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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."
In the Chicago area, the problem first surfaced in April 1999, when a Naperville North High School student was taken to Edwards Hospital after becoming ill in class.
At the time, a school official told the Tribune the boy was one of 15 students treated at the hospital that semester for abusing antihistamines and cold drugs.
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."
(c) 2004, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.