There is an emerging trend happening in homes across Tennessee, right under parents' noses. Recently, there have been news reports of overdoses and theft of this drug across the state as well as nationwide. The Tennessee REDLINE has been receiving calls and inquiries about it for nearly 3 years from various areas of the state. What is it? What is this drug? It is the abuse of over-thecounter cough suppressants. Dextromethorphan or DXM is a semisynthetic narcotic related to opium and found in many over-the-counter cough suppressants in the United States and most countries. DXM is contained in any drug whose name includes "DM" or "Tuss." The drug comes in various forms. Most common are cough suppressants in caplet or liquid form, including Corcidin, Robitussin, Vicks Formula 44, Drixoral, and several generic brands. (A caution: Not all medicines under these brands contain the drug since most brands put out several formulations. Look on the label for "DM," "Tuss," or "Maximum Strength.")
Less publicized and more easily obtained than the more well-known club-drug ecstasy, DXM's legal status and familiarity may lure some kids into taking it, despite the dangers it poses of addiction, injury, and death. "It's not an ugly drug. It's much less intimidating than snorting a powder or injecting a strange substance," said William Bobo, M.D., a psychiatrist who, along with Shannon Miller, M.D., is conducting an exhaustive review of the scientific literature on DXM.
Anyone, including minors, can buy these medicines at a local convenience mart or drugstore. And since the Food and Drug Administration (FDA) approves DXM for sale in over-the-counter medicines, those seeking a high, and especially teens, may assume it's "safe." "It's a very familiar substance, in short," said Bobo, and thus "it is felt to be benign by abusers." This underestimation of the drug's dangers and abuse potential is not limited to abusers, explained Miller. "Many clinicians simply aren't asking these questions--and certainly when they are faced with someone using it, they tend to minimize it."
DXM is related to opiates in its make-up, and it produces mind-altering highs. Misuse of the drug creates both depressant and mild hallucinogenic effects. It also acts as a dissociative anesthetic, similar to PCP and ketamine.
Emergency rooms increasingly report DXM overdoses and DXM-related crises. In spite of these serious potential adverse effects of DXM, the dangerous behavior it induces, and the ingredients ingested along with DXM-containing cough medicines, abusers keep returning because of the drug's legal status and easy access.
Its use is becoming more prevalent in dance clubs and at dance events called "raves," where it is sometimes used as an alternative for the more well-known drug ecstasy. Adolescent youth easily can obtain the drug because stores sell it over the counter, with no prescription required. Its street names include:
Dr. Shannon Miller is medical director, Polysubstance Rehabilitation Service and Dual-Diagnosis Rehabilitation Service, Veterans Administration Medical Center, Dayton, and associate professor, department of psychiatry, Wright State University School of Medicine.
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