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Abuse of DXM prompts state to lay down law on sale of cough, cold remedies to minors

You may have a bottle of Robitussin cough syrup in your medicine cabinet, and perhaps a box of Coricidin cough and cold tablets. Some Sudafed, too?

These and other popular cold remedies available over the counter no longer will be sold to minors after Gov. Andrew M. Cuomo signs legislation, perhaps as soon as today. The restrictions would take effect in late December.

The new law prohibits the sale to minors of medications that contain dextromethorphan, or DXM, an ingredient that federal officials warn is being abused by many young people for its high, which is described as similar to cocaine. Many addiction counselors say DXM is the next crystal meth.

More than 100 cold medications – including Robitussin, Coricidin HPB Cough & Cold and Alka-Seltzer Plus Cold & Cough – are affected by the legislation.

“It’s a drug of abuse that’s not necessarily on everyone’s radar,” said Nicholas F. Gazzoli, senior counselor at Horizon Health Services. “It mimics the effects of cocaine. Its extreme physiological effects include sweats, high fever, nausea, anxiousness, heart palpitations.

“It’s almost the same cycle of abuse as heroin addicts: When they stop using, they go through the same withdrawal.”

Research suggests that 15- to 19-year-olds – particularly males – are the most frequent abusers of DXM.

“They can get it out of their medicine cabinet at home, purchase it themselves or shoplift it,” said Kathleen Murphy Castillo, a licensed social worker. She believes that the new law needs more teeth.

Local case histories paint a disturbing picture, Gazzoli said.

Those who take the medications to get high often don’t expect the hallucinations, confusion, blurred vision and loss of motor control they also may experience.

The drug’s effects are believed to have contributed to the death of Elisa N. Mannella, who was 29 when she was killed in a car accident on Genesee Street in Cheektowaga.

In February 2011, Mannella was a passenger in a vehicle driven by her fiancé, Phillip G. Kane. Reports indicated that Kane, also 29, lost control of the car and abruptly turned into oncoming traffic, crashing into a pickup truck. Mannella was killed upon impact.

Kane, who was in serious condition after the crash, was charged with criminally negligent manslaughter after police said tests confirmed the presence of small amounts of drugs in his body, including cocaine. Kane was sentenced to six months in jail and five years’ probation.

“They were involved in all kinds of prescription drugs,” said Sandy Mannella-Schwendler, Elisa’s mother. “Their addiction was OxyContin, and they were also into Suboxone. They both had tried rehab but kept on getting thrown out.”

Mannella-Schwendler recalled what she saw after the accident when she visited the apartment her daughter shared with Kane in Depew.

“I was knee-deep in cough medicine bottles,” she said. “There were hundreds of bottles. The cough medicine was just something to get them through when they had no money for drugs at all. They’d take anything because they were always in withdrawal.”

Mannella-Schwendler is still grieving today. She cares for the couple’s 6-year-old son, Brandon Kane, a first-grader at SS. Peter & Paul School in Williamsville.

“She was my only child and the love of my life,” Mannella-Schwendler said. “That’s why I’m glad I have her son, because he’s very much like her.”

State Sen. Mark J. Grisanti, R-Buffalo, in January introduced the legislation to ban the sale of the cough medicines with DXM, and it was delivered to Cuomo on Sept. 17. Stores that violate the law will be subject to a fine of $250.

The Consumer Healthcare Products Association, a trade association representing the nation’s leading manufacturers of over-the-counter medications, released a statement in May advocating the legislation.

It described DXM as “an effective, non-narcotic cough suppressant that works by raising the coughing threshold in the brain. … Unfortunately, a small number of teenagers intentionally abuse excessive amounts of medicines containing DXM to get high.”

Critics of the new law fear that it may not be strong enough to curb the abuse by teens and adults who take the medications in large doses for the high.

According to the Community Anti-Drug Coalitions of America, about 5 percent of teenagers report having intentionally taken large amounts of cough medicine containing DXM for a recreational “high.”

Teens are attracted to DXM because of its accessibility, said Castillo, the social worker who would like to see even more restrictions in the law.

“First of all, the medication needs to be under the counter and out of the reach of the purchaser so it cannot be stolen,” Castillo said. “The amount purchased must also be limited, as some stores are already doing.”

Locally, stores including the Rite Aid and Walmart chains already have policies that require identification for purchase of medications containing DXM.

DXM is not new. It was first approved as a cough suppressant by the U.S. Food and Drug Administration in the 1950s.

“It’s been around for years,” said Mark W. Gunther, assistant vice president of behavioral health at Erie County Medical Center. “It’s one of the active ingredients in Robitussin.” He said he hasn’t seen a marked increase in patients seeking emergency care for overdoses of DXM.

“It’s not like we’ve seen a surge in that type of drug abuse,” he said. “It can be a difficult thing to withdraw from. Some people abuse it to the point of becoming psychotic so they sort of lose touch with reality.”

Gazzoli, who also is an acting therapist at Daemen College, said DXM is at the beginning of its evolution.

“There is an opiate epidemic going on right now,” he said. “You want to hope that DXM stays at 5 percent usage among teens because it is really scary.”


Adults only: Some of the cough and cold medications with DXM that will be restricted under new law:

• Cheracol D Cough

Lee Pharma-ceutical

• Coricidin HBP Cough & Cold

Schering-Plough HealthCare

• Alka-Seltzer Plus Cold & Cough

Bayer HealthCare

• Comtrex Day/Night Cough & Cold Maximum Strength

Novartis Consumer Health

• Delsym Extended-Release Suspension

Adams Respiratory Therapeutics

• Dimetapp Cold & Cough DM Elixir (Children’s Formula)

Wyeth Consumer Healthcare

• Mucinex DM

Adams Respiratory Therapeutics

• PediaCare Children’s Multi-Symptom Cold Liquid


• Robitussin Cough DM Liquid

Wyeth Consumer Healthcare

• Sudafed Multi-Symptom Cold & Cough • Liquid Caps


Source: Product websites