1. What is dextromethorphan?
2. Is dextromethorphan safe?
3. Is dextromethorphan addictive?
4. Is dextromethorphan effective?
5. Who abuses dextromethorphan and how common is its abuse?
6. What should parents know about dextromethorphan and abuse?
7. Why is it important for parents to monitor their children’s Internet usage?
8. What are the effects of abusing dextromethorphan?
9. What cough medicines contain dextromethorphan?
10. What are some of the slang terms for dextromethorphan?
11. What are the makers of OTC cough medicine doing about the potential abuse of dextromethorphan?
12. Where can parents go for more help?

1. What is dextromethorphan?

Dextromethorphan is a safe and effective active ingredient found in well over 100 over-the-counter cough and cold products. First approved by the U.S. Food and Drug Administration in the 1950s, it is an effective, non-narcotic, non-addictive cough suppressant that works by raising the coughing threshold in the brain. It is the most widely used cough suppressant in the United States.

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2. Is dextromethorphan safe?

Yes. When used according to the medicine label directions, cough medicine containing dextromethorphan produces few side effects and has a long history of both safety and effectiveness. These medicines are used safely by millions of Americans each year to relieve coughs due to the common cold or flu.

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3. Is dextromethorphan addictive?

No, dextromethorphan is not addictive. Clinical trials confirm that dextromethorphan does not produce physical addiction, lose effectiveness through increased tolerance, or cause withdrawal, even in high experimental doses. While the ingredient itself is not physically addictive, teens engaged in this sort of substance abuse behavior may develop a pattern of habitual use.

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4. Is dextromethorphan effective?

Yes, dextromethorphan is recognized by the U.S. Food and Drug Administration as a safe and effective cough suppressant and has been available over-the-counter for over 50 years.

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5. Who abuses dextromethorphan and how common is its abuse?

Dextromethorphan abuse is found primarily among teens. According to data collected in 2009 by the National Institute on Drug Abuse for its Monitoring the Future survey, five percent of teens have abused cough medicine to get high in the past year. This form of abuse involves taking large amounts of cough medicine to get high. It is not possible to accidentally abuse dextromethorphan; it takes vast amounts that are far beyond the recommended dosage.

Teens are abusing dextromethorphan by taking large amounts of over-the-counter cough medicine containing dextromethorphan or by ingesting the unfinished, raw form of dextromethorphan by mixing it with alcohol or illegal drugs. On May 20, 2005, FDA released a talk paper regarding the agency’s concerns surrounding the abuse of dextromethorphan (DXM). While the agency emphasized dextromethorphan’s safety and effectiveness when taken properly as a cough suppressant, the warning responds to reported deaths that may be associated with the consumption of raw, unfinished dextromethorphan purchased over the Internet—a practice that we are aggressively working to make illegal.

The raw form of dextromethorphan can be purchased over the Internet in unfinished form and is very dangerous when abused. CHPA and the makers of OTC cough medicines are working to pass federal legislation that would restrict the sale of raw, unfinished dextromethorphan to teens. CHPA supports legislation ensuring that only legitimate entities registered with FDA or relevant state agencies can purchase dextromethorphan in its raw, unfinished form. Currently, there are no national sales or purchase restrictions for dextromethorphan in this form. The Dextromethorphan Distribution Act (H.R. 1259) was passed by the U.S. House of Representatives on March 31, 2009. Similar legislation passed in the House in the 110th Congress.  CHPA is working to see that a companion bill is introduced and passed in the Senate as well.

Additionally, CHPA supports legislative and retail efforts to implement sales restrictions prohibiting the sale of OTC cough medicine to minors. In the 111th Congress, the Dextromethorphan Abuse Reduction Act (S. 1383) was introduced to accomplish this goal. CHPA, and partners such as the Community Anti-Drug Coalitions of America, the Food Marketing Institute, the National Association of Chain Drug Stores, and the Partnership for a Drug-Free America, are working with members of Congress to see the legislation enacted.

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6. What should parents know about dextromethorphan and abuse?

