TEENS ABUSING COUGH MEDICINE INGREDIENT

Michelle Hewett never suspected the cold medicine.

She knew James was using something -- maybe pot, maybe cocaine or
heroin. But when she searched her 16-year-old son's bedroom one
afternoon last spring, all she found was an empty Coricidin HBP Cough
and Cold box stuffed under his dresser.

What a slob, she thought. And then she returned to looking for
drugs.

It wasn't until James went into rehab a month later that Mrs. Hewett
learned that Coricidin -- or, more precisely, the active ingredient,
dextromethorphan -- was one of his favorites. Nearly every other night
for a year, James had taken 16 pills of the over-the-counter
medication and then slipped on his headphones. The next morning, he'd
often still be tripping as he headed to Clark High School in Plano,
where many of his friends, he said, would be coming down from their
own dextro-induced highs.

"How was I supposed to know?" Mrs. Hewett said recently. "We have
enough trouble keeping up with all the mainstream stuff, but I had
never heard about this. It's cough medicine."

Though sporadic reports of abuse date back at least a decade, the
dextromethorphan fad at schools such as Clark has surprised many
people, drug counselors and law enforcement officials included. Six
months ago, many of them had never heard of the drug, an ingredient in
dozens of cough-suppressing syrups and pills, such as Robitussin
Maximum Strength Cough and Coricidin.

Now, it's almost as popular among 14- to 17-year-olds in some parts of
North Texas as alcohol and marijuana, they say. Plano, where problems
with black-tar heroin abuse have attracted national attention, has
been especially hard-hit, counselors say.

"People don't think of it as a drug because it's sold over the
counter, but the truth is that a lot of kids are using it," said Chris
Godfrey, counselor at the Greater Dallas Council on Alcohol and Drug
Abuse.

"Occasionally we get a call from a mom saying, 'I just read my
daughter's diary, and I saw "DXM." What does that mean?' When we tell
them it's cough syrup," Ms. Godfrey said, "they say they're relieved.
They don't realize what they're dealing with."

When taken in excess, dextromethorphan -- called DXM, red devils and
Robo by users -- mimics the effects of PCP, alcohol and marijuana
combined, drug counselors and users say. It causes decreased motor
control and a loss of touch with reality.

Easy access

The reason for the surge in its popularity, especially among high
school students, is accessibility. Dextromethorphan products cost $5
to $7 and are on the shelves of every drugstore. And because few
parents know about the drug, there's less chance of being discovered
than with mainstream drugs.

Even if users are caught, there are no legal penalties: DXM is not a
controlled substance, even in large quantities.

"There's been a real upswing, but we have no control over it," said
Paul Villaescusa, an agent with the Dallas office of the Drug
Enforcement Administration. "This is outside of our realm."

And because the drug is so common, an ingredient in more than 140
over-the-counter syrups and capsules, drugstore officials say they can
do little to monitor the purchase of the products.

Local drug counselors say they know of no stores that have removed the
products from the shelves. A spokeswoman from Eckerd, one of the
area's largest drugstore chains, said making them inaccessible to
youth would inconvenience all customers.

If store managers notice unusual movement on the shelves, though, they
can decide to move the products behind the counter, she said.

Empty bottles

Ten years ago, University of Southern California professor Gregory A.
Thompson started getting calls from Los Angeles-area principals who
were noticing empty cough syrup bottles in fields near their campuses.

"Kids would drink an eight-ounce bottle of Robitussin on the way to
school," said Dr. Thompson, a professor of pharmaceutical medicine who
heads the Los Angeles Regional Drug Information Center. "It would be
like taking acid with four shots of Jack Daniel's."

Drug companies have since stopped including high alcohol dosages in
DXM products.

Campaign aborted

Several years later, Whitehall-Robins, the manufacturer of Robitussin,
considered launching a national public awareness campaign discouraging
DXM cough syrup abuse, said Bob D'Alessandro, an independent
substance-abuse consultant who works with the company.

"But I advised them not to do a campaign," Mr. D'Alessandro said,
"because at the time, probably only 20 percent of adolescents knew
that you can get high off of cough syrup. Putting it on television
would only inform the other 80 percent."

