Increasing numbers of California teens abuse over-the-counter cold medicine

December 04, 2006

The number of reported cases of dextromethorphan abuse in California increased 10-fold between 1999 and 2004, an increase that parallels national trends, according to a report in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. About three-quarters of the reported cases were among individuals age 9 to 17.

"Dextromethorphan has been used safely for years as a cough suppressant and is available in many over-the-counter (OTC) cough and cold preparations," the authors write as background information in the article. But when taken at high doses, the drug can cause hallucinations, and it has been abused for as many as four decades. Since the late 1990s, dextromethorphan abuse has increased among adolescents, in part because the drug is easily accessible and is perceived to be safe. Severe side effects have been reported at high doses, including rapid heartbeat, high blood pressure, agitation, loss of muscle control and psychosis (a loss of contact with reality).

Jodi K. Bryner, Pharm.D., School of Pharmacy, University of California, San Francisco, and colleagues analyzed the trend of dextromethorphan abuse in California as reflected in cases reported to the California Poison Control System (CPCS), a 24-hour emergency telephone service. The findings were then compared to national trends as reported to the American Association of Poison Control Centers and the Substance Abuse and Mental Health Service Administration's Drug Abuse Warning Network.

During the six-year period between 1999 and 2004, 1,411 calls to the CPCS were coded as dextromethorphan abuse. The researchers manually reviewed each one and found 1,382 non-duplicate cases. The frequency of dextromethorphan abuse calls increased by about 50 percent each year compared with the previous year, up to a total ten-fold increase (from .23 cases per 1,000 calls in 1999 to 2.15 cases per 1,000 calls in 2004). Calls involving youth aged 9 to 17 comprised 74.5 percent of those calls and increased 15-fold in that time period, from .11 to 1.68 cases per 1,000 calls, with the highest frequency among youth age 15 and 16. "The younger adolescent age distribution is further underscored by the observation that in CPCS reporting the combined frequency among 12- to 13-year-old subjects exceeded that of 18-year-old subjects," the authors write. The two national databases also experienced an increase in the number and proportion of dextromethorphan-related calls during the time period studied, as well as more frequent calls involving younger patients.

There are likely a number of reasons for this increase, the authors write. Products containing dextromethorphan are sold OTC at pharmacies and grocery stores, making them readily available and removing the stigma associated with illegal drugs. More children and teens now have unsupervised access to the Internet, where Web sites promoting abuse of the medication and even providing instructions proliferate. "Another factor is that it is easy to fool parents because these OTC products are commonly kept in the household," the authors write.

"In conclusion, this study showed an increasing trend of dextromethorphan abuse over a six-year period, particularly in adolescents younger than 18 years," they continue. "It is important for health care practitioners, manufacturers and retail establishments selling dextromethorphan-containing products to be aware of increasing dextromethorphan abuse to educate and hopefully prevent dextromethorphan abuse and the ensuing toxicity from occurring. Preventive measures, such as placing dextromethorphan-containing products behind pharmacy counters, may be an effective action to limit this increasing trend of abuse in adolescents."
(Arch Pediatr Adolesc Med. 2006;160:1217-1222. Available pre-embargo to the media at

Editor's Note: This study was supported in part by a grant from the National Institute on Drug Abuse. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail

The JAMA Network Journals

Related Abuse Articles from Brightsurf:

Children's fingertip injuries could signal abuse
Many children who suffer fingertip injuries have been abused, according to a Rutgers study.

Admissions to ER's for adolescent sexual abuse have more than doubled
Researchers found that emergency department admissions for children between 12 -- 17 doubled over a 6 year time period.

New tools help detect digital domestic abuse
A new clinical model developed by Cornell Tech researchers aims to respond systematically and effectively to the growing array of digital threats against victims of intimate partner violence.

Researchers link gene to cannabis abuse
New research from the national psychiatric project, iPSYCH, shows that a specific gene is associated with an increased risk of cannabis abuse.

Help for youth who have experienced sexual or physical abuse
There have not been many scientifically evaluated therapies for teens and young adults who have suffered physical or sexual abuse until now.

Fractures in children often indicate abuse
Physical abuse in children often remains undetected. Atypical fractures may indicate such abuse.

Emotional abuse may be linked with menopause misery
Smoking, obesity and a sedentary lifestyle have long been linked to heightened symptoms of menopause.

USPSTF recommendation statement on screening for intimate partner violence, elder abuse, and abuse of vulnerable adults
The US Preventive Services Task Force (USPSTF) recommends clinicians screen women of reproductive age for intimate partner violence and then connect women who screen positive to ongoing support services.

Older kids who abuse animals much more likely to have been abused themselves
Older children who abuse animals are two to three times as likely to have been abused themselves as kids that don't display this type of behavior, highlights a review of the available evidence published online in the Archives of Disease in Childhood.

Tracking the impact of early abuse and neglect
Maltreatment experienced before age 5 can have negative effects that continue to be seen nearly three decades later, according to a new study led by Lee Raby, an assistant professor of psychology at the University of Utah.

Read More: Abuse News and Abuse Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to