Health News Digest

August 9, 2010

Stacking the DEX: Overkill on Dextromethorphan


By  Michael D. Shaw

Approved by the FDA in 1958 for over-the-counter (OTC) sale as a cough suppressant, dextromethorphan (DEX or DXM) was first noticed during Navy and CIA efforts to identify a nonaddictive substitute for codeine. In a 1977 report to Secretary of Defense Harold Brown, it was revealed that this work examined the effects of 800 compounds on addicted patients, to come up with three: Darvon (a painkiller), Lomotil (anti-diarrhea), and dextromethorphan.

Prior to 1958, codeine phosphate was the principal cough medication, but had sedating side effects, not to mention the potential for physical addiction.

At present, there are more than 100 OTC medicines that contain DEX, either as the only active ingredient or in combination with other active ingredients. Examples include Alka-Seltzer Plus Cold & Cough Formula, TheraFlu Cough products, Triaminic cough products, Tylenol Cough and Tylenol Cold products, Vicks 44 Cough Relief products and certain Vicks DayQuil and NyQuil LiquiCaps. There also are a number of store brands that contain dextromethorphan.

Sadly, though, DEX—like all medications—can be abused, and this abuse is facilitated by its availability and numerous “instructive” websites.

A DEX abuser’s high is self-reported as giving a heightened sense of perceptual awareness, altered time perception, and visual hallucinations. However, the clinical presentation of DEX intoxication reads somewhat differently: Hyperexcitability, lethargy, ataxia (inability to coordinate voluntary muscular activity), slurred speech, sweating, hypertension, and/or nystagmus (rapid involuntary oscillation of the eyeballs occurring normally with dizziness).

It is noted that achieving this dubious high requires the ingestion of perhaps 25 to 50 times the recommended dose of DEX, which can translate to multiple bottles or packages of medicine.

While DEX abuse cuts across all age groups, it is most prevalent in youth and adolescents, and is therefore of significant interest. Sure enough, the FDA’s Drug Safety And Risk Management Advisory Committee will be meeting on September 14 to discuss the matter. This event is in response to a request from the Drug Enforcement Administration.

Washington hands believe that this meeting could lead to DEX-containing products being moved behind the counter, forcing consumers to get assistance from a pharmacist or store employee to access such medicines. Patients might also need a prescription from a medical doctor to purchase these products.

Reports from the Partnership for a Drug Free America indicate that 1 in 10 teens has abused OTC cough medicines to get high, and 28 percent know someone who has tried it. Bear in mind, though, that the same source also reports that 1 in 5 teens has abused a prescription pain medication.

Thus, is there really any point—other than political grandstanding—in punishing the vast majority of consumers and law abiding citizens, in a misguided effort to stem DEX abuse in teens?

Certainly, it is most disheartening that youth—or anyone—will turn to substance abuse. Clearly, something is missing in the lives of these people, but this problem is hardly a recent phenomenon.

Evidence of drug abuse can be traced back to ancient Sumeria, around 3500 BC. Indeed, drug abuse is as old as legitimate drug use.

The Consumer Healthcare Products Association, and many other groups, support a bill sponsored by Senators Dick Durbin (D-IL) and Charles Grassley (R-IA), prohibiting the sale of OTC cough medicines to individuals under the age of 18.

Another bill, introduced by Representatives Fred Upton (R-MI) and Rick Larsen (D-WA), would ensure that only legitimate entities registered with FDA or relevant state agencies can purchase raw, unfinished dextromethorphan, the most dangerous form of the ingredient when abused.

There are also numerous educational efforts in play, including the website—all of which make a whole lot more sense than imposing needless burdens on the typical consumer.