often in one sitting, they randomly take handfuls of pills, not caring what they are ingesting, and oblivious to the consequences of taking excessive amounts of medication or the potential danger of combining one drug
with another. Of major concern, of course, is combining DXM-containing medicines with non-drowsy antihistamines, SSRI anti-depressants, and MAOI inhibitors.

 

Why Get Involved?

Most users and their parents have no idea about the dangers of taking excessive amounts of DXM-containing cough medicines. Nor do they have a clue that other active ingredients in these preparations can be extremely dangerous if taken in high doses. They do not understand that the side effects can be worsened if used in combination with medications as explained above or taken with alcohol or illegal drugs.

We’re sure that as a retailer you are committed to the community where your store is located, and to the customers who walk through your doors. Because of your unique relationship with your consumers, we hope you will educate your community and help to stop abuse.

 

Things You Can Do

Here are things you can do right now to help combat OTC cough medicine abuse:

• Move OTC medications to visible and observable places in your store: This action may prevent shoplifting and over-purchasing of cough and cold medicines.
• Educate your employees: Provide training to your loss prevention personnel, stockers, pharmacy technicians, and others to be on the look-out for young people purchasing large amounts of cough and cold medicines that contain DXM. Also work with your local community colleges and/or other institutions that are responsible for training pharmacy technicians and ask for continuing education units (CEUs) for training in this area.
• Create posters and other materials to remind employees about this problem: Post these materials in staff and break rooms.
• Become a diligent observer: Notice if there is a run on cough medicine and who is purchasing it.
• Educate your pharmacists, if applicable, and don’t be afraid to share what you know about the side effects of taking too much cough medicine: Advise parents not to stockpile their OTC or prescription medicines—it creates greater accessibility to these drugs. Tell them to be on the alert for the warning signs of abuse, including disappearing bottles of cough syrup, empty bottles or multiple pill packs in a child’s room or trash can, and a child’s strange or unusual behavior. If you’re talking to teens, give them the straight story: Tell them the truth about the hazardous side effects of abuse. A free brochure for parents, What Every Parent Should Know about Cough Medicine Abuse, can be ordered through the Consumer Healthcare Products Association at www.chpa-info.org/pubs.
• Talk with your customers and distribute brochures. Tell them about the hazardous risks of combining DXM-containing medicines with other medications.
• Get involved, stay engaged: Your local community anti-drug coalition welcomes your participation in its prevention and intervention activities. Don’t hesitate to contact your local coalition for more information, on this, and other forms of drug abuse.

 

Want to Learn More?

Stop Cough Medicine Abuse Programs
Consumer Healthcare Products Association
www.StopMedicineAbuse.org

A Dose of Prevention Toolkit
Community Anti-Drug Coalitions of America, Consumer Healthcare Products Association:
www.doseofprevention.org

What Every Parent Needs to Know about Cough Medicine Abuse
Partnership for a Drug-Free America and Consumer Healthcare Products Association:
www.chpa-info.org/pubs

Dextromethorphan
Consumer Healthcare Products Association:
www.chpa-info.org/ChpaPortal/

Battling The Over-The-Counter High
Substance Abuse and Mental Health Services Administration:
http://ncadistore.samhsa.gov/catalog/mediaDetails.aspx?ID=371

Make Up Your Own Mind About Cough Medicine
Partnership for a Drug-Free America:
www.dxmstories.com