Combating OvertheCounter and Prescription Drug Abuse Using New CHPACADCA Community Toolkit

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Combating Over-the-Counter and Prescription Drug
Abuse Using New CHPA/CADCA Community Toolkit

• Missouri Department of Mental Health
• 2007 Spring Training Institute
• May 16 18, 2007

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Every Generation of Kids Looks for New Ways to
Get High
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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.

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

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National Institute on Drug Abuses Monitoring
the Future 2006 Survey

• Reports intentional abuse of cough medicine
  by
• 8th graders 4 of all students
• 10th graders 5 of all students
• 12th graders 7 of all students
• On par with abuse of other illicit drugs
• among this population group

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Kids Who Abuse OTC Cough Medicine to Get High
Because

• Their friends are doing it
• Its legal (therefore more accessible)
• Its low-cost or free
• Its seen as being safer than other forms of drug
  abuse.

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Kids Dont 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.

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Parents Dont Know About the Dangers Risks
Either

• Recent survey conducted by the Community
  Anti-Drug Coalitions of America (CADCA) and the
  Consumer Healthcare Products Association (CHPA)
  reports only 8 of parents are aware of cough
  medicine abuse
• 75 dont talk to their kids about the problem.

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Nor has it been on the radar screens of

• Educators
• Healthcare providers and first other responders
• Law enforcement officials.

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Some retailers who sell DXM-containing cough
medicines are aware of problem

• But might not know what to do about it.

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CADCA Coalitions Aware of Problem

• According to same CADCA/CHPA survey, 80 aware of
  DXM abuse
• 60 said cough medicine abuse was a problem among
  youth.

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A Dose of Prevention Toolkit
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A joint collaboration of Community Anti-Drug
Coalitions of America (CADCA) and the Consumer
Healthcare Products Association (CHPA)
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Toolkit Purpose

• Provides Coalitions/prevention leaders with the
  latest information
• Helps Coalitions reach out to key stakeholders to
  mobilize community.
• Parents
• Educators
• Healthcare professionals
• Law enforcement officials
• Retailers others

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Goal is to Provide You With

• Materials to localize and replicate
• Strategies to integrate and implement, involving
  key constituencies.

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Whats in the Toolkit

• An Overview
• Targeted Outreach Fact Sheets
• An Internet Alert
• A Sample Opinion Editorial (Op Ed)
• A Sample Press Release Media Advisory
• A Statistics and Quotes Sheet
• Camera-Ready Slicks (available online)
• Scripted Radio Public Service Announcements
  (Spring 2007)
• Promotional Events Planner (Spring 2007)

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Each Piece Will Provide Information About

• The problem
• What is DXM
• Statistical information about abuse
• Accessibility and ease of purchasing medicines
• The cough medicine abuse subculture
• Code names
• The DXM high
• The serious side effects if abused
• Methods of abuse and warning signs
• The Internet and DXM Cough Medicine Abuse
• Strategies for targeted audiences

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Understanding the Problem
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Detromethorphan (DEX)

• The active ingredient or one of the active
  ingredients in cough medicines which causes the
  high

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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
  codeines addictive qualities.

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More Than 100 Cough Cold Remedies Contain DXM
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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 products
• Triaminic cough syrups
• Tylenol Cold products
• Vicks 44 Cough Relief products
• Vicks NyQuil LiquiCaps
• Generic/store brands

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Inside the Cough Medicine Abuse Subculture
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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.

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Code names for Abusing DXM-Containing Cough
Medicines

• Roboing, Robo-tripping, Robo-fizzing, Smurfing
  (buying cough medicines from multiple retail
  stores), and Skittling

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Code names for Users

• Syrup heads or robotards"

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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

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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 toes
• Drowsiness and dizziness
• Fever and headaches
• Rashes and itchy skin
• Loss of consciousness

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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.

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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.

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Methods of Abuse
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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.

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Pills vs. Syrup

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

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Pharming Parties

• Kids 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

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OTC Cough Medicine Abuse and the Internet
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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.

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Web Sites Provide Information About

• How to achieve an ecstasy-like high based on a
  users height and weight
• How best to combine DXM with other drugs,
  alcohol, etc., and the dangerous side effects of
  other combinations.

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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.

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Social Networking Web Sites Spread Info About DXM
Abuse

• MySpace
• YouTube
• LiveJournal
• Facebook

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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.

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The Internet is a powerful tool for community
prevention, but its also a liability. --
Eric Gregory, MA, CPP Executive
Director The Save the Kids Coalition
Bowling Green, KY
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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/120875-dxm-trip
  -report.html

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Sample Strategies for Targeted Audiences
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Know the Warning Signs

• Empty cough medicine bottles/pill packs in kids
  room, backpack, locker, etc.
• Arrival of unexpected packages at home
• Young person exhibits one or more side effects of
  cough medicine abuse
• Changes in eating or sleeping patterns declining
  grades loss of interest in friends and
  activities.

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Things Parents Can Do

• Educate themselves
• Talk to their kids about dangers of abuse
• Think of medicine cabinets in the same way as
  liquor cabinets
• Avoid stockpiling cough medicines
• Monitor childs Internet use
• Watch for the signs of abuse.

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One More Thing Parents Can Do

• Contact a local, trusted drug abuse
  professional if they suspect their child is
  abusing OTC cough medicines.

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Things Educators Can Do

• Include OTC cough medicine abuse in drug abuse
  prevention units
• Ask PTAs to address topic at one or more meeting
• Craft implement staff training for teachers,
  school nurses, security, guidance, etc.

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Things Healthcare Providers Can Do

• Educate young people and their parents or
  guardians about the prevalence of abuse
• If a first responder, be aware of possible
  connection between a patients symptoms and OTC
  cough medicine abuse.

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Things Law Enforcement Officials Can Do

• Integrate OTC cough medicine abuse in the
  departments drug abuse training
• Put OTC cough medicine abuse on list of
  possibilities in alcohol/drug testing
• Be aware of pharming parties, and possible drug
  interactions.

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Things Retailers Can Do

• Move OTC medications to visible and observable
  places in their stores
• Educate customers and employees
• Create posters
• Work with local community colleges or other
  institutions responsible for training pharmacy
  technicians and ask for continuing education
  credits for training in this area.

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For All Targeted Audiences

• Be diligent observers
• Get involved, stay engaged by working with your
  local Coalition.

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Availability of Toolkit

• In hard copy
• On the Internet to be replicated and modified for
  local use.

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• www.doseofprevention.org

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Breakout session 1

• Media Outreach

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Breakout session 2

• Targeted Outreach

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Breakout session 3

• Measuring Your Success