COUGHING SYRUPS FOR RECREATIONAL PURPOSES….SHOULD BE SOLD AS OVER THE COUNTER MEDICINE

WHAT IS OVER THE COUNTER MEDICATION?
Over the counter (OTC) medication are those medicines which a person can get without prescription with the perception that it is safe to use for common health issues like colds, pain, allergies and digestive problems.

ARE OVER THE COUNTER MEDICATIONS REALLY SAFE?
OTC medicine is entirely safe when taken in recommended doses or as directed but it is not safe at all when taken in more than recommended doses which means if it is taken in high doses or taken with wrong combination or in wrong manner. Abuse of intoxicating substances especially of legal OTC medicine is one of the greatest risk factors among the adolescents and young adults due to its easily accessibility and lack of monitoring policy which might be result into over dose, organ damage, addiction problem and early death.

OTC DRUG WHICH CAN BE ABUSED
OTC medicine that can be abused which are as follow,
• Cold and cough syrups
• Diet aid
• Analgesics or pain reliever
• Motion sickness aid
• Laxatives
• Caffeine

REASON OF ABUSE FOR OTC MEDICINE
OTC drugs are abused due to easy accessibility, perception of safety, self-medication, curiosity, peer pressure and being low in price. It is commonly used in large amount intentionally for non-medical purposes or simply to achieve high.

WHY COUGH AND COLD SYRUPS ARE MISUSED?
Amongst all these medications, cough, flu and cold syrups are misused for recreational purpose which means something taken for pleasure. In simple words, we can say that it is taken voluntarily without any medical reason to get altered mental state or to achieve euphoria or hallucinations. These syrups are abused especially by youth and can be gate way for abusing more harder drug or substance like codeine and alcohol in future.

WHAT IS DEXTROMETHORPHAN (DXM)?
DXM is found in many OTC cold and flu medicines and in cough syrups. Dextromethorphan is the d-isomer of codeine analog of levorphanol. It is of synthetic origin and belongs to morphine. It is used as anti-tussive agent and controls cough by depressing the cough center in the medulla. However, it coughs suppression potency is approximately one-half that of codeine. It devoid of analgesic properties. It is prescribed for dry cough. Psychoactive properties (a substance which affect brain works and produce alterations in mood, feeling, thinking, behavior and awareness) of DXM are very mild in recommended doses but in high doses, it produces state of intense excitement (euphoria) and hallucinations. The effects of DXM are dose dependent which is listed as below,

DXM DOSE PLATEAU
Dissociative and hallucinations effects of DXM is different for different dose ranges which is divided into four plateau. Each plateau produces different type effect and experience for 70kg person. Let’s check out effects and risk of each plateau,
• 1st PLATEAU (MILD)
A dose ranges from 100mg-200mg produce mild stimulation and slight intoxication with the risk of dizziness and vomiting
• 2nd PLATEAU (MODERATE)
It is similar to alcohol intoxication. A dose range of 200-400mg produce euphoria, mild hallucinations, slurred speech and impairment of short-term memory temporarily. It is a dream like condition with the risk of motor function impairment and blurred vision.
• 3rd PLATEAU (STRONG)
In this plateau, a person experiences the effects which are comparable to ketamine or (phencyclidine). A dose from 400mg 600mg produce strong dissociation, intense hallucination and loss of motor coordination along with the high risk of nausea and panic attacks.
• 4th PLATEAU (TOXIC)
It can be from 500mg till 1500mg. An abuser became violent and experience increase in body temperature, blood pressure and heart rate, lack of coordination, shallow respiration, diarrhea, and psychosis, seizures, coma, brain damage, organ failure and may be death.

TOXICITY OF DXM WHEN COMBINED WITH OTHER DRUGS
DXM is also available in combination with other drugs which also have potential of different adverse effects. Abuse of these combination can result in following adverse effects by simply enhancing DXM effects,

• DXM with acetaminophen may causes liver damage.
• DXM with chlorpheniramine may increase heart rate and can cause lack of coordination, seizures and coma.
• DXM with guaifenesin may result in vomiting.

HOW ABUSE OF DXM CAN BE IDENTIFIED?
Abuse of DXM can be identified easily, if a person used it without any medical need in higher doses or frequently purchasing the same product having mood swings or confusion.

IS THERE ANY RECORD OF DXM INTOXICATION?
DXM is considered as legal high among the youngsters as the OTC cough medicine. It is widely abuse by teenagers and it is the cheapest way to get high. It is now drug of abuse for non-medical purposes. People may become addictive of DXM both behaviorally and physically over the time. It is difficult to calculate, how many deaths are due to DXM intoxication and how many people abuse it? The reason is very clear because it is an OTC drug and easily available from the local pharmacies.

HOW ABUSE OF DXM CAN BE PREVENTED?
Abuse of DXM can be prevented through education sessions in which risk factor of abuse of DXM should be disused.

CONCLUSION
As a cough suppressant, in low doses DXM have shown minimal sides effects at low risk level but at psychoactive higher doses, there are many negative effects are associated with it. Use of DXM for recreational purpose is very threatening which may lead to addiction, dependence, tolerance, acute and chronic sides effects and even death. In my opinion, there must be amendment in laws which enforce pharmacist not to sold it to teenagers and not to be sold it without prescription. Change in law will be helpful in protecting our children health and future. Review of law will assist us in stopping abusing and illegal use of this medication as entheogenic (induce spiritual development on religious rituals), and for recreational purposes.