Warning label

Teens find a dangerous, cheap high in over-the-counter cough medicine

By Will Evans — Bee Staff Writer
Published 2:15 a.m. PST Thursday, January 29, 2004

The first time Myles did “skittles” was at high school — and all the teachers were giving him strange looks. The curly haired sophomore couldn’t control his forehead, couldn’t put his eyebrows down.
His hands were quivering, his knees spasming. He couldn’t walk straight.
Scary, this being his first time, and this was not expected. A friend told him it would be like smoking a joint. But cough medicine — especially these Coricidin HBP pills, called skittles on the street — was “way more intense.”
At a party that night, Myles played the punching game bloody knuckles. He probably won, because he couldn’t feel a thing, and he woke up later with bashed-up hands.
Not feeling anything is a good feeling, says Myles, now 17, of Sacramento. But take it from him: “I actually don’t recommend taking the whole package.”
The use of cough medicine to get high is rising among teenagers nationwide and in the Sacramento region, according to poison-control centers.
The hallucination-inducing ingredient is the cough suppressant dextromethorphan (DXM). It’s found in many over-the-counter medicines, from Robitussin DM to DayQuil, which are safe at the recommended dosage. Often, the medications contain other drugs harmful in the large quantities necessary to get the DXM fix.
In particular vogue are the red pills of Coricidin HBP Cough & Cold. The Sacramento division of the California Poison Control System has seen an increase in calls related to abuse of the readily available medicine.
“It has a pretty high concentration of the cough suppressant, and we believe that’s why it is one of the drugs of choice for abuse,” says Judith Alsop, division director.
Cough medicine is not one of the most dangerous or widespread abused substances among young people.
Calls about teenagers misusing DXM doubled nationwide from 2000 to 2003, according to the American Association of Poison Control Centers, but the 3,271 cases of 2003 represent a tiny fraction of some 2.3 million total calls. Locally, high school students say it happens, but it’s not common.
“It’s not something that’s on our radar screen,” says Drug Enforcement Administration spokeswoman Rogene Waite. Neither the Sacramento Police Department nor the Sacramento County Sheriff’s Department has had to take action.
But a few DXM-related deaths reported around the country and the upswing in popularity has caused doctors, educators and industry to take note.
This month, Walgreens nationwide began limiting the sale of Coricidin HBP Cough & Cold to three packages per person, and some stores now guard it behind the counter instead of putting it on the shelf. The maker of Coricidin HBP, New Jersey-based Schering-Plough, worked with the Partnership for a Drug-Free America to develop an online resource at http://www.drugfreeamerica.org/dxm.
Despite those efforts, Web sites aimed at abusers of the medication offer tips on what kind and how much cough medicine to down, “fun” things to do while high, how to distill DXM powder from medication and how to buy the powder in bulk.
But those finer points aside, much of the appeal, say teenagers, is that it’s cheap and easily available — at the drugstore or at home in the medicine cabinet.
“If you didn’t have any money to get stoned, basically you just drink a bottle,” says Melissa Florez, a senior at McClatchy High School who guzzled cough syrup a few times when she was feeling depressed her sophomore year. “It seemed like the only thing to do was to get high however I could, and if it came down to a bottle of cough syrup, that’s how it was.”
But Florez, with pink bangs fringing her black hair and peace signs piercing her ears, describes the high as a woozy “sick feeling” and isn’t a fan.
One of the biggest dangers of chugging syrup and popping cold tablets comes from the active ingredients other than DXM, says Steve Offerman, attending emergency physician at UC Davis Medical Center.
“These products, many of them are mixed with other stuff, and you can get poisoning from that stuff as well,” he says.
In high doses, the antihistamine in Coricidin HBP Cough & Cold, for example, causes the heart to speed and symptoms of poor coordination on top of DXM’s effects. In large enough quantities, it could even lead to a coma. Other preparations of Coricidin HBP and other cough medicines include acetaminophen, or Tylenol, which can ruin the liver in whopping doses.
Some cough medications, when taken to get high, could cause heart attacks among people with a family history of cardiac problems or seizures among people susceptible to attacks, says Alsop.
The heavy sedation of high doses could cause breathing problems or lead people to damage their body by lying out in the cold, Offerman says.
And sedation is sometimes blended with a “Hulk-ish” hyperstimulation. Some young people seen by James Margolis of Sutter Center for Psychiatry become violent and assault others when strung out on cough suppressants. Others come in with self-induced cuts, he says.
“They’ll engage in dangerous behaviors,” Margolis says. “They’re not using good judgment (when high).”
Alsop is not aware of any fatalities in the region, but calls to the Sacramento center keep coming in, recently several a week:
* Two teenagers sent from school straight to the emergency room.
* A man who discovered two nieces watching a movie while tripping out.
* Freaked-out teenagers with raging heartbeats, afraid they took too much.
Mike Walsh, a toxicology specialist who fields calls, says the teens are usually sent to the hospital, given a nasty charcoal liquid, monitored till the effects wear off and sent home.
Most young people who do drugs in general have tried DXM, but most don’t stick with it, in the experience of Jon Daily, LCSW, CADC II, an alcohol and drug abuse counselor with Recovery Happens Counseling Services in Fair Oaks.
He saw skittle abuse pop up last year and peak during the summer. But it’s still less than the popularity of other medicinal highs, like that from Vicodin, Valium and Oxycontin, he says.
“Everybody was worried about kids smoking marijuana, using crank and using alcohol,” Margolis says. “What we’re experiencing is that probably two-thirds of drug abuse is stuff in the home or stuff you can get in the drugstore.”

Slang terms:
Red Devils,
Triple C,
A sampling of medications with DXM:
Coricidin HBP Cough & Cold, Robitussin DM, NyQuil, DayQuil, Tylenol Cold, Dimetapp Cold & Congestion Caplets, Sudafed Cold & Cough
Other ingredients to watch out for in cough medicine:
Chlorpheniramine: an antihistamine, which in high doses can cause increased heart rate, dilated pupils, uncoordination and lethargy, and even lead to seizures or a coma
Acetaminophen: pain reliever otherwise known as Tylenol, which in high doses can cause permanent liver damage
Pseudoephedrine: a decongestant which in high doses can cause increased heart rate and blood pressure, nervousness, agitation, irregular heartbeats and seizures
Phone numbers for help:
California Poison Control System: (800) 876-4766
Possible symptoms and side effects:
* Hallucinations
* Slurred speech, poor coordination and inability to move
* Drowsiness, sedation
* Dizziness, confusion, distorted perceptions
* Nausea, vomiting
* Rapid heart rate, dilated pupils
* Can become agitated, violent or psychotic
* Can become more susceptible to seizures, heart problems
* Death is possible, but rare
* Not addictive


Jon Daily, LCSW, CADC II

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