Michelle Hewett never suspected the cold medicine.
She knew James was using something – maybe pot, maybe cocaine or heroin. But when she searched her 16-year-old son’s bedroom one afternoon last spring, all she found was an empty Coricidin HBP Cough and Cold box stuffed under his dresser.
What a slob, she thought. And then she returned to looking for drugs.
It wasn’t until James went into rehab a month later that Mrs. Hewett learned that Coricidin – or, more precisely, the active ingredient, dextromethorphan – was one of his favorites. Nearly every other night for a year, James had taken 16 pills of the over-the-counter medication and then slipped on his headphones. The next morning, he’d often still be tripping as he headed to Clark High School in Plano, where many of his friends, he said, would be coming down from their own dextro-induced highs.
“How was I supposed to know?” Mrs. Hewett said recently. “We have enough trouble keeping up with all the mainstream stuff, but I had never heard about this. It’s cough medicine .”
Though sporadic reports of abuse date back at least a decade, the dextromethorphan fad at schools such as Clark has surprised many people, drug counselors and law enforcement officials included. Six months ago, many of them had never heard of the drug, an ingredient in dozens of cough-suppressing syrups and pills, such as Robitussin Maximum Strength Cough and Coricidin.
Now, it’s almost as popular among 14- to 17-year-olds in some parts of North Texas as alcohol and marijuana, they say. Plano, where problems with black-tar heroin abuse have attracted national attention, has been especially hard-hit, counselors say.
“People don’t think of it as a drug because it’s sold over the counter, but the truth is that a lot of kids are using it,” said Chris Godfrey, counselor at the Greater Dallas Council on Alcohol and Drug Abuse.
“Occasionally we get a call from a mom saying, “I just read my daughter’s diary, and I saw “DXM.” What does that mean?’ When we tell them it’s cough syrup,” Ms. Godfrey said, “they say they’re relieved. They don’t realize what they’re dealing with.”
When taken in excess, dextromethorphan – called DXM, red devils and Robo by users – mimics the effects of PCP, alcohol and marijuana combined, drug counselors and users say. It causes decreased motor control and a loss of touch with reality.
The reason for the surge in its popularity, especially among high school students, is accessibility. Dextromethorphan products cost $ 5 to $ 7 and are on the shelves of every drugstore. And because few parents know about the drug, there’s less chance of being discovered than with mainstream drugs.
Even if users are caught, there are no legal penalties: DXM is not a controlled substance, even in large quantities.
“There’s been a real upswing, but we have no control over it,” said Paul Villaescusa, an agent with the Dallas office of the Drug Enforcement Administration. “This is outside of our realm.”
And because the drug is so common, an ingredient in more than 140 over-the-counter syrups and capsules, drugstore officials say they can do little to monitor the purchase of the products.
Local drug counselors say they know of no stores that have removed the products from the shelves. A spokeswoman from Eckerd, one of the area’s largest drugstore chains, said making them inaccessible to youth would inconvenience all customers.
If store managers notice unusual movement on the shelves, though, they can decide to move the products behind the counter, she said.
Ten years ago, University of Southern California professor Gregory A. Thompson started getting calls from Los Angeles-area principals who were noticing empty cough syrup bottles in fields near their campuses.
“Kids would drink an eight-ounce bottle of Robitussin on the way to school,” said Dr. Thompson, a professor of pharmaceutical medicine who heads the Los Angeles Regional Drug Information Center. “It would be like taking acid with four shots of Jack Daniel’s.”
Drug companies have since stopped including high alcohol dosages in DXM products.
Several years later, Whitehall-Robins, the manufacturer of Robitussin, considered launching a national public awareness campaign discouraging DXM cough syrup abuse, said Bob D’Alessandro, an independent substance-abuse consultant who works with the company.
“But I advised them not to do a campaign,” Mr. D’Alessandro said, “because at the time, probably only 20 percent of adolescents knew that you can get high off of cough syrup. Putting it on television would only inform the other 80 percent.”