Dextromethorphan abuse is preventable. Substance abuse experts tell us that education is the most effective way to keep kids from abusing all types of substances, including over-the-counter medicines containing dextromethorphan. To help prevent or stop teen medicine abuse, parents should:

• Educate themselves about the problem of teens looking to otherwise safe and beneficial products, like medications, as a means to a high and know the warning signs.
• Talk to their teens about all types of drug abuse, including cough medicine abuse.
• Safeguard their medicine cabinets, and know what products they have and how many.
• Monitor their teen’s Internet use.
• Seek professional help if they think their child has a substance abuse problem.

The abuse of dextromethorphan involves taking large amounts of cough medicine to get high.

While many of our efforts are aimed at educating and empowering parents to take responsibility and action, CHPA also is working to expose the online promoters of dextromethorphan abuse for what they are: dangerous predators who are encouraging our teens to put their lives at risk. Few parents are aware that dextromethorphan also can be abused by ingesting the raw, unfinished form of dextromethorphan—often mixing it with alcohol or illegal drugs. The raw, unfinished form of dextromethorphan can be purchased over the Internet and is very dangerous when abused.

CHPA and the makers of cough medicines containing dextromethorphan are very concerned about this problem. We are committed to doing everything we can to stop it, and feel that parents need to be aware of the potential for abuse. Parents need to be active, aware, and involved…and we’re helping them do that.

Parents should be aware that some teenagers and young adults are intentionally trying to get high by taking large amounts of dextromethorphan cough medicines. While the intentional abuse of otherwise safe household products by teens is not limited to over-the-counter medications, parents should closely monitor their children's activities and use of household substances.

Parents also need to be aware that:

• Over-the-counter medicine—just like any medicine—is a serious substance, and should be taken only as directed;
• Dextromethorphan-containing medicines, like all medicines, should be stored in a safe, secure location.

Signs that abuse may be taking place:

• Empty cough medicine boxes or bottles in the trash of your child’s room, or boxes or bottles missing from the medicine cabinet
• Visiting pro-drug web sites that provide information on how to abuse dextromethorphan
• Changes in friends, physical appearance, sleeping, or eating patterns
• Declining grades
• Loss of interest in hobbies or favorite activities
• Hostile and uncooperative attitude
• Unexplained disappearance of household money
• Unusual chemical or medicinal smells on your child or in his or her room

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7. Why is it important for parents to monitor their children’s Internet usage?

While there is little in current teen culture that promotes the abuse of cough medicines containing dextromethorphan, the one exception is the Internet. There are a number of pro-drug web sites that promote dextromethorphan abuse and provide information on how to abuse dextromethorphan containing medicines.

To combat some of the misleading and dangerous information online, CHPA and the Partnership for a Drug-Free America created www.dxmstories.com to provide teens with accurate information about this substance abuse issue. In addition, there is information available for parents at www.drugfree.org/Parent/Resources/cough_medicine_abuse as well as educational brochures on cough medicine abuse. These targeted web sites serve as one component of the Rx and OTC Medicine Abuse Education Campaign. For more information on the campaign, contact CHPA’s Communications Department at 202.429.9260.

In addition, there have been reports of some teens buying raw, unfinished dextromethorphan on the Internet in order to get high. CHPA and its member companies are working to prohibit the sale or distribution of this unfinished dextromethorphan to all but those entities registered with the U.S. Food and Drug Administration. Already legislation has passed in Illinois. The 110th Congress introduced the Dextromethorphan Distribution Act (H.R. 970/S. 1378) that would have imposed such a restriction on a national level. The Dextromethorphan Distribution Act passed the House during the 110th Congress and again during the 111th Congress (H.R. 1259).

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8. What are the effects of abusing dextromethorphan?

The effects of the abuse of cough medicines containing dextromethorphan vary with the amount taken. Common effects include confusion, dizziness, blurred vision, slurred speech, loss of physical coordination, stomach pain, vomiting, and rapid heart beat, and can vary from person to person. Those who have abused dextromethorphan describe different “plateaus” ranging from mild distortions of color and sound to visual hallucinations, “out of-body” dissociative sensations, and loss of motor control. The effects worsen as the dose increases.

Side effects can also be worsened when the cough medicine being abuse contains other ingredients to treat more than just coughs or when combined with alcohol or illegal drugs.

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9. What cough medicines contain dextromethorphan?

