A little red pill that promises to relieve a cough or cold is raising concerns for York County health and school officials, who fear that recent incidents of local teens abusing the drug might become a countywide trend.
Now, local leaders hope to persuade retailers to change their perception of Coricidin HBP Cough & Cold, a cold medication for people with high blood pressure, and make it less accessible for youths.
Last month, two students at Rock Hill’s Renaissance Academy – an alternative school designed to give a second chance to expelled or suspended students – reportedly overdosed after taking more than the recommended amount of Coricidin, known among teens that use it as “Triple C.”
Bought in convenience stores or online, Triple C is composed of dextromethorphan, a cough suppressant capable of producing hallucinations and inducing vomiting if taken in excess.
It can be found in capsules or cough syrup and doesn’t require an ID or signature to buy.
So far this year, 11 people – all between the ages of 12 and 26 – have been treated at Piedmont Medical Center after overdosing on cold medicine containing dextromethorphan, particularly Robitussin and Delsym, according to data provided by Tiffany Sharpe, a clinical supervisor and educator for the hospital’s emergency department.
“I think that’s a lot,” Sharpe said.
Patients who abused the medicines went to the hospital suffering from hallucinations, psychotic episodes and high body temperature, she said, and “they tend to be a little more violent.”
There haven’t been any cough medicine overdose deaths in the county this year, York County Coroner Sabrina Gast said.
A 12-year-old overdose patient is “younger than I ever thought it would be,” said Bob Norwood, chairman of the York County All On Board Coalition, a group whose website says it aims to stop substance abuse. “It’s just ignorance – kids don’t know what they’re getting themselves into.”
Easy to get
Triple C – often called “Skittles” because the capsules resemble the candy of the same name – doesn’t require a prescription or proof of identity to purchase. It’s filled with 30 milligrams of dextromethorphan, approved by the Food and Drug Administration in 1958 and found in more than 100 common over-the-counter cough medicines.
Unlike amphetamines, opiates and depressants, dextromethorphan isn’t a schedule drug regulated by federal laws that dictate increased security and storage because of the potential for abuse.
“It is an effective medication when people use it right,” Norwood said. “This is not an illicit drug. This is a legitimate drug that you and I would take if we had a cold. It’s just being abused.”
“And it’s not illegal,” said Jamie Quinn, director of the Renaissance Academy on Flint Street Extension. “You can drive around with it in your car, and you’re not getting pulled over.”
Marvin Brown, commander of the county’s multijurisdictional drug enforcement unit, said he’s aware of Triple C and how teens use it, but his team doesn’t track or enforce it because it’s not an illegal drug.
It is, however, affordable.
A box of the generic version of Coricidin HBP Cough & Cold cost $2.25 at a Rock Hill Dollar General on a recent Monday. A box of the Coricidin HBP Maximum Strength Flu cost $3.25. Neither purchase requires a customer to show ID at the checkout.
Many pharmacies, including CVS, still require customers to present an ID or sign a log.
Members of All On Board want to encourage local and discount retailers that sell Triple C over the counter to make it harder for youth to get their hands on it by treating it like a prescription cold medication.
“It depends on where you buy it,” Quinn said. “If you go into CVS, you’re dealing with licensed pharmacists who are trained to handle medication. But at Dollar General, they’re not.”
In 2010, an FDA advisory committee said medicines containing dextromethorphan should not require prescriptions to purchase, despite receiving reports from the federal Drug Enforcement Administration that abuse of the drug is fueled by several “how-to” websites and Internet sales of the powdered form.
Amy Rose, spokeswoman for Merck & Co., the company that manufacturers Coricidin Cough & Cold, said in a statement that the company “actively monitors claims concerning possible abuse of our products that contain dextromethorphan, including Coricidin HBP Cough & Cold tablets, and we take these reports very seriously.”
Though harmless when used correctly, medicines containing dextromethorphan, notably Robitussin, have for years been abused for a quick high.
Symptoms of dextromethorphan abuse include dizziness, a sense of euphoria, nausea and vomiting, and distorted visual perceptions, according to the National Drug Institute.
According to a “Monitoring the Future” study by the University of Michigan, which gauges the latest trends in adolescent drug use nationwide, cough medicine abuse ranked third in a list of the top seven over-the-counter drugs abused by high school seniors in 2012, followed by tranquilizers and sedatives but preceded by Adderall and Vicodin.
Nonmedical use of dextromethorphan specifically accounted for 7,988 nationwide emergency department visits in 2008, the most recent data available, down from more than 10,000 visits a year earlier, according to data compiled by the Drug Abuse Warning Network.
Thirteen people died in 2007 and three died in 2008, usually after taking dextromethorphan with other drugs, according to the American Association of Poison Control Centers. One of those people, a 4-month-old girl, died after ingesting .07 grams of dextromethorphan alone.
“When they have used too much of it, there’s the vomiting and headaches,” said Lauren Goodman, a marriage and family therapist in Mission Viejo, Calif., who has treated several teens who have overdosed on Triple C. “If they abuse it too much, they’ll just die.”
Teens are attracted to Triple C, Goodman said, because it doesn’t have long-term addictive effects. Instead, they use it as a “party drug,” like ecstasy, for a one-time hallucinogenic high.
But the medicine is still addictive because teens develop attachments to the kind of behavior that results, said Jill Price, adolescent program coordinator for Keystone Substance Abuse Services in Rock Hill.
