1. Inside the Cough Medicine Abuse Subculture

2. Abuse of Rx and OTC Medicines Recent studies indicate that the abuse of prescription (Rx) and over-the-counter medicines (OTCs) to get high is a growing concern— particularly among young people between the ages of 12-17.

3.  Generation Rx Vicodin GHB Cough medicine Inhalants The Bad News

4. More Than 100 Cough & Cold Remedies Contain DXM

5. Abuse of Rx and OTC Medications Kids often turn to prescription or over-the counter (OTC) drugs, which are as easy to find as opening a family medicine cabinet.

6. To abuse cough and cold medicines that contain dextromethorphan (DXM) Latest Trend

7. One out of 10 young people aged 12-17 --2.4 million kids-- say they have abused DXM- containing OTC cough medicines to get high

8. National Institute on Drug Abuse’s Monitoring the Future 2006 Survey Reports intentional abuse of cough medicine by: 4% of all students 8 th graders = 4% of all students 5% of all students 10 th graders = 5% of all students 7% of all students 12th graders = 7% of all students On par with abuse of other illicit drugs among this population group

9. Kids Who Abuse OTC Cough Medicine to Get High Because: Their friends are doing it; It’s legal (therefore more accessible); It’s low-cost or free; It’s seen as being safer than other forms of drug abuse.

10. Kids Don’t Understand the Risks & Dangers of Abusing DXM Only 45% of teens and pre-teens believe that abusing cough medicine to get high is risky, which means that over half believe it is not.

11. (DEX) Detromethorphan (DEX) The active ingredient or one of the active ingredients in cough medicines which causes the “high”

12. DXM is Effective & Generally Safe When Taken in Recommended Doses Approved by the FDA in the 1950s; The most widely used cough suppressant in the U.S.; Filled the need for a medication that lacked codeine’s addictive qualities.

13. Sample of Products with DXM Alka-Seltzer Plus Cold & Cough Medicine Coricidin HBP Cough and Cold Dayquil LiquiCaps Dimetapp DM Robitussin cough products Sudafed cough productsSudafed cough products Triaminic cough syrupsTriaminic cough syrups Tylenol Cold productsTylenol Cold products Vicks 44 Cough Relief productsVicks 44 Cough Relief products Vicks NyQuil LiquiCapsVicks NyQuil LiquiCaps Generic/store brandsGeneric/store brands

14. “Code names” for DXM or Specific Products “Dex, DXM, Robo, Skittles, Syrup, Tussin;” “Triple-C or CCC” refers to a cold and cough remedy, which has potent doses of DXM.

15. “Code names” for Abusing DXM- Containing Cough Medicines “Roboing, Robo-tripping, Robo-fizzing, Smurfing (buying cough medicines from multiple retail stores), and Skittling”

16. “Code names” for Users “Syrup heads” or “robotards"

17. The “High” Similar to an ecstasy-like high Experience mild distortions of color and sound Strong visual hallucinations “Out-of-body" sensations Confusion Slurred speech Loss of motor control

18. The “Lows” Dehydration Delusions Panic attacks Memory problems Blurred vision Stomach pain, nausea, and vomiting High blood pressure and rapid heart beat Numbness of fingers and toesNumbness of fingers and toes Drowsiness and dizzinessDrowsiness and dizziness Fever and headachesFever and headaches Rashes and itchy skinRashes and itchy skin Loss of consciousnessLoss of consciousness

19. Side Effects Can Be Worsened If… The DXM-containing cough medicine being abused also contains other ingredients to treat more than just coughs; Taken with alcohol and illegal drugs; Used in combination with other medications.

20. Of Major Concern is Combining DXM With… Non-drowsy antihistamines SSRI anti-depressants MAOI inhibitors Combining DXM with these drugs is extremely dangerous and can send young people to the ER. Combining DXM with these drugs is extremely dangerous and can send young people to the ER.

