Abuse of OTC Drugs in Adolescence

 

Andrea L. Wall, R.Ph.

Abuse of non-prescription medications such as dextromethorphan and pseudoephedrine by teenagers has been well documented in the literature. Teens seeking to "get high" have easy access to products containing these agents at pharmacies, convenience stores, gas stations and mail order through the Internet.

Dextromethorphan is a cough suppressant found in over 140 OTC medications. It is available alone and in combination with antihistamines, analgesics and decongestants and as a liquid, tablet or capsule. Ingestion of tablets is popular because they are easier to take and have a higher concentration of dextromethorphan. The effects that teens experience resemble those seen with LSD such as euphoria and hallucinations. Dextromethorphan at recommended doses is considered safe for use in children and adults. To reach the effects experienced by those that abuse this agent doses of up to 15 tablets and greater than 4 ounces are ingested.¹

Two retrospective reviews of reports of abuse of Coricidin® products have been conducted by poison control centers and published in the literature. One review was performed by the California Poison Control System for the period of January through October 2000. The Texas Poison Network performed the other review in 1998 and 1999. Both reviews included data about the patients reason for use or misuse and symptoms experienced after ingestion. Some of these symptoms included tachycardia, agitation, slurred speech, and hypertension. Each review identified increasing trends in abuse.^{2 3}

Physicians have raised concerns about abuse of dextromethorphan in two letters published in Archives of Family Medicine. The first letter addresses the need for awareness by physicians of the potential problems with dextromethorphan abuse. The second letter describes a survey completed by students in grades 4-12 in schools in Albuquerque NM about their knowledge of OTC medications that are abused. Both suggest that this is a problem that should not be ignored.^{4 5}

The use of pseudoephedrine as an easily accessible ingredient to make methamphetamine has prompted many states to take action and limit both access and quantity of units sold. Missouri and North Dakota have enacted laws and several states such as Iowa and Oklahoma currently have proposals in front of their state legislators. A recent article in Drug Topics online newsmagazine March 8, 2004 "Pharmacies Keep an Eye on Cough and Cold Buyers" identifies precautions and steps many national chain pharmacies are taking to prevent large purchases of products containing pseudoephedrine in an effort to curb abuse.⁶

The DEA sponsored the Pseudoephedrine Retailers Meeting on February 28, 2003, to provide an overview of information about manufacturing of methamphetamine, legislation and cooperation and responsibilities of industry that sells products that contain pseudoephedrine. Printed public service information was developed as a result of this meeting and is available on the web at www.deadiversion.usdoj.gov/mtgs/pseudoephedrine.

Several professional organizations have policies regarding substance abuse and the role of the health care provider. ASHP has a statement on the role of the pharmacist in substance abuse prevention, education and assistance. APhA, in its Pharmacist Practice Activity Classification, states that pharmacists should provide education regarding the potential abuses and misuses of medications. Pharmacists should take a leadership role and be involved in community and government programs that educate the public about the dangers of abuse of OTC medications.

⁴Cranston J, Yoast R. Abuse of Dextromethorphan Arch Fam Med 1999 Mar/Apr (8).
⁵Noonan W, Miller W, Feeney D. Dextromethorphan Abuse among Youth Arch Fam Med 2000 Sep/Oct (9).
⁶www.drugtopics.com Mar 8, 2004

 

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