“We’ve seen some (teens) who have definitely been dependent on” Triple C, she said. “It’s just the high that they get. It’s different from marijuana.”
Triple C is more accessible than illicit drugs, she said.
“We’ve actually had some who have overdosed on that stuff,” Price said. “They’ve actually ended up over in the emergency room.”
There are a number of factors at play for teens who choose to use Triple C, she said, including problems at home, school or just plain curiosity.
“There really doesn’t have to be any rhyme or reason for it,” she said, adding that Keystone hasn’t treated a specific age range of patients abusing Triple C. “Some adolescents just try it because they’re curious, and they get hooked on it after trying it a couple of times.”
Years ago, counselors at Keystone saw an upsurge in the number of teens and young adults abusing Triple C, Price said. Now, it’s “leveled off,” though they “still see it periodically.”
Still, she said, when treating Keystone patients for cough medicine abuse, counselors see Triple C as the primary medication of choice.
Teens admitted to Keystone for cough medicine abuse are enrolled in Stepping Stones, an intensive adolescent outpatient program, in which they’re taught life skills and given information to help them kick the habit.
“A lot of the adolescents know what the substances do already, so we don’t need to educate them a lot on the actual drug … effects,” Price said. “If they have a sincere desire to not use, we give them skills to help them not use.”
As part of the Consumer Healthcare Products Association, Merck & Co. joined with other over-the-counter medicine producers to create StopMedicineAbuse.org, a website aimed at educating teens and parents about potential cough medicine abuse, spokeswoman Rose said.
They also joined with the Partnership at Drugfree.org, D.A.R.E. America, WebMD and other grassroots organizations to launch several campaigns against teenage medicine abuse, she said.
Incidents in York County
Two of Quinn’s Renaissance Academy students spent days in the hospital after their experience with Triple C. One of them discussed his attempts to get high on Facebook. The other said he got the meds from a local Walmart.
Both students exceeded the recommended dosage “exponentially,” Quinn said.
According to a brand-name box of medication containing dextromethorphan, adults and children 12 years or older shouldn’t take more than eight tablets within 24 hours. Parents should talk to a doctor before giving the medication to children younger than 12.
“Anecdotally, some of the students I know about are taking 16 of these pills at once,” he said.
One of the hospitalized students told Quinn it was the second time he had abused Triple C. The first time, he tried eight and “didn’t really hallucinate very much,” Quinn said.
He spoke to a classmate, who encouraged him to take 16 to get the full effect.
“So he did 16 of them,” Quinn said, “and he did hallucinate. He said he was in the hospital and saw centipedes crawling on the walls.”
Both students are now back in school.
Rock Hill school officials noted at least one more Triple C incident this past fall, said Keith Wilks, the school district’s executive student services director.
“That’s not to say it’s not an issue,” he said.
It’s possible, he said, that many teens abuse Triple C away from school.
“They’re with us only six hours a day,” he said. “The other 18 hours are unaccounted for.”
Sending information to parents about Triple C and other abused medication has been “hit or miss,” Wilks said, despite the annual student engagement conference, forums and other information sent home with students.
A lot of parents probably aren’t aware of the dangers, he said, especially during “cold and sinus” season. Parents might notice their teens taking cough medicine to combat a cold, “not realizing they maybe have 15 boxes in the trash.”
“We are not seeing as much Triple C in our school,” compared to the amount of prescription pill abuse that’s shown up recently, said Sheila Huckabee, assistant superintendent of Clover schools.
“We’ve had a couple of cases over the last two years that, when we look back, that’s probably what it was. … We didn’t know it at the time.”
But school officials are aware of teens abusing cough medicines, perceived to be safer than marijuana and other illicit drugs because they’re designed to be “good for you,” Huckabee said.
“The trend we’re seeing is that the kids are definitely experimenting with those types of drugs,” she said. “They think it’s going to give them a buzz or high.”
Although Triple C isn’t a prescription drug, she said, it’s “still along the same lines.”
Clover schools have reported 32 incidents related to prescription, over-the-counter and marijuana drug abuse this school year.
This school year, only one student in York was disciplined after coming to school under the influence of Triple C, said Lisa Spangler, the York school district’s coordinator for special projects.
Fort Mill schools haven’t seen any cases of Triple C abuse this school year, assistant superintendent Tommy Schmolze said, but he did offer a caveat.
“High school guidance counselors or administrators will tell you, the talk is there,” he said. “The kids know what they’re doing. Kids are savvy when it comes to Triple C and the effects of it.”
Four years ago, prescription drug abuse in Fort Mill began to surge among teens and young adults from affluent families, according to police and counselors.
“Skittle parties” – a game of “Russian Roulette” during which teens take a handful of prescription pills and “choke them down” – were popular, Schmolze said, and students fresh off surgeries would find themselves confronted by peers who asked to buy their meds.
The parties have scaled back and the number of reported incidents has declined, he said.
During the 2012-13 school year, Fort Mill schools documented four incidents in which students were either eligible for expulsion or had been charged for possession of or distributing a controlled substance – all involving prescription drugs, Schmolze said.
It’s unclear if education and awareness are contributors to the decline, he said, or if the incidents just aren’t reported as frequently.
Nevertheless, Norwood and Quinn are worried that more teens will catch on and flock to Triple C.
“Teenagers lack discipline,” Quinn said. “They always think more is better. They will over-indulge if given the opportunity.”
Jonathan McFadden • 803-329-4082