TEENS ABUSING COLD REMEDIES IN EPIDEMIC NUMBERS

CHICAGO -- Emergency room physicians and other health care
professionals are reporting a sharp increase in teens abusing
non-prescription cough and cold medicines, which are back in vogue as
recreational drugs because the products are both accessible and easier
to take than ever before. Users call it "skittles," "triple Cs" (for
Coricidin HBP Cough & Cold tablets) or "robo-tripping" to describe its
hallucinogenic effects, similar to PCP.

Medical personnel are calling it "an epidemic."

The latest concerns have caused some large drugstore chains to limit
purchases or move the product off the shelves. But the efforts don't
go far enough, say many critics, who are urging that all such products
be sold strictly from behind -- not over -- the counter.

"It's not illegal to purchase. It's not even illegal to take in large
quantities. It's just dangerous and foolish and that is what is
scaring everybody," said Dr. Charles Nozicka, director of pediatric
emergency medicine at St. Alexius Medical Center in Hoffman Estates,
Ill.

Nozicka estimates he has seen about 30 cold medicine-related overdoses
in the last year.

While students have been guzzling cough syrup for years, this is a
relatively new phenomenon. Sweet syrups would contain ingredients that
cause vomiting before reaching doses large enough to hallucinate.
Tablets don't have that effect.

The key ingredient is DXM, a cough suppressant that replaced opiates
in the 1970s and can be found in more than 120 products, all safe when
used as directed. But taking DXM in large quantities can cause slurred
speech, tremors, seizures and even death.

Because the product is at every pharmacy, the dangers are easy to
dismiss, said experts.

While no national agency tracks fatalities, at least five have been
attributed to cold medicines during the last year, including one in
September at Illinois State University.

More indicative of a growing problem: U.S. poison-control centers
logged some 3,200 calls related to the substance in 2003-twice the
number as in 2001.

"It wasn't something we really noticed before 2001," said Dr. Michael
Wahl, medical director of the Illinois Poison Center.

To raise awareness, the Chicago office of the U.S. Drug Enforcement
Administration issued a parental advisory in early February, citing a
"recent escalation" in area DXM abuse.

In addition, the American Medical Association voted in December to
pursue national restrictions on the products.

Dr. Tim Erickson, director of clinical toxicology at the University of
Illinois Medical Center at Chicago, realized that this was quickly
becoming the drug of choice when he searched for Coricidin to bring to
a conference and found stores were cleaned out.

"The word is out," Erickson said. "It has totally permeated the
adolescent population-especially in the suburbs."

Mike, 17, first heard about DXM from friends at his northwest suburban
Chicago high school. Easy access was the main attraction, whose
parents brought him to St. Alexius after he had tremors, he explained.

"The main reason I did it every day is because it was just so
available," said the senior, who asked that his last name not be used.
"I didn't need a connection. ... I could steal it. I could get it for
free."

The problem remains stubbornly under the radar.

Most cases don't end up in an emergency room. Even if they do,
personnel don't regularly test for legal substances. Nor are they
required to report the abuse to any agency.

Because the effects of DXM appear similar to PCP, they are often
erroneously attributed to the white crystalline powder.

And while marijuana or club drugs like Ecstasy are still more popular,
those substances usually arouse parental suspicion. Cold products --
especially during the winter -- do not.

"Kids can abuse a long time before adults suspect a problem, said Dr.
Louis Kraus, director of child and adolescent psychiatry at Rush
University Medical Center, who brought the issue to the AMA conference
in December.

"Even physicians are basically in the dark about this ... but it's at
every high school on (Chicago's) North Shore," said Kraus, who has a
private practice in Deerfield, Ill.

"Most of the children I see are at a very high risk for abusing other
substances ... mostly because of the ease of access. They're also at
high risk ... for more significant morbidity.

"Those who don't use it know of its potential devastating effects and
the ones who do use it don't care. So consequently, they are at much
higher risk for self destructive and very damaging behaviors."

While St. Alexius patient Mike was no stranger to pharmaceuticals,
Coricidin quickly zoomed to the top of the list. At the lower doses,
he would experience a pleasant euphoria "like a good body buzz." Most
of the time, though, he would opt for about 20 of the red pills -- or
a few more than a box -- which delivered something far more "intense."

According to the package, the recommended dose is one every six hours,
but Mike turned to the Internet to learn how much to take for his
height and weight, as well as for ways to enhance the experience.

Despite using the drug every day for about five months, Mike said he
never OD'd.

"But I was shaking a lot ... and I was at the point where I was
stealing it all the time ... and trying to get away from the house
just to get some. My parents knew about a lot of stuff, but they were
pretty clueless about this."

Eventually, his grades dropped from Bs and Cs to Ds and Fs. and his
parents "put two and two together" and brought him to Alexian Brothers
Behavioral Health Center, as well as Hazelden Clinic in near St. Paul,
Minn., for substance abuse treatment.

After three relapses, he said he has been clean for two months and
back at his high school, where he's just trying to get through his
senior year. Most of his pals are still using, so staying with his old
crowd would be "poison," he said. "I just couldn't do it."

Still, even after intensive therapy, he's at a loss to explain the
motivation. "It was kind of like something that happened. You hang out
with your friends. Someone says `You gotta try this' and it's just a
cool thing to do. And it's just so easy."

Coricidin's manufacturer, Schering-Plough HealthCare Products, has
stepped up efforts in recent months, including working with national
retailers and anti-drug organizations, according to Mary Fran Faraji,
spokeswoman for the New Jersey-based drugmaker. Last month, Walgreens
nationwide began limiting the sale of Coricidin HBP to three packages,
with other chains-such as Osco and Dominick's-following suit. They
leave it to the discretion of store managers whether to clamp down
further.

However, balancing the accessibility for the drug -- marketed to those
with high-blood pressure -- with restricting unauthorized use is a
continual challenge, said Carol Hively of Walgreens. The pharmacy has
shorter hours than the retail operation, creating potential problems
for consumers who genuinely need the drug, she said.

"It's a joke," Kraus said. "Kids who are shoplifting don't care about
how much they can buy. Until it's behind the counter, we're going to
continue to have an increasing problem."