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Parents: Learn about teen medicine abuse

Information for Law Enforcement

Just when you thought you were on top of the latest drug abuse trends, guess again. “Skittles, Robo, Dex, and Vitamin D” are among the code words for the current practice among young people getting high by taking large doses of over-the-counter (OTC) cough and cold medications containing dextromethorphan (DXM).

As men and women on the frontlines, your help is needed to raise awareness about this growing problem. We also ask that you put OTC cough preparations on the list of drug abuse or overdose possibilities when you evaluate crime or motor vehicle crash scenes. If OTC cough medicines are involved, you need to know that the side effects can be extremely dangerous.

This fact sheet gives you an insider’s look at cough medicine abuse and its subculture, provides information about possible signs of abuse, and suggests ways you can help. It addresses:

The Problem
Decoding Cough Medicine Abuse “Language”
Methods of Abuse
The “Highs” and “Lows” of Cough Medicine Abuse
Cough Medicine on the Internet
Things You Can Do

At-a-Glance

While over-the-counter (OTC) medicines provide millions with relief from cold and cough symptoms, the potential for abuse among youth demands our immediate attention.
One out of 10 people aged 12–17 have abused OTC cough medicines that contain dextromethorphan (DXM) to get high.
There are over 100 OTC cough medicines that contain DXM, either as the only active ingredient or in combination with other ingredients.
When these remedies are taken in excess, users can experience an “ecstasy-like” high along with extremely dangerous side effects.
Be on the look out for young people who have cough medicine bottles, pills, or strange-looking tablets in their possession or vehicles; or behavior that is characteristic of drug impairment and who might have an unusual chemical or medicinal smell.
Your help is needed to educate teens and their parents.
If you are a first responder, put possible cough medicine abuse or overdose on your radar screen.
When you go on party patrols, remember that pharming parties—parties during which assorted prescription and OTC medicines are used to get high—may be taking place.
Whenever possible, partner with your local community anti-drug coalition as it creates and implements prevention and intervention measures.

Some DXM Web Sites to Watch for:

The Problem

So now you know that OTC cough medicine should be considered a priority, along with other drugs of abuse. What may be news to you is that one out of 10 people—or 2.4 million kids from all backgrounds and communities—say they have taken cough medicine to get high. And a federally funded university survey estimates the intentional abuse of cough medicine among eight, tenth, and twelfth graders is at 3.6 percent, 5.3 percent, and 5.5 percent, respectively.

There are three factors that make this drug problem different from others you’ve encountered:

OTC cough medicines play an important role in addressing many families’ healthcare needs. 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, Dimetapp® DM, Mucinex® DM tablets, 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, and certain Vicks DayQuil and NyQuil LiquiCaps. There also are a number of store brands that contain dextromethorphan, as well.
Youth can obtain these medicines legally and easily from their home or a friend’s home, a local retail store, and the Internet.
There is also a lack of awareness among people of all ages, particularly teens and parents, about the dangerous side effects of medicines taken in excessive amounts.

As a first responder, you may be the first person on a crime or accident scene to say “If drugs are involved, maybe it’s cough medicine.” You may be the one to educate family members, the abuser, and others about the hazardous risks of abusing OTC cough medicines, which is why learning more about the abuse of these medicines is important.

Decoding Cough Medicine Abuse “Language”

In addition to those previously mentioned, kids have code names for DXM and the cough preparations. While nicknames vary by product and region, the most common are Dex, DXM, Syrup, Tussin, Triple-C or CCC. If a person is abusing DXM, popular expressions you may hear are Roboing, Dex-ing, and Skittling. Users are sometimes called syrup heads or robotards.

Methods of Abuse

Remarkably, kids are taking excessive amounts of pills or cough syrup, sometimes 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. Another dangerous method is to consume pure, unfinished DXM powders and pills which can be purchased in bulk over the Internet with no questions asked.

