Cough and Cold Medicine Abuse

Some over-the-counter (OTC) and prescrip- tion cough and cold medicines contain active ingredients that are psychoactive (mind- altering) at higher-than-recommended dos- ages and are frequently abused for this pur- pose. These products may also contain oth- er drugs, such as expectorants and antihis- tamines, which are dangerous at high doses and compound the dangers of abuse.

Two commonly abused cough and cold med- icines are: How Are Cough and Cold Medicines • Dextromethorphan (DXM), a cough Abused? suppressant and expectorant found in many OTC cold medicines. It may Cough and cold medicines are usually con- produce euphoria and dissociative ef- sumed orally in tablet, capsule, or syrup fects or even hallucinations when form. They may be mixed with soda for taken in quantities greater than the flavor and are often abused in combination recommended therapeutic dose. with other drugs, such as alcohol or mari- • Promethazine-codeine cough syrup, a juana. medication that contains codeine, an opioid that acts as a cough suppres- Because they are easily purchased in drug- sant and can also produce relaxation stores without a prescription, cough syr- and euphoria when consumed at a ups, pills, and gel capsules containing higher-than-prescribed dose. It also DXM—particularly “extra strength” contains promethazine HCl, an anti- forms—are frequently abused by young histamine that additionally acts as a people (who refer to the practice as “robo- sedative. Although only available by tripping” or “skittling”). To avoid nausea prescription, promethazine-codeine produced by high doses of the expectorant cough syrup is sometimes diverted guaifenesin commonly found in DXM- for abuse. containing syrups, young people may in- stead abuse Coricidin® HBP Cough & Cold capsules (street name C-C-C or triple-C), which contain DXM but lack guaifenesin.

Cough and Cold Medicines • May 2014 • Page 1 increase in the amount of dopamine in Drinking promethazine-codeine cough the brain’s reward pathway. Repeatedly syrup mixed with soda (a combination seeking to experience that feeling can called syrup, sizzurp, purple drank, barre, lead to addiction—a chronic relapsing or lean) was referenced frequently in brain disease characterized by inability some popular music beginning in the late to stop using a drug despite damaging 1990s and has become increasingly popu- consequences to a person’s life and lar among youth in several areas of the health. country. A variation of “purple drank” is promethazine-codeine cough syrup mixed What Are the Other Health Effects of with alcohol. Users may also flavor the Abusing Cough and Cold Medicines? mixture with the addition of hard candies. Abusing DXM can cause impaired motor How Does Abusing Cough and Cold function, numbness, nausea or vomiting, Medicines Affect the Brain? increased heart rate and blood pressure, and at high doses, extreme agitation, in- When taken as intended, cough and cold creased body temperature, and a buildup medicines safely treat symptoms of low- of excess acid in body fluids. High doses er and upper respiratory congestion and of acetaminophen, a pain reliever com- discomfort caused by colds and flu. But monly found with DXM, can cause liver when taken in higher quantities or when damage. On rare occasions, hypoxic such symptoms aren’t present, they may brain damage—caused by severe respir- affect the brain in ways very similar to il- atory depression and a lack of oxygen to legal drugs. the brain—has occurred as a result of the combination of DXM with decongest- When taken in high doses, DXM acts on ants often found in the medication. the same cell receptors as dissociative hallucinogenic drugs like PCP or keta- When abused, promethazine-codeine mine. Users describe effects ranging cough syrup presents a high risk of fatal from mild stimulation to alcohol- or ma- overdose due to its effect of depressing rijuana-like intoxication, and at high the central nervous system, which can doses, sensations of physical distortion slow or stop the heart and lungs. Mixing and hallucinations. with alcohol greatly increases this risk. Promethazine-codeine cough syrup has Codeine attaches to the same cell recep- been linked to the overdose deaths of a tors targeted by illegal opioids like hero- few prominent musicians. in. Consuming more than the daily rec- ommended therapeutic dose of pro- Learn More methazine-codeine cough syrup can produce euphoria similar to that pro- For more information on abuse of DXM, duced by other opioid drugs; people ad- see dicted to codeine may consume several http://www.deadiversion.usdoj.gov/dru times the recommended, safe amount. g_chem_info/dextro_m.pdf Also, both codeine and promethazine HCl act as depressants of the central nervous For more information on abuse of pro- system, producing sedating or calming methazine-codeine cough syrup, see effects. http://www.drugabuse.gov/drugs- abuse/emerging-trends When abused, both codeine and DXM di- rectly or indirectly cause a pleasurable

Cough and Cold Medicines • May 2014 • Page 2