SYRUP HEADS

Cough And Cold Medicines Have Become A Cheap And Legal - But Not Harmless -
Way To Get High

A TV ad shows two teenage girls yelling "Robitussin" as a geshundheit for
coughs. But in some adolescent circles, talk of the over-the-counter cold
medication has a whole different meaning.

Cough and cold medicines like Robitussin, Coricidin and Contac - whether in
bottled syrups or blister-packaged pills - have become a cheap, easy and
legal way for some teens to get high.

In fact, the growing use in North America of these drug-store stalwarts has
spawned a whole new lexicon, including "robotripping" and popping
"Skittles," "Red Devils" and "Triple Cs," the latter the street term for
Coricidin Cough and Cold. Those who take them for a high are called "syrup
heads."

All these non-prescription remedies contain dextromethorphan, or DXM, a
cough suppressant chemically related to morphine, a potent narcotic.
Fuelled by word of mouth and Internet how-to manuals, some teens are
guzzling cough syrup or downing a handful of tablets to get their "dex" hit.

"One of the classic things is they can get it easy enough, it's not
illegal, a lot of people have it in their medicine cabinets," says Bruce
Ballon, a psychiatrist who specializes in youth substance abuse at the
Centre for Addiction and Mental Health in Toronto. "It's not like you have
to get alcohol underage or get cannabis, you can just go off and buy cough
syrup."

But the dangers of taking many times the recommended adult dosage of these
decongestants and antihistamines are nothing to sneeze at, doctors say.

"Taking any medication in a different way than it's meant to be taken means
that you're putting yourself at risk for all kinds of complications," says
Dr. Karen Leslie, a pediatrician specializing in adolescent medicine at
Toronto's Hospital for Sick Children.

While the goal may be achieving the euphoria, dream-like state and
mind-body dissociation reportedly caused by DXM - robotripping refers not
just to the brand name, but also to a robot-like sensation - it comes at a
price. Adverse short-term effects can range from nausea and vomiting to
body itching, fever and loss of balance to an irregular heartbeat and
hallucinations. Over time, DXM abuse may lead to liver or brain damage.

And ingested at megadoses, the drugs are a prescription for really serious
trouble: seizures, psychosis, coma - even death.

There has been a rash of deaths among U.S. teens who overdosed on DXM
products in the last few years. Statistics on overdoses and deaths are not
available for Canada.

Leslie says abusing DXM products along with other substances, such as
alcohol, can be even more dangerous, since the depressive effects of booze
can mask the buzz from the DXM and other cough-and-cold stimulants.

"So if you're drinking and taking DXM, the alcohol might make it seem like
the DXM isn't doing enough, so you might take more DXM, and then you run
the risk of actually overdosing."

Cough and cold remedies aren't the only off-the-shelf medications abused.
Some adolescents Leslie sees tell her they take products to help them
sleep, calm anxiety or just make them feel better.

Painkillers like ibuprofen or acetaminophen fall in the latter category,
although Leslie says she thinks the good feelings teens experience are
merely a placebo - or psychological - effect.

Some young people take them for tension headaches, but there, too, they can
have repercussions if taken too frequently, which causes rebound headaches.
A 2004 study at a Cleveland, Ohio, headache clinic found more than 20 per
cent of 680 children aged six to 18 were overusing these garden-variety
painkillers. Some of the patients suffered kidney failure or intestinal
bleeding because of all the medication they were taking - in some cases, up
to 20 times a week.

Also, children under 19 should never take ASA, a drug found in Aspirin and
other headache products, because it has been linked to potentially deadly
Reye's syndrome, a condition that can arise following a viral infection
like the flu or chickenpox.

When it comes to more serious substance abuse, Ballon says most of the
teens he counsels are into cannabis and other illicit drugs or alcohol.
Off-the-shelf medications are just occasional bonbons added to the mix.
Only a few of the adolescents he has treated cited getting hooked on DXM as
their primary concern.

And within the hierarchical drug culture, there are certainly no bragging
rights for being a syrup head, he says.

'There's also some embarrassment around this one," says Ballon. "The
robotrippers who use the DXM, they usually keep it in the closet. It's not
like it's a popular thing to say, 'Look at me. I use cough syrup.'"

[SIDEBAR]

Q and A on dextromethorphan

What is it?

A synthetic drug chemically similar to the narcotics morphine and codeine.
Nicknames include Robo, Triple Cs, Rojo, Skittles, Dex, Tussin. Abuse is
called robotripping, tussing or dexing. Users are called syrup heads or
robotards.

What is it used for?

Drug manufacturers began using DXM in cough syrups in the 1970s to replace
codeine as a cough suppressant. It's now in more than 100 over-the-counter
cough and cold remedies.

What does it do?

At normal doses, controls coughs. At megadoses, creates effects similar to
the illicit drugs PCP or the anesthetic ketamine.

What adverse affects can it have?

Sweating, fever, dry mouth, dry, itchy skin, nausea, stomach pain,
vomiting, racing or irregular heart beat, high blood pressure, delusions,
hallucinations, seizures, coma, death.

How much is too much?

The recommended dose for adults is 15 to 30 milligrams, every six to eight
hours, not to exceed 120 milligrams daily. Mind-altering effects can occur
with a single dose of 100 milligrams. Some abusers ingest enough pills or
syrup for a dose of 240 to 360 milligrams.

How can I tell if someone is abusing DXM?

Be aware if someone is taking cough syrup or cough and cold pills after
symptoms of a cold or flu are over or if they're using them outside cold
and flu season. Watch to see if someone has a large supply of
DXM-containing products. Be on the lookout for signs of abuse, such as
slurred speech, sweating, confusion or nausea and vomiting.