Vigilance Counts with Dextromethorphan

Dextromethorphan is an older drug, originally approved in 1958 as a nonprescription cough medication. Over the years, manufacturers have introduced many new formulations, and it’s a popular product in the over-the-counter (OTC) aisles. Unfortunately, recreational dextromethorphan abuse tends to wax and wane, with increasing abuse noted beginning in the 1980s. Dextromethorphan’s accessibility is one reason why teenagers tend to abuse it.

The journal Clinical Toxicology has published an analysis of trends in dextromethorphan cough and cold product abuse exposures. The researchers, employees of the FDA, indicate that dextromethorphan abuse rates peaked in 2006. They subsequently declined among adolescents between the ages of 14 and 17 years.

The FDA published a “Talk Paper” in 2005 to raise awareness of the potential for dextromethorphan abuse. Many pharmacies have also restricted sales to minors. Other organizations across the nation have taken steps to increase awareness and address the problem head on.

This new study used data gathered from the 55 poison control centers in the United States and its territories. Of note, poison control centers categorize their data using generic codes. A full 30 generic codes describe cough and cold preparations that contain dextromethorphan. The study period was 2000 to 2015, and during this time, poison control centers fielded 72,260 abuse calls related to dextromethorphan. Approximately 77% of these calls were single substance exposures.

Calls related to dextromethorphan overdose tripled between 2000 and 2006. Beginning in 2007, the number of calls remained fairly stable. Individuals aged 14 to 17 years of age were most likely to abuse dextromethorphan; however, in this age group, the annual call rate decreased 20% between 2006 and 2015.

The authors note that they cannot establish a causal relationship, but the decline in annual dextromethorphan abuse calls in adolescents occured during the period of intense public health efforts designed to curtail OTC medication abuse. Some of those efforts focused specifically on dextromethorphan and this particular age group.

Most individuals reported toxicities that were moderate in nature and were treated with some form of medical treatment. Approximately 700 calls were associated with major affects that were life-threatening or resulted in long-term disability. Over 16 years, 8 deaths were associated with dextromethorphan abuse. The authors note that some autopsies may miss or failed to report dextromethorphan overdose, as reporting is voluntary.

Good news is buffered with some bad news. Although rates have plateaued among adolescents, young adults tend to be using dextromethorphan recreationally more often. The authors indicate that healthcare providers need to monitor continuously, and maintain their prevention efforts.

Reference

Karami S, Major JM, Calderon S, McAninch JK. Trends in dextromethorphan cough and cold products: 2000-2015 National Poison Data System intentional abuse exposure calls. Clin Toxicol (Phila). 2018;56(7):656-663.