Cough and Cold Medicine Abuse

Some over-the-counter (OTC) and syrup is sometimes diverted for prescription cough and cold medicines abuse. contain active ingredients that are psychoactive (mind-altering) at higher- than-recommended dosages and are frequently abused for this purpose. These products may also contain other drugs, such as expectorants and antihistamines, which are dangerous at high doses and compound the dangers of abuse.

Two commonly abused cough and cold medicines are:  Dextromethorphan (DXM), a cough suppressant and expectorant How Are Cough and Cold Medicines found in many OTC cold medicines. Abused? It may produce euphoria and dissociative effects or even Cough and cold medicines are usually hallucinations when taken in consumed orally in tablet, capsule, or quantities greater than the syrup form. They may be mixed with recommended therapeutic dose. soda for flavor and are often abused in  Promethazine-codeine cough syrup, combination with other drugs, such as a medication that contains alcohol or marijuana. codeine, an opioid that acts as a cough suppressant and can also Because they are easily purchased in produce relaxation and euphoria drugstores without a prescription, when consumed at a higher-than- cough syrups, pills, and gel capsules prescribed dose. It also contains containing DXM—particularly “extra promethazine HCl, an strength” forms—are frequently abused antihistamine that additionally by young people (who refer to the acts as a sedative. Although only practice as “robo-tripping” or available by prescription, “skittling”). To avoid nausea produced promethazine-codeine cough by high doses of the expectorant Cough and Cold Medicine Abuse • May 2014 • Page 1 guaifenesin commonly found in DXM- several times the recommended, safe containing syrups, young people may amount. Also, both codeine and instead abuse Coricidin® HBP Cough & promethazine HCl act as depressants of Cold capsules (street name C-C-C or the central nervous system, producing triple-C), which contain DXM but lack sedating or calming effects. guaifenesin. When abused, both codeine and DXM Drinking promethazine-codeine cough directly or indirectly cause a syrup mixed with soda (a combination pleasurable increase in the amount of called syrup, sizzurp, purple drank, dopamine in the brain’s reward barre, or lean) was referenced pathway. Repeatedly seeking to frequently in some popular music experience that feeling can lead to beginning in the late 1990s and has addiction—a chronic relapsing brain become increasingly popular among disease characterized by inability to youth in several areas of the country. A stop using a drug despite damaging variation of “purple drank” is consequences to a person’s life and promethazine-codeine cough syrup health. mixed with alcohol. Users may also flavor the mixture with the addition of What Are the Other Health Effects of hard candies. Abusing Cough and Cold Medicines?

How Does Abusing Cough and Cold Abusing DXM can cause impaired motor Medicines Affect the Brain? function, numbness, nausea or vomiting, increased heart rate and blood When taken as intended, cough and cold pressure, and at high doses, extreme medicines safely treat symptoms of agitation, increased body temperature, lower and upper respiratory congestion and a buildup of excess acid in body and discomfort caused by colds and flu. fluids. High doses of acetaminophen, a But when taken in higher quantities or pain reliever commonly found with when such symptoms aren’t present, DXM, can cause liver damage. On rare they may affect the brain in ways very occasions, hypoxic brain damage— similar to illegal drugs. caused by severe respiratory depression and a lack of oxygen to the When taken in high doses, DXM acts on brain—has occurred as a result of the the same cell receptors as dissociative combination of DXM with hallucinogenic drugs like PCP or decongestants often found in the ketamine. Users describe effects ranging medication. from mild stimulation to alcohol- or marijuana-like intoxication, and at high When abused, promethazine-codeine doses, sensations of physical distortion cough syrup presents a high risk of fatal and hallucinations. overdose due to its effect of depressing the central nervous system, which can Codeine attaches to the same cell slow or stop the heart and lungs. Mixing receptors targeted by illegal opioids like with alcohol greatly increases this risk. heroin. Consuming more than the daily Promethazine-codeine cough syrup has recommended therapeutic dose of been linked to the overdose deaths of a promethazine-codeine cough syrup can few prominent musicians. produce euphoria similar to that produced by other opioid drugs; people addicted to codeine may consume Cough and Cold Medicine Abuse • May 2014 • Page 2 Learn More

For more information on DXM, visit www.deadiversion.usdoj.gov/ drug_chem_info/dextro_m.pdf.

For more information on promethazine- codeine cough syrup, visit www.drugabuse.gov/drugs- abuse/emerging-trends.

Cough and Cold Medicine Abuse • May 2014 • Page 3