The abuse of dextromethorphan-based cough syrup: a pilot study of the community of Waynesboro, Pennsylvania

Adolescence, Fall, 1996 by Momodou N. Darboe, Gerald R. Keenan, Jr., Tamara K. Richards

INTRODUCTION

A recent study conducted by the University of Michigan's Institute for Social Research reported a significant drop in illegal drug abuse among high school seniors (United States Alcohol, Drug Abuse, and Mental Health Administration, 1991). Nevertheless, a recent national poll of U.S. citizens and parents reported ". . . drug use in general and teenagers' drug use in particular [as being] this nation's number one problem" (Eggert & Herting, 1991). The National Institute on Drug Abuse also has reported only a modest decline in drug use. However, ". . . health officials see a new and terrifying danger - teenagers who regularly abuse and combine many different drugs end up with shattered and impotent lives" (Downey, 1991).

A wide range of drugs are being used by the teenage population: 10-13% of students studied by Miller and Gold (1991) reported use of inhalants and, according to Eggert and Herting (1991), over 55% of high school students use illicit drugs. However, the most common drugs used are those easily obtained, typically from their own homes. They may include alcohol, codeine, marijuana, or inhalants such as paint or glue. "Hard" drugs, such as heroin, crack, and PCP were rarely used (Lewandowski & Westman, 1991).

Drugs are used (experimentally or habitually) for many reasons, the most common of which is to produce an immediate euphoric effect. Other common reasons reported by students include ". . . to make me more popular with my friends, so people would like me, because my parents used them, because someone else wanted me to, to make me feel more like an adult, because my friends use drugs, because it was a habit, and because I could make extra money selling them" (Novacek, Raskin, & Hogan, 1991). Novacek (1991) also discovered that ". . . the more reasons people have for using drugs and alcohol, the more frequently they use them".

An important consequence of teenage drug abuse is the increase in suicide rates: 28,100 suicides are reported per year among 15- to 24-year-olds (Downey, 1990-91). "All available evidence suggests substance abusers are at increased risk for suicide" (Downey, 1990-91). Drugs have been reported as the primary method used among adolescent suicide attempts. In addition, ". . . the suicide rate among alcoholics is an astonishing 58 times higher than that of the general population with approximately one out of every three suicides in the population alcohol-related" (Downey, 1990-91).

Studies also show abuse of licit drugs to be a precursor of illicit drug use. "History of solvent use may indicate individuals at high risk for intravenous drug abuse [IVDA] and youths who have used solvents should be considered at high risk for severe drug abuse, including IVDA" (Dinwiddie, 1991)

The improper use of drugs for nonmedical purposes not only is damaging to individual health, but is harmful to the society in many profound ways. The drugs in question may be classified in two broad categories: (1) licit psychoactive drugs such as caffeine, alcohol, and nicotine, as well as over-the-counter preparations, including pain killers and cold medications; and (2) illicit psychoactive drugs such as cocaine, heroin, and marijuana. The forms of abuse include experimental use (a short-term trial); social recreational use (occasional indulgence among friends to share an experience); circumstantial (situational use in specific stressful circumstances); intensified use (long-term, regular, and habitual use); and compulsive use (frequent use of the drug to the point where an individual becomes physiologically and/or psychologically dependent) (Jones, Gallaher, Bernard, & McFalls, 1988).

Drug abuse, both illicit and licit, is an ongoing serious national problem. To date, neither prevailing social policies, general law enforcement apparatus (at national and local levels), nor community efforts have been able to contain the problem. Like a multiheaded hydra, it regenerates itself in various new forms. The paper focuses on the community of Waynesboro and addresses the question of whether abuse of dextromethorphan-based cough syrup is sporadic and occurs in only isolated cases, or has become a new form of this national social problem.

Background

In August 1990, the Food and Drug Administration's Drug Advisory Committee held a hearing concerning the abuse of dextromethorphan (DM)-based cough syrup. The hearing was in response to the committee's inquiry into the alleged abuse of the drug, a similar hearing by the Pennsylvania Drug, Device, and Cosmetic Board earlier that year, and various press reports. Also, several states had reported abuses by teenagers of cough products containing dextromethorphan hybromide, including: Alabama, California, Colorado, Connecticut, Florida, Indiana, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Utah, Virginia, and Washington (Andel, Szucs, & Rosenburg, 1991; Krenzelok, 1990). Further, perhaps responding to the abuse potential of DM-based cough syrup, the South Central Pennsylvania Pharmacists Association petitioned the Pennsylvania Drug, Device, and Cosmetic Board to place the drugs in Schedule V, thereby limiting the products to pharmacy or physician dispensing and to patients over 18 years of age (Andel et al., 1991).