Teen Deaths May Be From DXM in Cough Medicines

FDA Warns Against Abuse of Dextromethorphan (DXM)

The Food and Drug Administration (FDA) is concerned about the abuse of dextromethorphan (DXM), a synthetically produced ingredient found in many over-the-counter (OTC) cough and cold remedies. The agency is working with other health and law enforcement authorities to address this serious issue and warn the public of potential harm, after five recently reported deaths of teenagers that may be associated with the consumption of powdered DXM sold in capsules.

Although DXM, when formulated properly and used in small amounts, can be safely used in cough suppressant medicines, abuse of the drug can cause death as well as other serious adverse events such as brain damage, seizure, loss of consciousness, and irregular heart beat.

DXM abuse, though not a new phenomenon, has developed into a disturbing new trend which involves the sale of pure DXM in powdered form. This pure DXM is often encapsulated by the "dealer" and offered for street use.

DXM has gradually replaced codeine as the most widely used cough suppressant in the United States. It is available OTC in capsule, liquid, liquid gelatin capsule, lozenge, and tablet forms. When ingested at recommended dosage levels, DXM is generally a safe and effective cough suppressant.

Legal but Lethal: The Danger of Abusing Over-the-Counter Drugs

Parents worry about their child being offered drugs from a stranger on a street corner or a friend at a party. But a child can get deadly drugs from a person you might never suspect-you. The over-the-counter (OTC) drugs you use to soothe a cough or clear a stuffy nose can be abused by kids looking for an easy and cheap way to get high.

OTC drugs are legal and mostly safe when used as directed, which may lead kids to believe that these drugs are always safe to take. The truth is, medication abuse can lead to addiction, overdose, and death. It's up to you to keep track of your child's use of OTC drugs and to stay alert for signs of abuse.

A Dangerous Dose

Nearly half of OTC drugs, more than 125 products, contain an ingredient called dextromethorphan (or DXM). It is in cough suppressants that can be found in stores in caplet or liquid form. It also can be ordered on the Internet.

When taken in very large doses, DXM can produce a high. It also can pose a real danger to the user, including:

• Impaired judgment and mental functioning
• Loss of coordination
• Dizziness
• Nausea
• Hot flashes
• Hallucinations
• Brain damage
• Seizure Death.

Watch for Signs

Watch for signs that your child may be abusing DXM or other OTC drugs:

• Your child takes large amounts of cold or cough remedies or takes a medication even when not ill.
• OTC drugs seem to vanish from your medicine cabinet.
• You find OTC drugs stashed in your child's room or backpack.

Falling grades, mood swings, and changes in normal habits or appearance also can signal a possible drug abuse problem.

One in 11 teens abused OTC medications, such as cough medicine. The problem is more common than you might think.

Keep Your Child Safe

Because OTC drugs are easy to get and legal to purchase, young people may not realize how harmful they can be. As parents, you need to know the facts about OTC drugs and warn your children. Let them know that OTC products are not "safer" to misuse simply because they are legal, have a legitimate purpose, and are easy to buy.

Other ways you can protect your children include:

• Monitor the OTC drugs in your home. Keep track of how much medicine is in each bottle.
• Avoid overstocking OTC drugs in your home.
• Don't allow your child to keep OTC drugs in his bedroom, backpack, or school locker.
• Monitor your child's Internet use. Watch out for Web sites your child may be visiting that promote OTC or other drug abuse.
• Role model responsible use of OTC and prescription medications.

Talking with your child about the responsible use of OTC drugs is one of the best ways to keep your child safe. Teach your child how to read and follow directions on the labels of all OTC drugs, and always monitor your child's use of these medications. OTC drugs are meant to help people, not hurt them, so make sure your child knows the health risks of abusing medicines.

Street Names for DXM:

• Candy
• C-C-C
• Dex
• DM
• Drex
• Red Devils
• Robo
• Rojo
• Skittles
• Tussin
• Velvet
• Vitamin D

Street Names for DXM Abuse:

• Dexing
• Robotripping
• Robodosing

Sources: FDA Talk Paper, T05-23, May 20, 2005. A Family Guide to Keeping Youth Mentally Healthy and Drug Free, The Substance Abuse and Mental Health Services Administration (SAMHSA)