Thursday, December 21, 2006

Reports on teenage drug use should include life-saving information

The latest federal report on adolescent drug use (Monitoring the Future) was released today. Generally fewer teenagers are using drugs of abuse, the University of Michigan researchers report. This is good news. But the anti-drug effort needs bad news or new dangers. This year’s “new” danger has been the methamphetamine “epidemic,” lamented by Attorney General Alberto Gonzales at the press conference at the National Press Club. However, the data shows that methamphetamine use among teenagers has actually declined dramatically since 1999.

For 2007, the danger du jour will be dextromethorphan (DXM), the common cough suppressant in cough syrup. The lead in today’s AP story on the Monitoring the Future study says teens “are turning to cough syrup.” The story should mention that when DXM is taken with acetaminophen, it is that common over-the-counter drug that can be lethal!

Earlier this month, the Los Angeles Times had a major story, “Teens try cough medicine for a high,” (Dec. 5, 2006). The official press release on the teenage drug use study did not mention dextromethorphan until page 5. However, the rates of annual prevalence among teenagers of using cough or cold medicine to get high are much greater than most common illegal drugs – 4 percent for 8th graders, 5 percent for 10th graders and 7 percent for 12th graders.

What are the dangers?

A typical adult dose of dextromethorphan in two tablespoons of cough syrup or a pill is 20-30 milligrams, or about .4mg/kg of body weight.

Dextromethorphan intoxication varies by dose. A moderate high is achieved at 2.5 to 7.5 mg/kg, or between 5 and 15 times the usual therapeutic dose, which can yield closed eye hallucinations or a “shamanic feel,” but cognitive function is severely disrupted and reaction time is delayed. Mood can range from mania to panic. The most intense highs are achieved at 15 mg/kg or about thirty times the usual dose and are intensely mentally disorienting with an out of body experience. See Erowid for life-saving information.

Aside from the danger of serious mentally disorienting effects of high dose dextromethorphan intoxication, another of its most significant dangers comes from the other drugs that are often present in cough and cold preparations.

Ddextromethorphan is often packaged with acetaminophen, for example, in Nyquil® Cold/Flu.
Used to relieve pain and fever, acetaminophen, is commonly used at dosages between 325 and 650 mg. But the hepatoxicity – liver damage – from acetaminophen can be triggered by an acute dose of 7 grams – ten to twenty times the usual dose.

Teenagers who use DXM products that contain acetaminophen to get high are in severe danger.

The Los Angeles Times story on teenagers use of cough syrup concluded with the story of the death of teenager Lucia Martino of Anaheim, CA from liver failure after swallowing 20 Coricidin pills. But it did not mention the danger from acetaminophen. (Some Coricidin preparations include DXM and acetaminophen, some include no DXM, and others with DXM that do not include acetaminophen).

News coverage and government spokespersons must mention that one of the dangers from this kind of drug use is related to the overdose of common over-the-counter drugs such as acetaminophen.

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