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Cough Medicine Abuse Subculture

Recent studies tell us that an estimated one out of 10 people aged 12?17 nationwide —that's 2.4 million kids from all backgrounds and geographic areas—say that they have taken cough medicine to get high. Further underscoring this trend, the National Institute on Drug Abuse's "Monitoring the Future" study estimates the intentional abuse of cough medicine among eighth, tenth, and twelfth graders is roughly at four percent, five percent, and seven percent, respectively—on par with cocaine.

There are more than 100 OTC medicines that contain DXM, either as the only active ingredient or in combination with other ingredients including Alka-Seltzer Plus Cold & Cough Medicine, Contac, Coricidin HBP Cough and Cold, Delsym, Dimetapp DM, Mucinex DM, PediaCare cough medicines, certain Robitussin cough medicines, Sudafed cough medicines, Theraflu cold and flu medicines, Triaminic cough medicines, Tylenol Cold medicines, Vicks 44 Cough Relief medicines, certain Vicks Dayquil and Nyquil medicines, and Zicam, to name a few. Kids have code-names for DXM and the cough preparations. While nicknames vary by product and region, the most common are "Dex, DXM, Robo, Syrup, Tussin, Triple-C, CCC, or Skittles." Popular expressions for abusing DXM are "Robo-tripping, Dex-ing, Robo-fizzing, Smurfing (buying cough medicines from multiple retail stores), and Skittling." Users are sometimes called "syrup heads or robotards."

Young people who abuse OTC cough medicine may purchase (or shoplift) multiple quantities of the medications and/or frequently return to your store to buy more. Some retailers report that kids guzzle down the syrup or pills in their stores, simply leaving the empty packages behind. In addition to buying these products off-the-shelf, some are visiting web sites and online communities that promote the abuse of DXM. These sites provide guides on how to achieve a high based on a user's height and weight; how to combine it with other drugs; and what effects are to be expected based on the amount consumed.

Methods of Abuse

A normal dose of cough medicine is 15?30 milligrams. Mind-altering effects can occur at doses of 100 milligrams, but many consume enough pills or syrup to equal 240?360 milligrams. In fact, some kids take up to 80 pills daily, or as much as 25?50 times beyond the recommended doses. Some users prefer pills over syrups because tablets are easier to conceal and consume. Alternately, others prefer the cough syrup and drink it undiluted, while still others mix it with sodas or even alcohol. They call this "Robo-fizzing." An equally dangerous option is that they consume the pure, unfinished DXM ingredient which can also be purchased over the Internet.

Presciption and OTC medicines may also be used for a worrisome activity kids call "pharming." With their friends, they amass pills—including DXM-containing medicines they've collected from home or elsewhere. Often in one sitting, they randomly take handfuls of pills, not caring what they are ingesting, and oblivious to the consequences of taking excessive amounts of medication or the potential danger of combining one drug
with another. Of major concern, of course, is combining DXM-containing medicines with non-drowsy antihistamines, SSRI anti-depressants, and MAOI inhibitors.

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