The company is considering creating a Web page to warn adults about
the problem, he said. In addition, Mr. D'Alessandro speaks to parents
and pharmacists in communities where Robitussin abuse is occurring.

Lower-level abuse causes feelings of euphoria, stupor, excitability
and changes in muscle reflexes, according to medical texts and users'
accounts. In larger amounts, dextromethorphan acts as a dissociative,
causing hallucinations and detachment from reality.

"It's a really intense body trip like acid, but I didn't get any
visuals. I knew some people who did," said James, the Clark High
student, who used inhalants and a host of other drugs along with
Coricidin. "For me, it was more like I was really, really drunk. You
have the same loss of motor coordination, and you stutter a lot."

Undesirable side effects include skin irritation -- the "Robo itch" --
shortness of breath, dizziness, temporary sexual dysfunction, nausea
and hangovers. It is rarely addictive, according to medical texts.

Fatal mix

Although DXM by itself is unlikely to cause death or serious injury,
Dr. Thompson said, large doses can be fatal in combination with
antidepressants or prescription nondrowsy allergy medicines, such as
Allegra and Claritin. Also, some drugs that accompany dextromethorphan
in cold syrups and pills can pose overdose risks.

Antihistamines can cause drowsiness, nervousness and even seizures.
Expectorants, which clear phlegm from the throat and nasal passages,
can trigger vomiting. And acetaminophen, the main ingredient in
Tylenol, can cause deadly liver damage with prolonged abuse.

The huge doses exacerbate the damage. Sabina Stern, program
coordinator of the Collin County Substance Abuse Program, has heard of
people taking as many as 100 pills in one sitting.

"Unfortunately, what young people tend to think is that if two pills
feel good, four pills will feel great. And if a friend says take 24,
they'll say OK," said Ms. Stern, who has counseled about 50 teens with
DXM problems in the last six months. "Teenagers don't think like
adults think. The fact that a drug has side effects doesn't enter into
their minds."

James said that after he and his friends started taking Coricidin
regularly, a few did research the drug's side effects on the Internet.
Learning about the damage that the medication could cause didn't stop
them, though.

Several dozen Web pages, including the comprehensive Dextromethorphan
FAQs (Frequently Asked Questions), offer tips on everything from how
to chug two bottles of Robitussin without vomiting to warnings about
drug interactions.

Web warnings

Although some pages seem geared toward younger users, the FAQs site,
which has 60,000-plus words on the subject, contains a couple of
disclaimers discouraging DXM use by teens: "Attention Parents. . . . I
am not a good influence for your children, nor do I claim to be.

"Attention Kids. . . . If you think school is boring, try
rehab."

Besides providing general information about dextromethorphan, the Web
offers instructions on how to extract pure DXM from syrups and how to
order the drug in pure powder form, which Drug Enforcement
Administration officials say is legal.

At least three mail-order services offering DXM are based in the
United States -- in Austin; Greensboro, N.C.; and Santa Barbara,
Calif. The services, which were reviewed in a recent issue of an
online magazine for DXM users, sell the drug for $2 to $4 per gram,
for "research purposes only." None of the three had a listed telephone
number.

Last month, a 26-year-old Bedford man was arrested by North Richland
Hills police on charges of possessing 600 grams of what officials
thought was ecstasy. After testing the substance, though,
investigators discovered that it was dextromethorphan, ordered through
the mail.

Prosecutors dropped the charges.

One of James' friends also ordered pure DXM. Claiming to work for a
hospital, he purchased a 20-pound bag and had it delivered to a post
office box. He then sold the drug, at $5 a gram, to classmates in
Clark High's bathrooms and hallways. On an average day, James said,
the student would sell five or six grams.

For Mrs. Hewett, the details are still shocking. "It's unbelievable,"
she said. "The problem is just so widespread. . . .

"I read up on drugs. I gave James drug tests. I did everything I
could, but it seemed like the harder I tried, the more he
deteriorated."

Now that James has cleaned himself up, Mrs. Hewett wants to spread the
word to other parents, who, she suspects, are as clueless as she was.

"There's a total lack of information," she said. "I told several
people at work the other day that kids are taking Coricidin to get
high, and they looked at me like I was crazy.

"Until it happens to their kids, they just don't know."