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Daniel J. DeNoon
WebMD Health News
Reviewed By Louise Chang, MD
Today's reports of four Pennsylvania 10th-graders hospitalized after taking pink pills sold over the Internet as Snurf have parents scrambling to learn more about this little-known drug.
It's not yet clear exactly what the Snurf product actually contains. But the kids' symptoms — and the effects reported by Snurf takers in online drug-user message boards — point to dextromethorphan, the cough suppressant ingredient in Robitussin and other over-the-counter medicines.
Dextromethorphan, known by users as DXM, dex, or robo, is a synthetic morphine analog that lacks opioid-like effects, says Deborah Levine, MD, attending physician at New York's Bellevue Hospital Center. Levine recently published a study on "pharming," the abuse of prescription and nonprescription drugs by teens.
"It's the ninth- and 10th-graders who are doing the dex," Levine tells WebMD. "One in 10 kids in grades seven to 12 have used it. In California, they have seen a 15-fold increase in kids age 9-17."
While use of illegal drugs is down among teens, use of DXM and other over-the-counter drugs is on the rise from eighth grade onward, says Michael Windle, PhD, chair of behavior sciences and health education at Emory University's Rollins School of Public Health.
"The message isn't out there of the potential dangers of using these substances. You have a very dangerous combination of fairly easy access with absence of messages of potential harm," Windle tells WebMD.
Snurf Pills Herbal?
The Pennsylvania teens may not have been trying to get DXM when they obtained the Snurf pills. Users report that the package listed its "herbal" ingredients as "Fevizia, Palenzia, and De la Amazon."
No such herbs exist, according to multiple references. Since the Pennsylvania school incident, Snurf itself is hard to find on the Internet, although it's been sold at least since 2005.
But other products listing the same ingredients — such as Snuffadelic and Red Dawn Vector Euphoria Enhancer — are readily available.
The "herbal" moniker may make teens think the drugs are safe or even healthful, warns Windle, leader of a landmark, 20-year study of the long-term effects of teen substance abuse.
"They say it is not illegal and that it's an herb, so adolescents may think it is actually healthy for you," Windle says. "This is a clever marketing gimmick to sell it online. You remove any guilt these adolescents may have about taking a drug."
Moreover, Windle says that since these drugs are not illegal, teens often feel that they are more acceptable to peers and even to parents than are illegal drugs such as marijuana.
Yet both the desired effects and the side effects can be devastating. At extreme doses, Levine says, DXM causes the same kinds of dissociative symptoms — memory loss, depression, anxiety, detachment from self, sense of unreality, blurred sense of identity — seen with ketamine, a very dangerous drug of abuse known as "special K."
"DXM definitely has toxicity. At the drug doses the kids take — six to 12 times the regular dose — you can have serious toxicities, especially if they take cough syrup that contains antihistamines or Tylenol," she says. "Even at lower doses that give some impairment, kids can get into dangerous situations. It is the combination of toxicity and impairment that leads to harm."
Windle warns that "these products can produce a very severe side effect that under some conditions could require hospitalization or even result in death."
Levine warns parents to take stock of their medicine cabinets, including nonprescription drugs.
"I would just warn parents to be cognizant of what their children are like; to know their daily routines and to know if they are too tired, or if their school performance off," she says. "Talk to kids. They should know these are serious medicines. Injuries and even deaths can occur."
SOURCES: Fox News web site: "Snurf Pills Bought Online Sicken High School Students." Levine, D.A. Current Opinions in Pediatrics, June 2007; vol 19: pp 270-274. Schwartz, R.H. Clinical Pediatrics, September 2005; vol 44: pp 565-568. Deborah Levine, MD, attending physician, Bellevue Hospital Center, New York University Medical Center. Michael Windle, PhD, professor and chairman of behavior sciences and health education, Rollins School of Public Health, Emory University, Atlanta. Natural Medicines Comprehensive Database, accessed online Sept. 9, 2008. HolisticOnLine, accessed Sept. 9, 2008. Ulbricht, C.E. and Basch, E.M. (eds.). Natural Standard Herb Supplement Reference, Mosby Inc., 2005.
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