There are well over 100 OTC medicines that contain DXM, either as the only active ingredient or in combination with other active ingredients. Examples include Alka-Seltzer Plus Cold & Cough Formula, Coricidin HBP Cough and Cold, some Delsym products, Dimetapp® DM, some Mucinex® products, PediaCare cough medicines, certain Robitussin® cough products, Sudafed cough products, TheraFlu® Cough products, Triaminic® cough products, Tylenol Cough and Tylenol Cold products, Vicks 44 Cough Relief products, certain Vicks DayQuil and NyQuil LiquiCaps, and Zicam. There also are a number of store brands that contain dextromethorphan, as well.

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10. What are some of the slang terms for dextromethorphan?

Slang terms for dextromethorphan vary by product and region. Adults should be familiar with the most common terms, which include Dex, DXM, Robo, Skittles, Syrup, Triple-C, and Tussin. Terms for using dextromethorphan include: Robo-ing, Robo-tripping, and Skittling, among others.

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11. What are the makers of OTC cough medicine doing about the potential abuse of dextromethorphan?

The nonprescription medicine industry takes very seriously the abuse of its products and is engaged in a multi-year, multi-pronged approach to fight teen cough medicine abuse. These efforts are now housed in one comprehensive web site, www.StopMedicineAbuse.org. The site provides access to all of CHPA’s educational programs and resources, including downloadable materials for community leaders, free pamphlets for parents in both English and Spanish, resources for additional information on talking to teens about substance abuse issues, StopMedicineAbuse.org’s recently launched Facebook fan page, and the award-winning grassroots Five Moms Campaign.

Partnership for a Drug-Free America
The nonprescription medicine industry sought out the experts at the Partnership for a Drug-Free America (the Partnership) for assistance in combating the intentional abuse of its products. Together, CHPA and Partnership began an ongoing initiative in 2003 to ensure that adults with influence and oversight over young people are aware that teens may be considering abusing DXM. Aside from efforts to educate key audiences regarding the potential for abuse of medicines containing DXM, CHPA, in conjunction with the Partnership, launched the Rx and OTC Medicine Abuse Education Campaign in May 2006. This multi-year communications campaign will help parents and families understand and prevent the abuse of medicines, including cough medicines containing DXM, by teenagers and young adults.

Specifically, CHPA and the Partnership are:

• Distributing public service announcements to help raise parental awareness about this teen substance abuse problem;
• Disseminating an educational brochure for parents, Preventing Teen Cough Medicine Abuse: A Parent's Guide, in English and Spanish.
• Operating a parent-oriented web site with information on DXM abuse, as well as a teen-oriented site—DXMstories.com—to provide teens with accurate information about this substance abuse issue;
• Reaching out with information to a variety of organizations, including parent groups, educator associations, the poison control center network, health professional organizations, and law enforcement; and
• Supporting federal legislation to keep raw, unfinished dextromethorphan out of teens’ hands.

Community Anti-Drug Coalition of America
CHPA also joined forces with the Community Anti-Drug Coalitions of America (CADCA) to develop a new educational community toolkit to help coalition and prevention leaders mobilize their communities and educate key stakeholders about the dangers of OTC cough medicine abuse. CADCA represents over 5,000 community coalitions nationwide. This toolkit was first unveiled at CADCA's National Leadership Forum VII in February 2007.

Additionally, CHPA and CADCA support the designation of a "National Medicine Abuse Awareness Month.” This initiative highlights one month a year to provide an opportunity for parents to educate themselves and to talk to their teens about the dangers associated with medicine abuse. Dovetailing this effort, CHPA and CADCA host town hall meetings nationwide with local CADCA affiliates. States interested in hosting their own town hall meeting have access to all materials in the toolkit.

In September 2008, CADCA, CHPA, and the Pharmaceutical Research and Manufacturers of America (PhRMA) introduced a new tool in the fight against medicine abuse. Provided to 250 Newspaper in Education programs nationwide as well as online, this 16-page newspaper supplement, Stay Smart, Don't Start: The Truth About Drugs and Alcohol, educates young people and parents about the dangers of abusing over-the-counter cough medicine and prescription drugs. In addition, the partners published a teen-directed brochure, The Real Truth About Rx and OTC Medicine Abuse.

