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Medicine Cabinet Hazards: Your Teens Could Be at Risk

You have a cough or cold, and all you want is relief from the annoying symptoms. You stop at the store for an over-the-counter remedy, and the cashier asks you to produce a driver’s license. For cough medicine? For real?

Florida became the 10th state in the nation to ban the sale of dextromethorphan to minors with a new law that went into effect in January. The effort is aimed at reducing the number of kids who get high on the drug, contained in more than 100 cough and cold relief products in the U.S. That means that many Florida stores may ask consumers for identification when purchasing these products. And, although not required to do so, some stores may even start keeping these remedies behind the pharmacy counter, as they already must do with pseudoephedrine, another over-the-counter drug subject to abuse.

Considering these steps, parents may want to ask themselves if they, too, are doing enough at home to restrict kids’ access to this and other potentially dangerous medicines.

The Problem: Easy Accessibility

Kids who want to experiment with substances don’t have to get them from a dealer. More than 40 percent of teens who admit to abusing or misusing drugs say they got them from their home medicine cabinet, according to a survey by the National Institute on Drug Abuse [1].

The easy accessibility allows young people to start early. For example, eighth graders who admitted abusing drugs reported a 61 percent increase in the misuse of over-the-counter cough medicine last year, according to the NIDA survey [2].

“We do see side effects from cough and cold preparations that are widely available over the counter,” said Fernando Mendoza, M.D. [3], medical director of the emergency department at Baptist Children’s Hospital [4].  “Pre-teens are experimenting more often with risky behaviors.”

It’s a reality that can be hard for some families to accept. The same parents who were once so vigilant about keeping medicines out of reach of toddlers often relax as kids get older and accidental ingestion is no longer a threat.

“Don’t let your guard down just because you are past the toddler stage,” Dr. Mendoza advised. “Your children explored when they were small, and they continue to explore as they get older. Pre-teens and adolescents are curious by nature — whether it is about alcohol, drugs, vaping or medicines we have at home.”

Cough Medicine Specifics

Although the new Florida law restricts the sale of dextromethorphan, also known as DXM, the drug is not banned. And that means families will continue to have it in their medicine cabinets. In fact, most families probably have some products containing DXM at home right now, considering it is the most widely used cough suppressant in the United States, according to the Consumer Healthcare Products Association [5].  Dextromethorphan can be found in Robitussin, Dimetapp, Dayquil, Nyquil, Triaminic, Vicks Formula 44, Comtrex, Contact, Theraflu, Mucinex, Pediacare — and many others. It is in not only in cough syrups and cold liquids, but also in tablets and gel-caps.

Approved by the Food and Drug Administration [6] in the 1950s, DMX is synthetic substance that is chemically related to codeine. It works by lowering the cough reflex threshold in the brain. The drug is considered safe at recommended doses, but preteens and teens have been known to consume hundreds of times the recommended dose in search of a high.

Those who have abused dextromethorphan describe different “plateaus” ranging from mild distortions of their surroundings, to visual hallucinations and “out of-body” dissociative sensations. Side effects include vomiting, dizziness, blurred vision, slurred speech, loss of physical coordination and more. DXM can cause heart or nervous system damage, according to the Florida Poison Control Center [7]. The effects worsen as the dose increases. The danger also increases if the product consumed is a multi-symptom remedy that contains additional active ingredients, or if it is combined with alcohol.

An Over-Reliance on Cough and Cold Medicines

Many adolescents try DXM because they assume — incorrectly — that even at high doses it still must be safer than illicit drugs. And because the drug is so common, parents also have a tendency to underestimate it, according to experts at NIDA [8] and other organizations [9].

“Just because it is easily available does not mean it is safe,” Dr. Mendoza said.

Some health advocates [10] and medical experts [11] have questioned America’s reliance on cough and cold medicines, even when there is a legitimate illness. “We have to remember that cough and cold preparations are meant to treat the symptoms — not the cause,” Dr. Mendoza said.

Side Effects and Age Restrictions

Due to potential side effects, cough and cold medicines are not recommended for children under 4 by the FDA and the American Academy of Pediatrics [12], and the doctors’ organization is considering raising the recommendation against their use to children under age 6, Dr. Mendoza said.

Parents should always keep watch and seek advice from their doctor if cough or cold symptoms worsen or if there is any sign of difficulty breathing, dehydration or persistent high fevers, Dr. Mendoza said. But if it is just a typical cold, in most cases the symptoms will resolve themselves [13] with a little time and some rest, he said.

“Our expectations for quick resolutions to these viral illnesses has to be tempered by the reality that sometimes all we can do is let them run their course,” Dr. Mendoza said. “Often, home remedies, such as using honey in older children for cough, can be surprisingly effective, as was proven in a recent study.”

Instead, in hopes of feeling better or of helping our children feel better, we often reach for products such as those containing DXM. And once the illness passes, we store the leftovers for the next time, which opens the door to a whole new problem.

“Parents may be influenced by direct-to-consumer advertising, which can depict these over-the-counter medications as effective and otherwise harmless,” he said. “But the desire for symptomatic relief can come at a cost, with unexpected side effects.”