Pubdate: Fri, 13 Feb 2004
Source: Chicago Tribune (IL)
Copyright: 2004 Chicago Tribune Company
Contact:  http://www.chicagotribune.com/
Details: http://www.mapinc.org/media/82
Author: Bonnie Miller Rubin, Tribune staff reporter

ABUSE OF COLD MEDICINE ON RISE

Some Stores Try to Thwart Teens

Emergency room physicians are reporting a sharp increase in teens
abusing non-prescription cough and cold medicines, which are back in
vogue as recreational drugs because the products are accessible and
easier to take than ever before.

Users call it "skittles," "triple Cs" (for Coricidin HBP Cough & Cold
tablets) or "robo-tripping" to describe its hallucinogenic effects.
Medical personnel are calling it "an epidemic."

The latest concerns have caused some drugstore chains to limit
purchases. But the efforts don't go far enough, say many critics, who
are urging that all such products be sold strictly from behind the
counter.

"It's not illegal to purchase. It's not even illegal to take in large
quantities. It's just dangerous and foolish and that is what is
scaring everybody," said Dr. Charles Nozicka, director of pediatric
emergency medicine at St. Alexius Medical Center in Hoffman Estates.

Nozicka estimates he has seen about 30 cold medicine-related overdoses
in the last year.

While students have been guzzling cough syrup for years, this is a
relatively new phenomenon. Sweet syrups would contain ingredients that
cause vomiting before reaching doses large enough to hallucinate.
Tablets don't have that effect.

The key ingredient is DXM, a cough suppressant that replaced opiates
in the 1970s and can be found in more than 120 products, all safe when
used as directed. But taking DXM in large quantities can cause slurred
speech, tremors, seizures and even death. Because the product is at
every pharmacy, the dangers are easy to dismiss, said experts.

While no national agency tracks fatalities, at least five have been
attributed to cold medicines during the last year, including one in
September at Illinois State University. More indicative of a growing
problem: U.S. poison-control centers logged some 3,200 calls related
to the substance in 2003--twice the number as in 2001. Locally, the
Illinois Poison Center got 160 calls last year--an increase of 26
percent since 2001.

"It wasn't something we really noticed before 2001," said Dr. Michael
Wahl, medical director of the Illinois Poison Center.

To raise awareness, the Chicago office of the U.S. Drug Enforcement
Administration issued a parental advisory last week, citing a "recent
escalation" in area DXM abuse. In addition, the American Medical
Association voted in December to pursue national restrictions on the
products.

Dr. Tim Erickson, director of clinical toxicology at the University of
Illinois Medical Center at Chicago, realized that this was quickly
becoming the drug of choice when he searched for Coricidin and found
stores were cleaned out.

"The word is out," Erickson said. "It has totally permeated the
adolescent population--especially in the suburbs."

Mike, 17, first heard about DXM from friends at his northwest suburban
high school.

"The main reason I did it every day is because it was just so
available," said the senior, who asked that his last name not be used.
"I didn't need a connection. ... I could steal it. I could get it for
free."

The addiction remains stubbornly under the radar. Most cases don't end
up in an emergency room. Even if they do, personnel don't regularly
test for legal substances. And while marijuana and Ecstasy are still
more popular, those substances usually arouse parental suspicion. No
such alarms go off for cold products--especially in the winter.

"Kids can abuse a long time before adults suspect a problem, said Dr.
Louis Kraus, director of child and adolescent psychiatry at Rush
University Medical Center, who brought the issue to the AMA. "Even
physicians are basically in the dark about this ... but it's at every
high school on the North Shore," said Kraus, who has a private
practice in Deerfield.

While Mike was no stranger to pharmaceuticals, Coricidin quickly
zoomed to the top of the list. At the lower doses, he would experience
a pleasant euphoria "like a good body buzz." Most of the time, though,
he would opt for about 20 of the red pills--or a few more than a
box--which delivered something far more "intense." (Recommended dose:
one every six hours).

Despite using the drug every day for about five months, Mike said he
never OD'd. "But I was shaking a lot ... and I was at the point where
I was stealing it all the time. ... My parents knew about a lot of
stuff, but they were pretty clueless about this."

Eventually, his grades dropped and his parents "put two and two
together" and brought him to Alexian Brothers Behavioral Health
Center, as well as Hazelden Clinic near St. Paul, for substance abuse
treatment.

After three relapses, he said that he has been clean for two months
and back at school, where he's just trying to get through his senior
year.

Coricidin's manufacturer, Schering-Plough HealthCare Products, has
stepped up efforts in recent months, including working with national
retailers and anti-drug organizations, according to Mary Fran Faraji,
spokeswoman for the New Jersey-based drugmaker.

Last month, Walgreens nationwide began limiting the sale of Coricidin
HBP to three packages, with other chains--such as Osco and
Dominick's--following suit. They leave it to the discretion of store
managers whether to clamp down further.

But until all stores keep it out of reach, most health-care
professionals won't be satisfied.

"It's a joke," Kraus said. "Kids who are shoplifting don't care about
how much they can buy. Until it's behind the counter, we're going to
continue to have an increasing problem."

[sidebar]

DXM ABUSE INCREASING

State health-care professionals have seen a rise in the number of
drug abuse cases involving DXM, an ingredient in cough syrup.

ILLINOIS POISON CENTER CALLS
Related to DXM

2001: 127

2002: 140

2003: 160

DXM (DEXTROMETHORPHAN)

Use: Cough suppressant commonly found in over-the counter cough medicines.

How it is abused: At higherthan-recommended doses it can produce
hallucinogenic effects and distorted perceptions of sight and sound.
Signs of abuse: Nausea, vomiting, diarrhea, abdominal pain, poor
coordination, rapid heart rate, dizziness. At very high doses, DXM
can cause the inability to move arms or legs or talk, slowed
breathing and even death.

Slang terms: Dex, Robo, Skittles, Syrup, Triple-C, Tussin

Source - Illinois Poison Center, Drug Enforcement Administration
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MAP posted-by: Richard Lake