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Abuse of cough and cold medications revisited: Let us step up our efforts preventing abuse

Updated on February 3, 2014

Although there are excellent hubs on use and abuse of cough and cold remedies published during past four years, which I have listed below, due to rising trend of abuse of some over-the counter products, I decided to publish this hub with new revelations.

Non-medical use of cough and cold medications by school children in the grades 7 - 12 has increased from 2009 - 2013 period. This was revealed by the latest annual survey report named as " 2013 Ontario Student Drug Use and Health Survey" [OSDUHS] published by the CAMH. According to the report, the increase is by 2.5%. In 2009 the figure was 7.2% while it sgot up to 9.7 in 2013, just a matter of four years. In terms of numbers, it is huge; 94,100 [estimated based on the sample figures]. This is just at least once use during a period of 12 months.

However, the estimated number of students who reported that they consumed six or more times during the period was about 20,000!

Remember, these values are estimated based on the responses from the students who were at the school at the time of the survey. The students who would likely to addicted to those are likely to be out of the school. Is n't it?

Percentages of Ontario middle and high school students' use of cough and cold medications " to get high" during 12 month period

use of cough and cold medications "to get high" during past 12 months
at least once
six or more times
Source: Ontario Student Drug Use and Health Survey 2013 CAMH

Cough and cold medications for kids under 2 years: No More

we must be aware that the FDA [ the US Food and Drug Administration Authority] has made public that common over-the counter medications are no more for the children aged under two years.

This is because of seriousness of its side effects. They include rapid heart rates, decreased levels of consciousness, convulsions, and even sometimes death.

We can easily identify these products. When you are going to buy these products, look for the following terms; nasal decongestants, cough suppressants, expectorants, and antihistamines. If you read these terms in the labels, this warning is for these products.

moreover, FDA clearly mentions that they do not have any data to prove that these products are effective for kids under two years. This does not whatsoever mean that these products are recommended for children and adults above two years of age.

And also, be aware that in 2007, the Consumer Healthcare Products Association voluntarily withdrew their Over-the counter cough and cold medicines marketed for infants and children under two years according to the FDA.

Why teens abuse these products?

These products contain a chemical called, Dextromethorphan, in short either DXM or DM, which gives a "high" feeling with more than recommended amounts. Since it is legal, cheap, available in household, they will go for it.

What are the common products?

There are more than 100 commercial products, some of them you may already have even now at your home. Some of these are Dimetapp DM, Nyquil, Robitussin, Coricidin, Delsym, Zicam, Theraflu, and Vick’s Formula 44. It is available at various packaging forms such as syrups, capsules, lozenges, tablets, and gels.

How big is the business?

This is a multi-million dollar business. According the FDA statistics, in 2009 alone in the US, around 12 million single-ingredient products of DXM [86% as oral liquids], and around 140 million combination products [60% as oral liquids] of DXM have been sold as over-the-counter sales. The corresponding figures in the previous year [2008] were around 10 million and 130 million.

The most common combination preparation contains acetaminophen [ The common brand name is Tylenol] in addition to the DXM. in 2009, as much as 95 million bottles have been bought by US clients.

In spite of the increase in OTC sales, prescription of DXM products shows downward trend from 2000 - 2009.

How effective are these medications

some examples are as follows;

  • American College of Chest Physicians, in 2006, recommended not to take DXM for upper respiratory tract infections since it has only a very small effect.

Deaths due to DXM

Several deaths have been reported due to ingestion of cough and cold medications containing DXM.

According to the US FDA Adverse Events Reporting System [AERS], when two brand names [Coricidin and Delsym] were considered, in 2009, 246 cases of Coricidin abuse and 34 cases of Delsym abuse has been reported. Of Coricidin cases, 50% were hospitalised resulting in 8 deaths. Whereas in Delsym abuses, 16 people were hospitalised resulting in 4 deaths.

In 2008, hospitals reported an average of 2.1 emergency room visits per 10,000 bottles of DXM products. This was a significant increase when compared to 2004 abuse ratio, which was just 1.5.

Are DXM containing cough and cold medications effective?

See results


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