FDA looks to curb “robo-tripping”

Abuse of cough medicine containing dextromethorphan, known as “robo-tripping”, is on the rise according to the U.S. Drug Enforcement Administration, which has asked the Food and Drug Administration to look into ways to control the abuse. The DEA says that emergency room visits from abuse of the drug have increased in recent years and about half of those visits involve young people aged 12 to 20.

Dextromethorphan (which is a cough suppressant) is not very effective at controlling the most common coughs caused by cold or flu. It is available over-the-counter in more than 120 products, such as Coricidin, Nyquil Cough, Robitussin DM, and Vicks 44. When used as directed, dextromethorphan is considered safe by the FDA. But even standard doses of the drug can cause agitation, muscle spasms, and allergic reactions. Overdosing can bring hallucinations, rapid heartbeat, loss of coordination, and a ''high'' similar to psychotropic drugs like PCP. Some of the products also contain other ingredients, like the pain-reliever, fever-reducer acetaminophen, which can cause liver damage when overused or combined with alcohol, and the decongestant pseudoephedrine, which can increase blood pressure.

The DEA says that the Internet may play a role in the spread of "robo-tripping," because a proliferation of how-to websites now explain how to abuse the drug. A quick look at You Tube shows that a number of young people apparently videotape themselves abusing the drug and post the video of themselves or their friends “robo-tripping” online. Pop-culture may play a role in the rise as well. The rapper ‘Lil Wayne has sung about “sippin’ syrup” and in 2009 talked to Katie Couric about his addiction to prescription cough syrup.

On September 14th the FDA will convene a meeting to review the increased incidents of cough medicine abuse, and consider whether increased restrictions could help curb the problem. In the meantime, if you have young people in your home, be aware of the risk of cough medicine abuse. And if you want to replace your dextromethorphan products with remedies that actually help treat a, see How to Treat a Cough.

Robo Tripping: The Legal High

An alarming number of teens are getting high — not on illegal drugs but on something found in many homes.It’s a dangerous addiction that can go unnoticed until its too late. As CBS 2’s Mary Calvi reports, it’s a legal high called robotripping.

Dextromethorphan or DXM can be found in more than 100 cough medicines. More than 3 million teens nationwide have tried robotripping. “It’s in your house, like everybody has it in their cabinets,” “Amanda” said. Amanda said she started robotripping at the age of 16 and then couldn’t stop. For one year, abusing cough medicine took over her life.

CBS 2: “How addictive was it for you?” Amanda: “It’s definitely addictive. It’s not something parents can catch onto easily.” Parents may warn their children about illegal drugs, but experts say abusing cough medicine is usually not something most parents think of or worry about.

“They don’t think it’s as big of a deal because it’s a household product, something that they can buy in the store and a lot of times they don’t even know their children might be using it,” said Eriach Fox of Daytop Rehabilitation Center.

Studies show more than half of the teens in rehab have used cough medicine with DXM to get high. “It was kind of a friend thing at first and as soon as I did it and didn’t feel pain anymore, I stuck with it and started using every day,” Amanda said.

Once she started, her addiction quickly spiraled out of control. “My family just had enough of me and my attitudes and my out late at night and not coming home and not knowing what I was doing,” she said.

Experts warn parents to be aware of what’s in the medicine cabinet. Cough medicines with DXM have a clear warning label telling parents to learn about teen medicine abuse. The earlier the abuse is discovered, the better, because, as in Amanda’s case, when DXM is not enough to get a high, teens may move onto something else. “I was using heroine,” Amanda said. “I started to shoot up which is something I promised myself I would never do.

I lost my family. I lost my friends. I lost my everything.” At the age of 18, she had nothing.

“I had to figure out what to do on my own,” Amanda said. It took everything she had left to make the decision to check herself into rehab. Now, a few months later, she’s clean. She’s finishing high school at the Daytop Rehabilitation Center. She’s also in their chorus, using her voice to rise out of addiction.

“There’s definitely a lot of mountains and definitely a lot of hills that I am hitting right now and I feel like if I try hard enough I can get over them,” Amanda said. She’s using her strength to create a future all her own.

Tripping Over Robo-Tripping

Later this month an FDA advisory committee is scheduled to consider whether the agency should require a prescription for Robitussin, NyQuil, and other medications containing dextromethorphan (DXM), a cough suppressant that has dramatic psychoactive effects in large doses (starting around 10 times the normal dose). This week, in anticipation of the meeting, the FDA posted 135 pages of information about DXM, which you can peruse here (PDF). The case for scheduling DXM is weak, but that does not mean it will not happen. Other possibilities include banning sales to minors (a measure supported by the pharmaceutical industry) or putting DXM-containing products behind the pharmacist’s counter (which would mean they could not be sold outside drugstores).

