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Cough Medicine as a Drug of Abuse
Could my patient be abusing OTC dextromethorphan?
In recent years, adolescents have begun to turn to unconventional sources of drugs to abuse. One such drug that is becoming more and more popular among teenagers is dextromethorphan, a common ingredient in many cough and cold medications. In large doses, dextromethorphan is broken down into dextrorphan, which can produce euphoria and hallucinations—effects similar to those of phencyclidine. Because dextromethorphan is readily available as an inexpensive over-the-counter medication, it is an attractive target of abuse among adolescents. In addition to the effects that draw teens to abuse the drug, dextromethorphan can also cause serious side effects, including respiratory depression, blurred vision, blood pressure changes, tachycardia, and neurologic depression.
In a study recently published in Archives of Pediatrics and Adolescent Medicine, Bryner and colleagues1 retrospectively reviewed cases of dextromethorphan abuse among teenagers in California between 1999 and 2004. By year, the authors looked at the proportion of all reports made to the California Poison Control System (CPCS) that were related to dextromethorphan. (They excluded cases of unintentional overdoses.) In addition to the CPCS cases, they also examined reports made to the American Association of Poison Control Centers (AAPCC) and to the Drug Abuse Warning Network--a program of the Substance Abuse and Mental Health Services Administration. The authors discovered similar findings from each of the 3 databases: both the absolute number and the relative proportion of reports related to dextromethorphan abuse grew each year.
Over the study period, there was a 10-fold increase in the number of cases of dextromethorphan abuse reported in California to the CPCS and a 7-fold increase in the cases reported nationally to the AAPCC. Over this same period, 74.5% of the California cases involved adolescents. The proportion increased in the more recent years reviewed.
The data in the study reflect calls made to poison control centers. Thus, the overall incidence of dextromethorphan as a drug of abuse among teenagers is probably underreported. It can only be assumed that dextromethorphan use is becoming more and more prevalent among adolescents (reflected by the increasing number of cases reported to poison control centers).
In a recent letter published in Pediatrics, Falck and colleagues2 discussed their survey of more than 4000 11th and 12th grade students. Results showed that 4.9% of the seniors and 3.4% of the juniors reported using dextromethorphan "to get high or intoxicated."
While the Bryner study has limitations related to reporting, it does shed light on a worrisome trend. It is difficult to collect accurate data about drugs of abuse among adolescents. Nevertheless, the study offers us, as general pediatricians, a small insight into a dangerous trend among teenagers. We need to keep our eyes open to the changing substances being abused. We need to revise our approach to taking drug and alcohol( histories from our adolescent patients and to include questions about over-the-counter medications that the patient may be misusing. Most important, we need to make teens aware of potential harm from dextromethorphan abuse. ■