People have been buying and using over-the-counter remedies for coughs and colds for more than 50 years, according to the Consumer Healthcare Products Association (CHPA), a trade association representing U.S. manufacturers and distributors of over-the-counter medicines, and the CHPA says it’s as alarmed as anyone about recent findings that teens are turning to those products to get an easily available “high.”

In voluminous press releases and colorful brochures in English and Spanish, the CHPA is hoping to stem widespread teen misuse of OTC drugs such as cough medicines, reported in the most recent Monitoring the Future survey of 8th, 10th, and 12th grade students in U.S. schools. And the CHPA says it’s working with the Community Anti-Drug Coalitions of America to develop “the first toolkit entirely focused on addressing and preventing cough medicine abuse.”

The Monitoring the Future survey, which is conducted every year by investigators at the University of Michigan, asked students for the first time this year about their non-medical use of over-the counter medicines such as cough suppressants, and found that 4.2 percent of 8th graders, 5.3 percent of 10th graders, and 6.9 percent of 12th graders reported taking cough or cold medicines with dextromethorphan (DXM) during the past year to get high. Since there are no previous-year data to compare, it is not known whether such use of over-the-counter medications is growing, but the National Institute on Drug Abuse, which sponsors the Monitoring the Future surveys, expressed “concern” about non-medical use of over the counter drugs.

How it all started is not clear, given the 50-year record of over-the-counter cold medication, but the CHPA says the Internet is partly responsible. “The Internet is full of predators who actively encourage dextromethorphan abuse and even provide detailed instructions,” CHPA president Linda Suydam said in a statement released simultaneously with the 2006 Monitoring the Future study.

The dextromethorphan Suydam refers to is the active ingredient in more than 100 over-the-counter cough and cold products; it was first approved by the federal Food and Drug Administration (FDA) in 1954 as a cough suppressant that works by raising the coughing threshold in the brain. The ingredient is not considered addictive, even in high experimental doses, but the CHPA notes that “teens engaged in this sort of substance abuse behavior may develop a pattern of habitual use.”

“It is not possible to accidentally abuse dextromethorphan; it takes vast amounts that are far beyond the recommended dosage,” the CHPA said in a fact sheet. However, the fact sheet points out, a raw, unfinished form of dextromethorphan can be purchased over the Internet and is very dangerous when abused—mixed with alcohol or other drugs, for example. The CHPA said it’s working with members of Congress to get legislation passed that would ban the sale or distribution of this unfinished dextromethorphan by all but entities registered with the Food and Drug Administration.

The CHPA urges parents to be aware of the possibility that their teens are buying lots of cough medicine, or taking it from the family medicine cabinet, and should watch for symptoms of acute overdose, including confusion, dizziness, blurred vision, slurred speech, loss of physical coordination, stomach pain, vomiting, and rapid heart beat. The fact sheet also offers some of the slang terms for dextromethorphan, which vary by product and region of the country but may include Dex, DXM, Robo, Skittles, Triple-C, and Tussin. If you are using, you may be Robo-ing, Robo-tripping, or Skittling.

And just to be clear what is being talked about, the CHPA provides examples of some of the OTC medicines that contain dextromethorphan, including:

• Alka-Seltzer Plus Cold and Cough Medicine,
• Coricidin HBP Cough and Cold,
• Dimetapp DM,
• Mucinex DM tablets,
• PediaCare cough medicines,
• Select Robitussin cough products,
• Sudafed cough products,
• Theraflu cough products,
• Triaminic cough products,
• Tylenol Cough and Tylenol Cold products,
• Vicks 44 Cough Relief products,
• CertainVicks DayQuil and NyQuil LiquiCaps.

The CHPA points out that there are a number of store brands that contain dextromethorphan, as well.

Unspoken in the CHPA’s handouts is a powerful incentive to companies to reduce abuse of their over-the-counter drugs, which account for billion of dollars of sale every year. The cloud on the horizon for the companies is the possibility that, if misuse becomes rampant, the medications will become available only “back of the counter,” dispensed by pharmacists rather than pulled off a shelf, possibly even with a requirement that purchasers sign a register at the time of purchase.

The CHPA and Partnership for a Drug-Free America offer a background paper on cough medicine abuse for parents and educators at www.drugfree.org/drug_guide/DXM, and a teen-oriented website that’s intended to counter misinformation available on line, at www.dxmstories.com.