21. A Normal Dose of Cough Medicine is 15-30 Milligrams Mind-altering effects can occur at doses as low as 100 milligrams; Kids consume enough pills or syrup to equal 240-360 milligrams, or 25-50 times beyond the recommended doses; Some even take up to 80 pills/day.Some even take up to 80 pills/day.

22. Pills vs. Syrup Pills easier to conceal and consume; Drink cough syrup undiluted; Consume pure, unfinished DXM powders and pills, purchased over the Internet; “Robo-fizzing.”Mix pills, powders or syrup with sodas or alcohol, called “Robo-fizzing.”

23. “Pharming” Parties Rx OTCKids collect Rx and OTC pills; Mix together and randomly consume handfuls of tablets; Oblivious to consequences; –Taking excessive amount of pills –Potential danger of combining drugs

24. OTC Cough Medicine Abuse and the Internet

25. Why the Internet? Hundreds of web sites/online communities provide information about abuse of DXM- containing cough medicine; Sites assume visitors are users; No questions asked; Has helped create a subculture of abuse.

26. Web Sites Provide Information About… How to achieve an ecstasy-like high based on a user’s height and weight; How best to combine DXM with other drugs, alcohol, etc., and the dangerous side effects of other combinations.

27. Web Sites Are Also Online Drug Dealers Sell pure, raw, DXM “in bulk” with no questions asked; Kids can log-on to specific sites and purchase bulk amounts of the pure DXM with only a credit card or PayPal and shipping address.

28. Social Networking Web Sites Spread Info About DXM Abuse MySpaceMySpace YouTubeYouTube LiveJournalLiveJournal FacebookFacebook

29. Postings on Social Networks Detailed instructions and conversations about DXM abuse; Blogs and videos with postings of how and when kids will take DXM-containing cough medicines; Footage of kids while “high.”

30. Sample Web Sites www.third-plateau.org www.erowid.org www.dextroverse.org www.lycaeum.org www.myspace.com/dextromethorphan http://forum.grasscity.com/general/1208 75-dxm-trip-report.htmlhttp://forum.grasscity.com/general/1208 75-dxm-trip-report.html

31. Sample of Products with DXM Alka-Seltzer Plus Cold & Cough Medicine Coricidin HBP Cough and Cold Dimetapp DM Robitussin cough products Sudafed cough medicines Triaminic cough syrups Tylenol Cold products Vicks 44 Cough Relief products Vicks NyQuil and Dayquil Medicines Generic/store brands

32. StopMedicineAbuse.org : Online resource on cough medicine abuse  StopMedicineAbuse.org, comprehensive site featuring all educational programming aimed at addressing medicine abuse  FiveMoms.com —a social networking site where parents can interact with other parents, read blog entries, and learn more about medicine abuse  DXMstories.com — an interactive website where you can view testimonials on medicine abuse.  DoseOfPrevention.org, —engage groups in your communities to prevent medicine abuse with the toolkit created by CADCA and CHPA

33. Survey Highlights on Parents 73 percent of coalition members said they do not think parents in their communities are aware that OTC medicine abuse is a problem among youth. 75 percent responded that parents do not talk to their children and teens about the dangers of abusing OTC cough meds.

34. Survey Highlights on Schools Many coalition leaders also felt that schools were not adequately addressing the issue. More than half said school surveys in their community do not include questions about the abuse of cough medicines.

35. Dose of Prevention Campaign In response, CADCA partnered with the Consumer Healthcare Products Association (CHPA), which represents the makers of over-the-counter medicines, and launched the Dose of Prevention campaign, to educate communities about cough medicine abuse.

36. A Dose of Prevention Toolkit Online in downloadable format to be replicated and modified for local use. www.DoseOfPrevention.org

37. What’s in the Toolkit An Overview Targeted Outreach Fact Sheets −Parents −Educators −Healthcare Providers −Retailers −Law Enforcement An Internet Alert Sample Media Outreach Materials −Op-Ed −Press Release & Media Advisory −Statistics and Quotes Sheet