Pubdate: Tue, 05 Dec 2006
Source: San Jose Mercury News (CA)
Copyright: 2006 San Jose Mercury News
Author: Barbara Feder Ostrov, Mercury News


Kids call it robo-tripping or skittling -- downing high doses of 
cough syrup or pills to get high off dextromethorphan, a cough 
suppressant commonly found in over-the-counter medicines.

A new study concludes that robo-tripping is sharply on the rise among 
teenagers -- a finding worrisome to any parent who's wondered about 
that bottle (or two or three) of Robitussin or Coricidin in their 
kid's medicine cabinet.

Calls to the California Poison Control System's 24-hour hotline 
involving teen abuse of the ingredient ballooned by 15 times over six 
years, from 23 in 1999 to 375 in 2004. Although they represent a tiny 
fraction of all calls made to the hotline -- fewer than two in 1,000 
- -- the uptick worries Ilene B. Anderson, a senior toxicologist for 
the system and senior author of the study.

"We have a product that causes you to get high, that's inexpensive, 
that's readily available, and there's a false perception that because 
it's over the counter, it's safe," Anderson said. "It lacks the 
stigma of cocaine or heroin, and it's easy to fool your parents about it."

Federal Studies

The study's results echo those of national studies released in recent 
years by the federal government. Ironically, the rise of 
robo-tripping appears to coincide with the decline in popularity of 
LSD, the club drug ecstasy, and GHB, known as the date rape drug.

In large doses, dextromethorphan can cause euphoria and 
hallucinations, part of the "high" teens describe on Internet sites 
promoting the drug known as DXM, CCC, Triple C, Skittles and Robo. It 
also can result in seizures, vomiting, dangerous spikes in blood 
pressure or body temperature and psychosis, and fatal overdoses have 
been reported.

The drug is particularly dangerous when used along with 
antidepressants, such as Prozac or Zoloft, or the club drug ecstasy, 
Anderson said. And teens who abuse cold medications containing 
acetaminophen, or Tylenol, risk permanent liver damage.

Anderson blamed part of the increase on Internet sites that promote 
abuse of the drug and offer detailed information on how many pills or 
swigs are needed to get high. A pure powder form of dextromethorphan, 
used by pharmaceutical manufacturers and researchers, easily can be 
purchased online. Rap songs, such as Three 6 Mafia's "Sippin' On Some 
Syrup," also have popularized robo-tripping. Even "South Park" has 
featured a robo-tripping story line.

"It's no longer just word of mouth," Anderson said.

Poison Control Hotline

The study was carried out by researchers at the University of 
California-San Francisco's school of pharmacy, which operates the 
poison control hotline. They found that nearly three-quarters of all 
calls regarding dextromethorphan involved youths aged 9 to 17, with 
most cases of frequent abuse in 15- and 16-year-olds.

The most-abused medication in this age group was Coricidin HPB Cough 
& Cold Tablets, which contain a relatively high dose of the cough 
suppressant. Those brightly colored pills have garnered the street 
name Skittles for the candy they resemble. The next most popular were 
Robitussin products containing the cough suppressant -- hence the 
street name Robo.

Brenda Stern, who oversees drug abuse treatment programs for a 
counseling agency serving the Palo Alto school district, says teens 
who robo-trip are also abusing other drugs, an observation borne out 
by the California study. She said about 10 percent to 15 percent of 
teens referred to her program have abused cold medicines, which still 
lag behind alcohol, marijuana and cocaine as favored drugs of abuse 
among the students she sees.

The first reports of dextromethorphan abuse surfaced in the 1960s, 
when it was the sole ingredient in an over-the-county cold remedy 
called Romilar. It was voluntarily removed from the market.

In the mid-90s, makers of products containing dextromethorphan 
started hearing new reports of abuse, said Elizabeth Assey, 
spokeswoman for the Consumer Health Products Association, an industry 
group. The group has since worked with the Partnership for a 
Drug-Free America on a campaign to make the public aware of the problem.

Adults in the Dark

"There really is a disconnect where teens know about the potential 
for abuse, and parents don't," Assey said. "This report really 
underscores the need for more education and awareness about this trend."

Some supermarkets and drug stores have resorted to storing certain 
types of dextromethorphan products behind the counter, as they do 
products containing the stimulant pseudoephedrine. But so many 
products contain the cough suppressant that it's difficult to 
restrict them all.

The study was published Monday in the December issue of Archives of 
Pediatrics and Adolescent Medicine.
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