"Although DXM, when formulated properly and used in small amounts, can be safely used in cough suppressant medicines," the FDA says, "abuse of the drug can cause death as well as other serious adverse events such as brain damage, seizure, loss of consciousness, and irregular heart beat." But this sort of thing does not seem to happen very often. "Considering its widespread over the counter (OTC) availability," the FDA concedes, "relatively few reports of serious abuse-related events involving DXM have been published."

DXM has been on the market since 1958, when the FDA approved it as a "nonaddictive substitute for codeine" (which was switched to prescription-only status in an effort to discourage nonmedical use). It is an ingredient in more than 125 OTC products. Yet the FDA cites only five deaths caused by DXM overdoses in the United States, all of them in 2005 and all of them involving not cold remedies but DXM powder purchased for recreational use. By contrast, aspirin causes hundreds of deaths every year.

What about nonfatal events? According to the Drug Abuse Warning Network, there were 3,914 DXM-related emergency room visits in 2008, compared to 7,933 for pseudoephedrine and 39,215 for diphenhydramine, the antihistamine in Benadryl. And while the Drug Enforcement Administration says it is "concerned with the increasing abuse of dextromethorphan, especially among adolescents," the government-sponsored Monitoring the Future Study indicates that nonmedical use of "OTC cough/cold medicines" is down among eighth-graders and 12th-graders since 2006 (the first year the survey asked about this drug category) and up only slightly among 10th-graders, 6 percent of whom reported past-year use in 2009, compared to 5.3 percent in 2006.

"Because of the drug's perceived safety, ease of availability, and desired psychoactive effects, it is sought after by those seeking to alter their mental state," the FDA says. It leaves out another factor in DXM's appeal to teenagers: the drug laws, which increase the cost, effort, and risk involved in obtaining safer alternatives such as marijuana. It's hard to for me to imagine that DXM would have much of a following in the absence of drug prohibition. Maybe I'm biased, since I do not even like the psychoactive effects of a therapeutic dose, which I find so unpleasant that I avoid products containing DXM.

But consider the DEA's description (included in the FDA packet) of "four dose-dependent 'plateaux'":

1. 1st (100–200 mg): Mild stimulation
2. 2nd (200–400 mg): Euphoria and hallucinations
3. 3rd (300–600 mg): Distorted visual perceptions, loss of motor coordination
4. 4th (500-1,500 mg): Dissociative sedation

Which, in the long tradition of anti-drug warnings that also serve as pro-drug publicity, makes DXM sound pretty appealing. A DXM powder user describes his experience here. The Partnership for a Drug-Free America tries to scare you away from the stuff here. Previous Reason coverage of DXM dread here.

Cordaro Howard Battling Torn Labrum

I’ve learned that the shoulder injury to Buffalo Bills tackle Cordaro Howard that Chan Gailey touched briefly on during his press conference Monday, is actually a torn labrum in the shoulder. He also has a sprained rotator.

Howard first hurt the shoulder early in the game at Kansas City, which was his second career start at right tackle. The injury got progressively and he was really laboring before being shut down in the second half against Chicago this past Sunday.

Howard is working on strengthening the shoulder but won’t be in the lineup when Buffalo hosts the Detroit Lions Sunday. He hopes to be back when Buffalo travels to Cincinnati in two weeks. He is planning on having surgery on the shoulder after the season is over.

Mansfield Wrotto will get the start at right tackle Sunday, and rookie Ed Wang is expected to be activated as a game day reserve for the first time in his career.

Linebacker Andra Davis tried to battle a torn labrum over the past several weeks. It ended with him being placed on injured reserved yesterday.

Jake Long's labrum damaged

Miami Dolphins Pro Bowl left tackle Jake Long not only disclocated his shoulder Sunday, but he also suffered damage to his labrum during the same injury, according to team sources.

Long, who played the first month of the season with a sprained MCL in his knee, has not ruled out playing Thursday night against the Chicago Bears. He may be fitted with a shoulder harness, but he is questionable, at best, the sources said.

Long played with the injury until late in the fourth quarter of the Dolphins' 29-17 victory over the Tennessee Titans.

Dolphins coach Tony Sparano did not disclose many details about Long's injury but added that the former No. 1 pick was a "tough guy."

Long's injury is just the latest ailment for a banged-up Dolphins team that has alternated wins and losses since a two-game losing streak in Weeks 3-4.

Quarterback Chad Pennington was placed on injured reserve Monday with a shoulder injury and fellow signal caller Chad Henne suffered a knee injury against the Titans that may sideline him against the Bears.

Also, like Long, AFC sack leader Cameron Wake (hip) and safety Chris Clemons (groin) finished Sunday's game on the bench.

The Dolphins listed 13 players -- not including Pennington -- on their injury report Monday, with Henne, Long, Clemons and center Joe Berger (knee) the most seriously hurt.

"We have a lot of guys bumped up right now," Sparano said. "We're sorting through it all." Reported that Jake Long also has some labrum damage w shoulder injury. Long may try to wear shoulder harness but is iffy vs. Bears