Cough Syrup Abuse: Teens Are Drinking the Stuff to Get High

From the WebMD Archives

Oct. 25, 2000 -- Could your preteen or adolescent child be abusing ... Nyquil? It's quite possible, researchers at the University of New Mexico in Albuquerque tell WebMD. When they surveyed kids in grades 4-12 from local public schools, they found that about a quarter of the students knew someone who had taken an over-the-counter cough medication to get high.

Dennis M. Feeney, PhD, a professor of psychology and neurosciences, tells WebMD that his team was originally testing the antiseizure effect of the cough syrup ingredient dextromethorphan, or DM, in animals. DM is the active ingredient in cough-suppressant syrups. Some studies have shown that DM reduces the severity of seizures in certain cases, says Feeney. But when it was given to epileptic animals that had seizures, he says, it actually increased the number of seizures in these animals.

This surprising finding was soon corroborated by another group of researchers. "They gave epileptic patients the normal DM dose every day for a month," says Feeney, "and they had more seizures than normal."

"So we started reviewing the literature and ran across obscure papers, in odd scientific journals, reporting cases of DM abuse, and even deaths," Feeney tells WebMD. According to the reports, DM in larger-than-normal dosages causes a response similar to LSD. Like LSD and PCP, or 'angel dust,' DM is thought to cause hallucinations.

The evidence was mounting, but it was at a local grocery store that Feeney began to suspect that something truly dangerous was going on. "I ran into a kid ... wearing a T-shirt [depicting] the Robitussin bottle label. When I asked where he'd bought it, he told me that he'd made it himself," he says.

"Most people look at me and don't think I could be a professional scientist," says Feeney, a self-described ponytailed, wheelchair-bound, 60-something. "They think I'm an old hippie who wrecked his motorcycle," so kids tend to be less guarded. The young man confided to Sweeney that he often drank bottles of Robitussin and other cough suppressants.

And the object, Feeney learned, was not to get drunk on the medicine's high alcohol content. "This kid new the difference between the alcohol and the DM," he says. "He'd taken PCP and LSD, and he told me that the best 'trip' he'd had was on DM." Feeney went home and called poison control. "They told me that DM was not on their [abused substances] list," he says. That was all he needed to hear. Feeney called his colleagues, and they began preparing the survey.

Researcher William R. Miller, PhD, distinguished professor of psychology and psychiatry, tells WebMD that the survey listed 16 common over-the-counter medications, nine of which contain DM, plus two fictitious drugs to help weed out false responses. In all, almost 400 fourth-12th graders were asked to circle any drug that they knew fellow students were using to "get high." The results of the survey are published in the September/October issue of the medical journal Archives of Family Medicine.

The students identified over-the-counter drugs containing DM significantly more often than those that didn't contain DM. Nyquil was the most frequently reported brand, with 46.6% of high school students, and 36.2% of the entire group, reporting that someone they knew had abused it. Interestingly, dextromethorphan itself was rarely selected. Other popular brands included Robitussin (although only 8 of its 12 varieties contain DM), Vicks 44D, and Tylenol Cough.

"We think this is an overlooked drug of abuse," says Miller, "and certainly one of great concern in terms of its toxicity." Although he's not advocating that the FDA make DM a controlled substance, Miller tells WebMD that he does "think this ought to be looked at."

"We don't comment on individual studies," FDA spokesperson Sharon Jayne tells WebMD. But, she adds, "there is always the possibility that this or any other OTC ingredient will come up for review, especially if [reports] of adverse reactions start coming into our database."

And, if the survey results are representative of schools across the county, that could very well be the case, the researchers say. Although there is no evidence to suggest that DM is addictive, there is plenty of evidence to suggest that it's dangerous. "There have been deaths associated with it," says Feeney. "Whether it directly caused the deaths, I don't know. [But,] if kids drove under the influence of DM, for example, that would be awful. I think there should be a warning on the bottle. Especially for epileptics, but also for potential abuse."

In addition to being on guard for the usual signs of trouble -- failing grades, mood swings, changes in a child's physical appearance -- parents should also be keeping an eye out for "mysteriously empty or disappearing cough syrup bottles," say the researchers. Only those syrups that are labeled cough suppressants, not expectorants, contain DM.