Abuse of cough and cold medicines

China Daily (Hong Kong) - - CHINA -

Some over-the-counter and pre­scrip­tion cough and cold medicines con­tain ac­tive ingredients that are psy­choac­tive (mind-al­ter­ing) at higher-thanrec­om­mended dosages, which re­sults in them fre­quently be­ing 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 found in many OTC cold medicines. It may pro­duce eu­pho­ria and dis­so­cia­tive ef­fects or even hal­lu­ci­na­tions when taken in quan­ti­ties greater than the rec­om­mended ther­a­peu­tic dose.

Promet­hazine-codeine cough syrup, a med­i­ca­tion that con­tains codeine, an opi­oid that acts as a cough sup­pres­sant and can also make the user feel re­laxed and eu­phoric when con­sumed at a higher-than-pre­scribed dose. It also con­tains promet­hazine HCl (hy­drochlo­ride), an an­ti­his­tamine that ad­di­tion­ally acts as a seda­tive. Al­though only avail­able by pre­scrip­tion, promet­hazine-codeine cough syrup is some­times di­verted for abuse by users.

Cough and cold medicines are usu­ally con­sumed orally in tablet, cap­sule, or syrup form. They may be mixed with soda for fla­vor and are of­ten abused in com­bi­na­tion with other drugs, such as al­co­hol or mar­i­juana.

Be­cause they are eas­ily pur­chased in drug­stores with­out a pre­scrip­tion, cough syrups, pills and gel cap­sules con­tain­ing DXM — es­pe­cially the “ex­tra strength” forms — are fre­quently abused by young peo­ple (who re­fer to the prac­tice as “robo-trip­ping” or “skit­tling”). To avoid nau­sea pro­duced by high doses of the ex­pec­to­rant guaife­n­esin, which is com­monly found in syrups con­tain­ing DXM, young peo­ple may in­stead abuse Co­ri­cidin HBP Cough & Cold cap­sules (street name: C-C-C or triple-C), which con­tain DXM but lack guaife­n­esin.

Drink­ing promet­hazine-codeine cough syrup mixed with soda (a com­bi­na­tion called syrup, siz­zurp, pur­ple drank, barre, or lean) was ref­er­enced fre­quently in some pop­u­lar mu­sic be­gin­ning in the late 1990s and has be­come in­creas­ingly pop­u­lar among youth in sev­eral ar­eas of the coun­try. A vari­a­tion of pur­ple drank is a promet­hazinecodeine cough syrup mixed with al­co­hol.

It was the ex­cru­ci­at­ing six-year re­ha­bil­i­ta­tion process that pro­pelled me to search for ways to save my own son as well as other teenagers who are ad­dicted to new psy­choac­tive sub­stances.

In Fe­bru­ary 2004, I re­ceived a phone call ask­ing me to go to the hospi­tal be­cause my 13-year-old son had col­lapsed at school and a pos­i­tive re­sult in a urine test sug­gested he was us­ing drugs.

When he re­gained con­scious­ness, my son as­sured me that he didn’t do drugs, but he ad­mit­ted to drink­ing a prepa­ra­tion he called “cough syrup” be­fore he col­lapsed.

Be­cause it was the first time he had taken the drink and re­cov­ered quickly I didn’t take the mat­ter se­ri­ously.

Three years later, my son pan­icked one day when he found a large amount of blood in his urine. He called me for help and re­peat­edly asked: “Am I go­ing to die?”

He con­fessed that he had con­tin­ued to drink the prepa­ra­tion in the three years since his col­lapse.

I im­me­di­ately gave up my job as a se­nior mar­ket­ing man­ager at a large life in­sur­ance com­pany, and be­came de­ter­mined to pro­tect my son from new psy­choac­tive sub­stances, such as codeine in the “cough syrup”.

Codeine is a le­gally pre­scribed sub­stance in med­i­ca­tions used to reduce and con­trol cough­ing. When it is used over a long pe­riod or in large doses, it can be ad­dic­tive.

It wasn’t un­til May 1 last year that codeine was listed as a con­trolled sub­stance, mean­ing that only li­censed en­ti­ties are al­lowed to use it. Pre­scrip­tions of medicines con­tain­ing codeine should not ex­ceed seven days’ dosage.

I re­gret that I knew too lit­tle about the sub­stance when my son had his first drink of “cough syrup” in 2004.

In De­cem­ber 2011, my son pro­posed set­ting up an or­ga­ni­za­tion to pro­mote aware­ness of drug pre­ven­tion and how to break de­pen­dence on psy­choac­tive sub­stances that aren’t cat­e­go­rized as il­le­gal drugs.

In the past five years, the or­ga­ni­za­tion — The Dian­dian Care Cen­ter for Ado­les­cent Drug Ad­dic­tion — has or­ga­nized more than 300 activities and handed out 600,000 brochures to help teenagers and their par­ents.

Zhou Li­hui spoke with Zhang Yi

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