Cases of dextromethorphan abuse reported to the California Poison Control System increased 10-fold in all age groups–and increased 15-fold in adolescents–between 1999 and 2004, said Jodi K. Bryner, Pharm.D., of the University of California, San Francisco, and her associates.
A similar national trend was noted during the same time frame in two databases that track nationwide drug abuse, the researchers reported (Arch. Pediatr. Adolesc. Med. 2006;160:1217–22).
Dextromethorphan is increasingly popular among adolescents because it is easily–and legally–available in over-the-counter cough and cold remedies, is relatively inexpensive, and lacks the stigma of drug abuse.
Dr. Bryner and her associates examined trends in dextromethorphan abuse in a review of all 1,382 cases reported to California's poison control system during the 6-year period. A total of 75% of all cases occurred in adolescents, and the abuse peaked at age 15–16 years.
Most cases resulted in minor (46%) or moderate (42%) outcomes. Minor outcomes included minimal symptoms such as drowsiness, GI effects, or sinus tachycardia, which resolved rapidly. Moderate outcomes included more pronounced, prolonged, or systemic symptoms such as agitation, disorientation, hallucinations, brief hypotension, and a single brief seizure.
Major outcomes such as life-threatening symptoms or those that caused significant residual disability occurred in seven cases and included respiratory depression or aspiration requiring intubation, cardiovascular compromise, and prolonged or multiple seizures. There were no fatalities.
The extent of dextromethorphan abuse is likely far greater than that reported here, because often only the severest cases are called in to the poison control system and because laboratory testing for the drug is not routinely available in most hospitals, Dr. Bryner and her associates said.