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Dextromethorphan Abuse Among Youth
Recent letters to the Archives of Family Medicine have addressed the abuse potential and dangers of dextromethorphan (DM), a common ingredient in over-the-counter (OTC) medications.1-2 Abuse of DM among youth has been reported since the 1960s,3 and clinical reports continue to document this problem,4 but the prevalence of DM abuse is unclear. Family physicians may be interested in the results of a survey we administered (with active parental consent) to a sample of 376 in 4th- through 12th-grade students at 5 public schools (about 40% of all students) in Albuquerque, NM. The survey did not query personal use, but rather asked whether respondents knew of other students who used specific OTC medicines to "get high." Nine of the 16 OTC medications listed contain DM (Table 1). Muriatic acid and DM were also listed to discern whether young people were familiar with the ingredients independent of the OTCs that contain them. Two fictitious drug names (Supressin, Nalpar) were added to the list to detect false-positive response patterns. Sixty surveys were rejected based on the endorsement of 1 or both of the 2 false items, and 1 survey was rejected for reporting implausible demographics, leaving 315 valid surveys for analysis.
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Reported Abuse of Over-the-Counter Medications by Youth
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Over-the-counter drugs containing DM ranked significantly higher in selection than those without DM (t1,314 = 5.86; P<.001). Most frequently identified as an abused OTC (46.6% of high school students) was Nyquil (Proctor & Gamble, Cincinnati, Ohio) (containing both DM and alcohol), and 6 of the 7 OTC medications most frequently selected (>15%) contained DM. Reported abuse of DM increased with student age (r = 0.23, P<.01). Selection of DM and muriatic acid was relatively low (6.2% and 12.9%, respectively).
Consistent with our findings, laboratory investigations using adult humans indicate that DM produces subjective experiences that are very similar to the effects of other popular drugs of abuse (barbiturates, LSD, and PCP).5 Bem and Peck6 documented 64 spontaneous reports of DM dependence that are inconsistent with prior reports that have concluded that DM has no addictive properties. Other studies have found that DM can produce serious behavioral and central nervous system effects (including behavioral stereotypies, epileptic seizures, and death) that are related to the dose and frequency of administration.7 In patients with epilepsy, DM has been found to significantly increase the frequency of complex partial seizures at very low antitussive doses, further corroborating laboratory data.7-8 This evidence suggests that DM is an OTC drug with a more serious abuse potential than is generally realized or reported in the literature, and its accessibility may make it particularly attractive to youth.
W. Craig Noonan, PhD;
William R. Miller, PhD;
Dennis M. Feeney, PhD
Department of Psychology
The University of New Mexico
Albuquerque, NM 87131-1161
1. Cranston JW, Yoast R. Abuse of dextromethorphan. Arch Fam Med. 1999;8:99-100.
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2. McFee RB, Mofenson HC, Caraccio TR. Dextromethorphan: another "ecstasy"? Arch Fam Med. 2000;9:123.
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3. McCarthy JP. Some less familiar drugs of abuse. Med J Aust. 1971;20:1078-1081.
4. Murray S, Brewerton T. Abuse of over-the-counter dextromethorphan by teenagers. South Med J. 1993;86:1151-1153.
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5. Jasinski DR, Martin WR, Mansky PA. Progress Report on the Assessment of the Antagonists Nalbuphine and GPA-2087 for Abuse Potential and Studies of the Effects of Dextromethorphan in Man. Bethesda, Md; NIMH Addiction Research Center, Committee on Problems of Drug Dependence; 1971:143-178.
6. Bem JL, Peck R. Dextromethorphan: an overview of safety issues. Drug Saf. 1992;7:190-199.
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7. Fisher RS, Cysyk BJ, Lesser RP, Hart JL, Schwerdt O, Gordon B. Dextromethorphan for treatment of complex partial seizures. Neurology. 1990;40:547-549.
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8. Takazawa A, Anderson P, Abraham WC. Effects of dextromethorphan, a nonopioid antitussive, on development and expression of amygdaloid kindled seizures. Epilepsia. 1990;31:496-502.
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Arch Fam Med. 2000;9:791-792.
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