Five Moms: Stopping Cough Medicine Abuse
In May 2007, CHPA launched "Five Moms: Stopping Cough Medicine Abuse," an online grassroots campaign to help parents fight teen medicine abuse. At the heart of the Five Moms Campaign are five exceptional women, from different walks of life and from all across the country, who are all dedicated to spreading the word about the dangers of cough medicine abuse.

This campaign is designed to use the very same tactics medicine abusers are using: spreading and promoting information on the Internet. The Five Moms’ goal is to get the word out to as many parents as possible that cough medicine abuse is happening in their homes, and that the Internet is a driving force.

In 2009, the Five Moms Campaign became part of CHPA’s overall Stop Medicine Abuse initiatives. Through the StopMedicineAbuse.org web site, parents can sign up for the electronic newsletter, view the "viral video," or use the “tell-a-friend” tool (in English and Spanish) to spread the word about this teen substance abuse behavior.

D.A.R.E. America
D.A.R.E. America and CHPA have teamed up with the Pharmaceutical Research and Manufacturers of America (PhRMA) and Abbott Laboratories to launch a new, specialized curriculum for fifth-, seventh-, and ninth-graders that counters the abuse of prescription and over-the-counter drugs. These lessons are designed to be taught after students complete their regular D.A.R.E. curriculum.

In addition to CHPA, PhRMA, and Abbott, D.A.R.E. American's Rx and OTC Drug Abuse Curriculum was developed with the support and expertise of law enforcement officers, the U.S. Office of National Drug Control Policy, the National Council on Patient Information and Education, the U.S. Drug Enforcement Agency, the Food and Drug Administration, the National Institute of Drug Abuse, Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAP), and the Partnership for a Drug-Free America. The program was expanded so that members of the National Association of School Nurses and the American Association of School Administrators can teach the lessons to school children, as well as D.A.R.E. officers.

For more information about the innovative program, visit D.A.R.E. America online.

National Association of School Nurses
In 2010, CHPA teamed up with the National Association of School Nurses to launch Home to Homeroom, an educational program that teams parents with the medical expert in their teen’s school—the school nurse—to help prevent and address teen medicine abuse.

Home to Homeroom provides parents with advice and tools on how to integrate medicine abuse into regular drug talks with teens, how to keep the dialogue going, and how to find resources to support at-risk teens. Found at StopMedicineAbuse.org, the campaign features a toolkit for school nurses, downloadable materials, and frequent digests posted on the web site.

Others
Additionally, CHPA has been reaching out to a variety of organizations, including parent groups, education associations, health professional societies, law enforcement, the retail community, pharmacists, and others to raise awareness on the issue.

Federal Legislative Initiatives
CHPA is working on a number of legislative initiatives on the federal level to complement the industry’s educational efforts to curb teen cough medicine abuse.

CHPA supports legislative and retail efforts to implement sales restrictions prohibiting the sale of OTC cough medicine to minors.  In the 111th Congress, the Dextromethorphan Abuse Reduction Act (S. 1383) was introduced to accomplish this goal. CHPA, and partners such as the Community Anti-Drug Coalitions of America, the Food Marketing Institute, the National Association of Chain Drug Stores, and the Partnership for a Drug-Free America, are working with members of Congress to see the legislation enacted.

CHPA also supports legislation ensuring 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. Currently, there are no national sales or purchase restrictions for dextromethorphan in this form. The Dextromethorphan Distribution Act (H.R. 1259) was passed by the U.S. House of Representatives on March 31, 2009. Similar legislation passed in the House in the 110th Congress.  CHPA is working to see that a companion bill is introduced and passed in the Senate as well.

Additionally, CHPA supports the designation of one month every year as National Medicine Abuse Awareness Month. This designation provides a further incentive to communities to engage in awareness-building events and draws attention to this teen substance abuse behavior.

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12. Where can parents go for more help?

CHPA encourages parents and other adults in the position to influence teens to visit StopMedicineAbuse.org. The site provides an overview to the issue, resources for more information as well as tips for talking with teens about substance abuse, a free electronic newsletter and publications, and more.

In addition, CHPA and the Partnership for a Drug-Free America created a teen-oriented web site—DXMstories.com—to counter some of the misinformation available online. The site provides accurate information about the side effects of dextromethorphan abuse, resources for treatment centers, and first-hand videos from teens who have abused dextromethorphan and their parents.