Teenagers' use of over-the-counter cold and cough medicines to get a cheap high -- a practice known as "robotripping" -- is rising 50% a year and becoming one of the fastest-growing drug abuse problems in California and around the country, according to a study released Monday.
Since 1999, teen abuse of Coricidin pills, Robitussin syrup and other common medications has risen 10-fold, data from the California Poison Control System show. The widely available and inexpensive medicines are growing in popularity while use of illegal drugs such as Ecstasy, LSD and the date rape drug GHB have dropped, according to the report.
"Hey, Mom and Dad, pay attention," said Marilyn MacDougall, executive director of the Orange County Sheriff Department's drug abuse prevention program. "Over-the-counter medicines are the upcoming way your kids are going to abuse drugs."
The cold remedies are valued for an ingredient called dextromethorphan, which can cause hallucinations and out-of-body experiences. In extreme cases, like that of 16-year-old Anaheim student Lucia Martino, they can cause death. The drug, known by kids as DXM or Dex, was first abused in the 1960s when it was in a cough medicine called Romilar, which was withdrawn from the market in 1973.
Health officials spotted a revival in the late 1990s. About two-thirds of abusers now take Coricidin HBP Cough & Cold, whose candy-red tablets are nicknamed CCC, triple C and skittles. Robotripping takes its name from Robitussin, the second most abused cold medicine.
A study in May by the Partnership for a Drug-Free America estimated that 2.4 million teens -- about 1 in 10 -- got high on cough medicines in 2005. That puts it on a par with cocaine and slightly above methamphetamine.
California school administrators are learning of the craze the hard way. In El Dorado, a community outside of Sacramento noted for its apple orchards and Christmas tree farms, seven high school students were rushed to the emergency room in October after taking Coricidin. The Union Mine High School students had purchased several boxes at a dollar store and swallowed five to eight tablets each during their morning snack time.
Administrators found out after one student started vomiting in class.
"This is new to us -- it caught a lot of people by surprise," said Principal Carl Fickle. "It didn't catch the kids by surprise."
The latest study, published in the December issue of the Archives of Pediatrics and Adolescent Medicine, found that the growth of dextromethorphan abuse is being driven by children ages 9 to 17.
Abuse is most common among 15- and 16-year-olds, the study found. The number of 12- and 13-year-olds using the drug exceeds the number of 18-year-olds, indicating that it is popular in middle schools as well as high schools, according to senior author Ilene B. Anderson, a toxicology management specialist at the California Poison Control System.
"I did not expect 12-year-olds to be abusing it," Anderson said.
The study was based on a review of 1,382 calls made to the California Poison Control Center over a six-year period involving cases of dextromethorphan exposure. Those calls were generally made in emergency situations, usually by physicians treating overdose patients in hospitals. They represent only a fraction of overall drug use, Anderson said.
"If someone is abusing dextro and gets a high, they don't call us," she said. "I think it is grossly underreported."
Of the cases reported to the state poison control center, seven -- amounting to 0.5% of the total -- were life-threatening. None resulted in death, according to the study. The number of deaths nationwide is unknown.
The researchers compared the California findings with general statistics from the American Assn. of Poison Control Centers and the Drug Abuse Warning Network and found that the trends here are in line with the rest of the country.
Dextromethorphan appeals to teens because it "is easily and legally available in most pharmacies and large grocery stores," Anderson said. "It's relatively inexpensive -- in many cases, one package can cause hallucinations."
Websites offer testimonials about the buzz the drug provides. Some users describe it as "slightly intoxicating," though others compare their experiences with the hallucinatory effects of ketamine or PCP.
Dextromethorphan users can consult online calculators -- where they enter their weight, brand of medicine and "plateau" of high they want to achieve -- to determine how big a dose to take.
And because the cough remedies look innocuous, Anderson said, "you can have a package, and your parents would never even suspect it, compared to a little white bag of powder, which certainly would cause a red flag to go up."
When taken in large quantities, dextromethorphan can make the heart race and blood pressure rise. Some users become agitated and others lethargic, confused, dizzy or act as if they are inebriated. Life-threatening side-effects include seizures and elevated body temperature, Anderson said.
Users can also have adverse reactions from overdosing on other ingredients in the cold remedies. High quantities of pseudoephedrine and antihistamines, for example, can cause irregular heart beats, high blood pressure and seizures, Anderson said.
"The one that scares me the most is acetaminophen [the medicine in Tylenol] because it can cause liver failure," she said.
State lawmakers in California and elsewhere have tried to ban sales to minors of the hundreds of products that contain dextromethorphan, but those efforts have so far failed. Some drug stores, including Walgreens, Rite Aid and Wal-Mart, have voluntarily restricted access to customers younger than 18.
U.S. consumers spent about $4.5 billion on cold and cough remedies last year, according to the Consumer Healthcare Products Assn., a trade group representing manufacturers of over-the-counter medicines. The group is pushing federal legislation to ban online sales of pure dextromethorphan in powdered form and is also working to shut down websites promoting the drug's recreational use, President Linda Suydam said.
Federal legislation that would restrict the sale of dextromethorphan powder to researchers, drug makers and other legitimate users is expected to be voted on this week by the House of Representatives. The legislative effort was prompted by the overdose deaths last year of five teens in Florida, Washington and Virginia.
Teens are continuing to die. One was Lucia Martino, a junior at Canyon High School in Anaheim.
In September, the gregarious soccer player swallowed 20 Coricidin pills in pursuit of a cheap high while the rest of her family slept. Her mother found her vomiting the next morning and took her to the emergency room.
Doctors there were baffled by her malfunctioning liver and struggled to pinpoint the cause. Four days later, after Lucia had fallen into a coma, a friend pulled a nurse aside and told her about the pills.
It was too late. She died less than a day later, on Sept. 17. At the funeral, her parents left the casket open so the hundreds of teens in attendance could see how the pills had swelled Lucia's athletic, 125-pound frame to a bloated 170 pounds.
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Cheap and dangerous high
Abuse of over-the-counter cold and cough medicines by teens is rising 50% a year, according to the California Poison Control System. A separate survey of 7th to 12th graders found that one in 10 had used medicines containing dextromethorphan to get high.
Types of drugs teenagers have tried
Percent of those surveyed
Prescription medicine*: 19%
Cough medicine: 10%
*That a doctor did not prescribe for them
Source: Partnership for a Drug-Free America. Graphics reporting by Seema Mehta