1. An Educational Perspective Based on Information Contained In The Indiana Prevention Resource Center Factline on DXM

2. By the end of this presentation: you will have… (1) Been exposed to general information about DXM. (2) Learned some basic facts about DXM users in Indiana. (3) Viewed the potential consequences of DXM use, both short-term and long-term. (4) Learned about prevention efforts in Indiana. Indiana Prevention Resource Center

3. Dextromethorphan, DXM, is a cough suppressant found in many over the counter cold medications. Its use is approved by the food and drug administration, and it is considered generally safe when taken in the recommended dosages. Indiana Prevention Resource Center When consumed in large volumes DXM can have dangerous side effects.

4. Indiana Prevention Resource Center Over 140 OTC cough and cold remedies contain DXM It is available in capsule, liquid, liquid gelatin capsule, and lozenge and tablet form. Additionally, the drug is available in powdered form on the internet.

5. Indiana Prevention Resource Center - DXM abusers typically ingest the drug orally, however some abusers snort the pure powdered form. - The volume of the drug ingested depends on the effect and body weight of the abuser. According to the National Drug Intelligence Center, 250 to 1,500 mg of the drug can be ingested in a single dosage, far above the recommended dose of 10 to 20 mg.

6. Indiana Prevention Resource Center Calls Involving Abuse or Misuse of DXM to Poison Control Centers 1,1113,2712003 1,1392,8812002 1,1072,2762001 9001,6232000 All Other Age Groups TeenagersYear Source: American Association of Poison Control Centers. Levels of DXM abuse are Difficult to determine because National surveys do not include questions regarding DXM abuse.

7. Indiana Prevention Resource Center Calls Involving Abuse or Misuse of DXM to Poison Control Centers 1,1113,2712003 1,1392,8812002 1,1072,2762001 9001,6232000 All Other Age Groups TeenagersYear Source: American Association of Poison Control Centers. However, some information may be gleaned from emergency department admissions and poison control center data. These data anecdotally suggest that the incidence of DXM abuse is highest among individuals aged 12-20, and abuse is becoming more common.

8. Age CategoryEstimated ED visits % of visits a ED visits per 100,000 population 0-11 260 5% 0.5 12-20 2,684 48% 7.1 12-17 1,791 32% 7.1 18-20 892 16% 7.2 21-34 1,473 26% 2.6 35+ 1,164 21% 0.8 ED visits involving DXM, by age and reason for visit Source: DAWN Issue 32, 2006 – Emergency Department Visits Involving Dextromethorphan

9. Indiana Prevention Resource Center Dex Robo Skittles Triple C DM Rojo Velvet Red Devils

10. Indiana Prevention Resource Center The effects of DXM abuse vary with the amount taken, but common effects can include: Confusion Dizziness Double or Blurred Vision Slurred Speech Abdominal Pain Impaired Physical Coordination Mind and body dissociation Hallucinations Nausea Vomiting Rapid Heart Beat Drowsiness Disorientation Body Itching Rash Diarrhea

11. Indiana Prevention Resource Center Other active ingredients in DXM over-the-counter products can be harmful when ingested in quantities above the recommended dosage. Acetaminophen: Liver damage Chlorpheniramine: Increased heart rate, lack of coordination, seizures Guaifenesin: Vomiting

12. Consult DXM dir: to do Indiana Prevention Resource Center

13. Content in this presentation based, in part, on a Factline produced by Bilesha Perera, Ph.D, MS in 2005 and © The Indiana Prevention Resource Center. Contact us Indiana Prevention Resource Center 2735 East 10th Street, CA110 Bloomington, IN 47408-2602 Phone: 1-800-346-3077 or 812-855-1237 Fax: 812-855-4940 E-mail: drugprc@indiana.edudrugprc@indiana.edu http://www.drugs.indiana.edu The Indiana Prevention Resource Center is funded, in part, by a contract with the Indiana Family and Social Services Administration, Division of Mental Health and Addiction, financially supported through HHS/Substance Abuse Mental Health Services Administration, Center for Substance Abuse Prevention, Substance Abuse Prevention and Treatment Block Grant. The IPRC is operated by the Indiana University Department of Applied Health Science and School of Health, Physical Education and Recreation. It is affiliated with the Department's Institute of Drug Abuse Prevention. The opinions expressed herein are those of the authors and not necessarily those of the Trustees of Indiana University or the Indiana Family and Social Services Administration. Indiana University accepts full responsibility for the content of this publication. © Copyright, 2005 by the Trustees of Indiana University. Indiana Prevention Resource Center