They're candy coated, and the kids call them "Skittles," Triple-C's, and Dex.
Nick first heard about them when he was 13. He worried that people in school were getting wise to his smoking and selling pot, so he tried a few Triple-C's. Not only did he love the multifaceted high, but even better than that, they're perfectly legal - nothing more than Coricidin Cough & Cold tablets available at any drugstore.
Nick gave up his illicit drugs for the ease of a legal cough suppressant. But he still ended up a serious addict, almost killing himself twice by overdosing.
Over the past several years, drug counselors around the country have noticed a significant hike in the abuse of the cough suppressant dextromethorphan (DXM). Poison-control centers have also reported a doubling of the number of calls since 2001. But because it's a legal drug, it's not tracked by any of the major groups that follow teen drug use. So it's difficult to gauge how just how widespread the problem is.
And because it's been around for decades, some experts worry that the levels of abuse may be exaggerated by the media, only tipping off more kids to a new legal high.
But as far as Nick is concerned, DXM abuse is already out of hand. "If the adults are just figuring it out, all the kids already know about it," he says, now 17 and clean and sober for two years.
What little is known about the increasing levels of abuse of DXM has already prompted some adults to take action. Legislation has been introduced in three states - New York, New Jersey, and California - that would restrict the sale of products with DXM to minors. Parent groups have called on pharmacies to keep Robitussin and Coricidin behind the counter, and some local stores have complied.
And the trade group that represents the manufacturers of the over-the-counter drugs, the Consumer Health Care Products Association, has started an educational campaign, sending out thousands of brochures that warn parents and educators about the dangers of having too many cold remedies stocked in the medicine cabinet. It's also working in conjunction with the Partnership for a Drug-Free America, which is now conducting its first study to gauge the prevalence of DXM abuse.
Right now, it believes that abuse levels are fairly low, about 2 to 3 percent of the population. One possible factor: At least with cough syrup, robo-tripping - as it's sometimes called - is not necessarily a pleasant way to get high.
"Robo-tripping produces very, very severe nausea prior to the opiatelike high, so there's a natural barrier against extended use in large segments of the population," says Tom Hedrick, director and founding member of the Partnership.
Downing a bottle of cough syrup may be rough on the stomach, but kids have learned that popping a handful of Coricidin tablets is far less disruptive to the digestive tract. And it's the abuse of the so-called Triple-C's that appears to be on the rise. The Community Epidemiology Working Group (CEWG) of the National Institutes of Health reported increases in Triple-C abuse in Texas, Georgia, Michigan, and Minnesota. For instance, in the Minneapolis-St. Paul area, calls to poison centers about DXM grew from 73 in 2001 to 111 in 2003. Sixty percent were related to Coricidin and 7 percent to Robitussin.
At Hazelden, the renowned drug education and rehabilitation centers, Carol Falkowski estimates that half of the 600 children treated in its Center for Youth and Families in Plymouth, Minn., this year had at least tried the drug.
David Ettesvold, a drug-prevention counselor north of the Twin Cities, estimates that about 30 percent of the 200 kids he saw this past year had tried DXM. For 10 percent of them, including Nick, it became their drug of choice. Five years ago, Mr. Ettesvold says, it hardly showed up at all - maybe half a percent even mentioned it.
"There's potential for this to become epidemic, and it's extremely dangerous," says Ettesvold. "I don't think the kids know exactly what type to take, and if they experiment with it, they could overdose quite easily."
There's a thriving subculture on the Internet that offers advice on which cough suppressants produce the best high and how to take them. Some even contain instructions on how to extract the DXM from the cough syrup. The Partnership and other drug-education groups have countered with sites that explain the dangers of abuse. (See graphic, left.) But drug educators also find themselves in a bind with DXM. They don't want the kids to learn how to use it to get high, because it's so easy to get. (Shoplifting is even easier than buying it, according to Nick, who didn't want his last name used.) But if kids don't know which Coricidin or Robitussin to take, they could easily cause themselves severe physical damage. That's in part because many products with DXM in them are multisystem cold remedies. To ingest enough DXM to get high, a child may end up taking an overdose of Tylenol.
"That's very damaging to the liver, and it can lead to death," says Joel Giles, a professor a the University of Colorado School of Pharmacy in Denver.
A handful of deaths attributed to overdoses that are connected with DXM have been reported in the past few months. The manufacturers of the cold and cough remedies maintain that DXM is extremely safe and effective, when taken as directed. And it's not addictive, either, when taken as directed.
"But we need to build an awareness among kids of the potential harm that taking extreme amounts of these products can cause," says Virginia Cox of the Consumer Health Care Products Association in Washington.
Nick agrees with that and does what he can to spread the word about how destructive his own addiction became. But he also believes that DXM products should be regulated and kept behind the counter. That's a move the manufacturers are balking at, in part because more than 250 products contain DXM.
But Nick is adamant. "They're just too easy to get," he says. "It's well worth the effort to put it behind the counter."