The company is considering creating a Web page to warn adults about the problem, he said. In addition, Mr. D’Alessandro speaks to parents and pharmacists in communities where Robitussin abuse is occurring.
Lower-level abuse causes feelings of euphoria, stupor, excitability and changes in muscle reflexes, according to medical texts and users’ accounts. In larger amounts, dextromethorphan acts as a dissociative, causing hallucinations and detachment from reality.
“It’s a really intense body trip like acid, but I didn’t get any visuals. I knew some people who did,” said James, the Clark High student, who used inhalants and a host of other drugs along with Coricidin. “For me, it was more like I was really, really drunk. You have the same loss of motor coordination, and you stutter a lot.”
Undesirable side effects include skin irritation – the “Robo itch” – shortness of breath, dizziness, temporary sexual dysfunction, nausea and hangovers. It is rarely addictive, according to medical texts.
Although DXM by itself is unlikely to cause death or serious injury, Dr. Thompson said, large doses can be fatal in combination with antidepressants or prescription nondrowsy allergy medicines, such as Allegra and Claritin. Also, some drugs that accompany dextromethorphan in cold syrups and pills can pose overdose risks.
Antihistamines can cause drowsiness, nervousness and even seizures. Expectorants, which clear phlegm from the throat and nasal passages, can trigger vomiting. And acetaminophen, the main ingredient in Tylenol, can cause deadly liver damage with prolonged abuse.
The huge doses exacerbate the damage. Sabina Stern, program coordinator of the Collin County Substance Abuse Program, has heard of people taking as many as 100 pills in one sitting.
“Unfortunately, what young people tend to think is that if two pills feel good, four pills will feel great. And if a friend says take 24, they’ll say OK,” said Ms. Stern, who has counseled about 50 teens with DXM problems in the last six months. “Teenagers don’t think like adults think. The fact that a drug has side effects doesn’t enter into their minds.”
James said that after he and his friends started taking Coricidin regularly, a few did research the drug’s side effects on the Internet. Learning about the damage that the medication could cause didn’t stop them, though.
Several dozen Web pages, including the comprehensive Dextromethorphan FAQs (Frequently Asked Questions), offer tips on everything from how to chug two bottles of Robitussin without vomiting to warnings about drug interactions.
Although some pages seem geared toward younger users, the FAQs site, which has 60,000-plus words on the subject, contains a couple of disclaimers discouraging DXM use by teens: “Attention Parents. . . . I am not a good influence for your children, nor do I claim to be.
“Attention Kids. . . . If you think school is boring, try rehab.”
Besides providing general information about dextromethorphan, the Web offers instructions on how to extract pure DXM from syrups and how to order the drug in pure powder form, which Drug Enforcement Administration officials say is legal.
At least three mail-order services offering DXM are based in the United States – in Austin; Greensboro, N.C.; and Santa Barbara, Calif. The services, which were reviewed in a recent issue of an online magazine for DXM users, sell the drug for $ 2 to $ 4 per gram, for “research purposes only.” None of the three had a listed telephone number.
Last month, a 26-year-old Bedford man was arrested by North Richland Hills police on charges of possessing 600 grams of what officials thought was ecstasy. After testing the substance, though, investigators discovered that it was dextromethorphan, ordered through the mail.
Prosecutors dropped the charges.
One of James’ friends also ordered pure DXM. Claiming to work for a hospital, he purchased a 20-pound bag and had it delivered to a post office box. He then sold the drug, at $ 5 a gram, to classmates in Clark High’s bathrooms and hallways. On an average day, James said, the student would sell five or six grams.
For Mrs. Hewett, the details are still shocking. “It’s unbelievable,” she said. “The problem is just so widespread. . . .
“I read up on drugs. I gave James drug tests. I did everything I could, but it seemed like the harder I tried, the more he deteriorated.”
Now that James has cleaned himself up, Mrs. Hewett wants to spread the word to other parents, who, she suspects, are as clueless as she was.
“There’s a total lack of information,” she said. “I told several people at work the other day that kids are taking Coricidin to get high, and they looked at me like I was crazy.
“Until it happens to their kids, they just don’t know.”