Increasing numbers of California teens abuse over-the-counter cold medicine

The number of reported cases of dextromethorphan abuse in California increased 10-fold between 1999 and 2004, an increase that parallels national trends, according to a report in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. About three-quarters of the reported cases were among individuals age 9 to 17.

"Dextromethorphan has been used safely for years as a cough suppressant and is available in many over-the-counter (OTC) cough and cold preparations," the authors write as background information in the article. But when taken at high doses, the drug can cause hallucinations, and it has been abused for as many as four decades. Since the late 1990s, dextromethorphan abuse has increased among adolescents, in part because the drug is easily accessible and is perceived to be safe. Severe side effects have been reported at high doses, including rapid heartbeat, high blood pressure, agitation, loss of muscle control and psychosis (a loss of contact with reality).

Jodi K. Bryner, Pharm.D., School of Pharmacy, University of California, San Francisco, and colleagues analyzed the trend of dextromethorphan abuse in California as reflected in cases reported to the California Poison Control System (CPCS), a 24-hour emergency telephone service. The findings were then compared to national trends as reported to the American Association of Poison Control Centers and the Substance Abuse and Mental Health Service Administration's Drug Abuse Warning Network.

During the six-year period between 1999 and 2004, 1,411 calls to the CPCS were coded as dextromethorphan abuse. The researchers manually reviewed each one and found 1,382 non-duplicate cases. The frequency of dextromethorphan abuse calls increased by about 50 percent each year compared with the previous year, up to a total ten-fold increase (from .23 cases per 1,000 calls in 1999 to 2.15 cases per 1,000 calls in 2004). Calls involving youth aged 9 to 17 comprised 74.5 percent of those calls and increased 15-fold in that time period, from .11 to 1.68 cases per 1,000 calls, with the highest frequency among youth age 15 and 16. "The younger adolescent age distribution is further underscored by the observation that in CPCS reporting the combined frequency among 12- to 13-year-old subjects exceeded that of 18-year-old subjects," the authors write. The two national databases also experienced an increase in the number and proportion of dextromethorphan-related calls during the time period studied, as well as more frequent calls involving younger patients.

There are likely a number of reasons for this increase, the authors write. Products containing dextromethorphan are sold OTC at pharmacies and grocery stores, making them readily available and removing the stigma associated with illegal drugs. More children and teens now have unsupervised access to the Internet, where Web sites promoting abuse of the medication and even providing instructions proliferate. "Another factor is that it is easy to fool parents because these OTC products are commonly kept in the household," the authors write.

"In conclusion, this study showed an increasing trend of dextromethorphan abuse over a six-year period, particularly in adolescents younger than 18 years," they continue. "It is important for health care practitioners, manufacturers and retail establishments selling dextromethorphan-containing products to be aware of increasing dextromethorphan abuse to educate and hopefully prevent dextromethorphan abuse and the ensuing toxicity from occurring. Preventive measures, such as placing dextromethorphan-containing products behind pharmacy counters, may be an effective action to limit this increasing trend of abuse in adolescents."

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(Arch Pediatr Adolesc Med. 2006;160:1217-1222. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported in part by a grant from the National Institute on Drug Abuse. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.


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