One of the most worrisome party activities kids participate in is called “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 serious concern is combining DXM-containing medicines with non-drowsy antihistamines, alcohol, SSRI anti-depressants, and MAOI inhibitors. Combining DXM with these drugs is extremely dangerous and can send young people to the emergency room.

The “Highs” and “Lows” of Cough Medicine Abuse

DXM abusers say that a cough medicine high is similar to an ecstasy-like high. They may experience mild distortions of color and sound, strong visual hallucinations, “out-of-body” sensations, confusion, slurred speech, and the loss of motor control. Serious side effects can include:

Delusions
Panic attacks
Memory problems
Blurred vision
Stomach pain, nausea, and vomiting
High blood pressure and rapid heartbeat
Numbness of fingers and toes
Drowsiness and dizziness
Fever and headaches
Rashes and itchy skin
Loss of consciousness

The effects can be worsened if the DXM-containing cough medicine being abused also includes other ingredients to treat more than just coughs, and, as described above, if used in combination with other medications, or taken with alcohol and illegal drugs.

Cough Medicine on the Internet

Web sites and online communities that promote the abuse of DXM-containing products are pervasive on the Internet. These Internet predators are putting children at risk by encouraging the abuse of cough medicine and giving detailed instructions on how to abuse these medicines. Some sites provide guides on how to achieve a high based on a user’s height and weight, how to combine DXM with other drugs, and what effects or “plateaus” to expect based on the amount consumed. Other web sites provide access to raw, unfinished DXM, thus serving as dangerous online drug dealers. The frightening reality is that kids can log-on to these sites and purchase large amounts of pure DXM with only a credit card or PayPal account and a shipping address, and packages arrive at their door.

Web sites promoting DXM abuse are not the only online sources providing dangerous content to kids. Social networking sites such as MySpace, YouTube, LiveJournal, and Facebook are filled with detailed instructions, user conversation, and videos of DXM abuse. Users blog and post videos about specific plans to take DXM, how and when they will take it, and even recounts of the abuse itself. Through these outlets, users actively compare notes, exchange approaches, and promote abuse.

Things You Can Do

Educate youth and their parents: Discuss the hazardous side effects of cough medicine abuse with teens and their care givers whenever you do school outreach programs. Parents need to be advised not to stockpile their OTC medicines, and to be on the alert for the warning signs of cough medicine abuse, including:
- Empty cough medicine boxes or bottles in the trash of a child’s room or in a child’s backpack or school locker
- Purchase or use of large amounts of cough medicine when not ill.
- Missing boxes or bottles of medication from the medicine cabinet
- Visiting pro-drug web sites that provide information on how to abuse dextromethorphan
- Internet orders (for example, note the arrival of unexpected packages, or payments by credit card or PayPal account.)
- Changes in friends, physical appearance, or sleeping or eating patterns
- Declining grades
- Loss of interest in hobbies or favorite activities
- Hostile and uncooperative attitude
- Unexplained disappearance of household money
- Unusual chemical or medicinal smells on a child or in his or her room
- Hearing a child use certain slang terms for DXM abuse, such as Skittling, Tussing, Robo-Tripping, Triple Cs, Robo-tripping, and Dex.
If you are a first responder, be aware of a possible connection between a person’s symptoms and cough medicine overdose or abuse: When you ask drug-related questions, be sure to include OTC cough medicine in the discussion.
When you go on party patrols, remember that pharming parties may be taking place: Kids might be abusing DXM in combination with other medications.
If you test drivers for alcohol and/or other drugs, keep in mind that drivers may be abusing an OTC cough medicine: These medicines may not necessarily show up on standard drug screens.
Integrate OTC cough medicine abuse into the department’s drug abuse training: Work with your local community anti-drug coalition to create targeted materials that police officers can use.
Be a diligent observer: If you suspect that someone has a cough medicine abuse problem, don’t hesitate to take action—connect the user and family to appropriate resources in your community.
Get involved, stay engaged: As a first responder, your local community anti-drug coalition welcomes your participation in its prevention and intervention activities. Don’t hesitate to contact them for more information on this, and other, forms of drug abuse.