Abuse of OTC Abuse of OTC DrugsDrugs

John Clay Kirtley, Pharm.D.John Clay Kirtley, Pharm.D.Assistant ProfessorAssistant Professor

UAMS College of PharmacyUAMS College of PharmacySeptember 28, 2004September 28, 2004

Commonly Abused OTC Commonly Abused OTC DrugsDrugs

• InhalantsInhalants

• DXM – DXM – DextromethorphanDextromethorphan

• MethamphetaminesMethamphetamines

InhalantsInhalants

• Organic SolventsOrganic Solvents

• NitritesNitrites

• Nitrous OxideNitrous Oxide

Junior and Senior High StudentsInhalant Use

Have Tried Currently Use

Introductory Age

15-20%

2-6% 13

Organic SolventsOrganic Solvents

• Rubber CementRubber Cement

• GlueGlue

• Paint thinnerPaint thinner

• Hair sprayHair spray

• Model cementModel cement

• GasolineGasoline

• PropanePropane

• Marker pensMarker pens

• BalloonsBalloons

• Correction fluidCorrection fluid

• FreonFreon

• Canned airCanned air

• Nail polish Nail polish removerremover

• Air freshenerAir freshener

NitritesNitrites

• PoppersPoppers

• SnappersSnappers

• Heart MedicationHeart Medication

• RushRush

• BoltBolt

• ClimaxClimax

• Video Head CleanerVideo Head Cleaner

Nitrous OxideNitrous Oxide

• Dentist’s officeDentist’s office

• Whippets – Whipped cream dispensersWhippets – Whipped cream dispensers

*First inhalant used for recreational *First inhalant used for recreational purposespurposes

Adverse Effects of InhalantsAdverse Effects of Inhalants

• CNS Depression or Brain DamageCNS Depression or Brain Damage

• SSD SSD Sudden Sniffing DeathSudden Sniffing Death Organic Solvents Organic Solvents

• Arrhythmias Arrhythmias Organic Solvents Organic Solvents

• Cardiac Arrest Cardiac Arrest Organic Solvents Organic Solvents

• Increased Ocular PressureIncreased Ocular Pressure Nitrites Nitrites

• Coughing and Nose BleedsCoughing and Nose Bleeds

DextromethorphanDextromethorphan

• Corcidin HBPCorcidin HBP

• DexaloneDexalone

• RobigelsRobigels

• Robitussin DMRobitussin DM

• Vicks 44DVicks 44D

Abuse DosesAbuse DosesThresholdThreshold UnknownUnknownLight UseLight Use 100- 100-200mg200mgCommon useCommon use 200- 200-400mg400mgStrong tolerance 300-Strong tolerance 300-600mg600mgHeavy tolerance Heavy tolerance 600- 600-1500mg1500mgRisk of deathRisk of death 2500- 2500-20,000mg20,000mg

• Extracting DXM??Extracting DXM??

4.10   How am I Supposed to Drink Cough Syrup?

Good question. Part of the reason DXM isn't terribly popular is that drinking cough syrup is, well, disgusting. However, here is a suggested method courtesy of "JR":

Materials:

2 glasses A sink with COLD water cough syrup toothpaste Procedure:

1. Fill one glass with water, the other with Robo. Keep the water running (it makes the sensation less gross for some reason). Do not allow Robo to be smelled under any circumstances!

2. Pinch nose shut with one hand 3. Sip water 4. Take 5-6 deep hyperventilative breaths 5. Slam the entire 8oz bottle of Robo at one time. 6. While still holding nose, drink remainder of water 7. Refill glass with water and drink the entire glass of water. 8. Repeat again, for a third glass of water. 9. Still holding your nose, spread toothpaste in your mouth, thoroughly coating the inside of your mouth. 10. Release your nose, and exhale through both nose and mouth.

Minty fresh!

Drinking Cough Syrup?Drinking Cough Syrup?

Adverse Effects of Adverse Effects of DextromethorphanDextromethorphan

• NauseaNausea

• VomitingVomiting

• HallucinationsHallucinations

• DizzinessDizziness

• StuporStupor

Poison Control Center Poison Control Center CallsCalls

• 34 Calls in 2000*34 Calls in 2000*

• 3,271 calls in 2003*3,271 calls in 2003*

**nationwidenationwide

Searching the WebSearching the Web

• http://www.nida.nih.gov/infofax/hsyouthtrends.hthttp://www.nida.nih.gov/infofax/hsyouthtrends.htmlml

• http://www.totse.com/en/drugs/otc/index.htmlhttp://www.totse.com/en/drugs/otc/index.html

• http://www.erowid.org/http://www.erowid.org/

• http://www.lycaeum.org/drugs.old/synthetics/dxm/http://www.lycaeum.org/drugs.old/synthetics/dxm/faq/contents.htmlfaq/contents.html

• http://www.deadiversion.usdoj.gov/drugs_concern/http://www.deadiversion.usdoj.gov/drugs_concern/

• http://www.deadiversion.usdoj.gov/pubs/brochurehttp://www.deadiversion.usdoj.gov/pubs/brochures/pseudo/poster2.pdfs/pseudo/poster2.pdf

• Google Google OTC Drug Abuse = 65,200 hits OTC Drug Abuse = 65,200 hits

• Google Google DXM = 89,400 hits DXM = 89,400 hits

MethamphetaminesMethamphetamines• Pseudoephedrine – “The diversion of over-Pseudoephedrine – “The diversion of over-

the-counter pseudoephedrine containing the-counter pseudoephedrine containing products is one of the major contributing products is one of the major contributing factors to the methamphetamine situation factors to the methamphetamine situation in the United States.”in the United States.” -DEA Diversion

Control Program Nine (9) gram single transactions Three (3) gram per package

• 120 mg. Pseudoephedrine HCL = 92 tablets

• • 120 mg. Pseudoephedrine HCL = 31 120 mg. Pseudoephedrine HCL = 31 tabletstablets

• 60 mg. Pseudoephedrine HCL = 184 tablets

• • 60 mg. Pseudoephedrine HCL = 62 60 mg. Pseudoephedrine HCL = 62 tabletstablets

• 30 mg. Pseudoephedrine HCL = 367 tablets 

• • 30 mg. Pseudoephedrine HCL = 123 30 mg. Pseudoephedrine HCL = 123 tabletstablets

Methods of DiversionMethods of Diversion

•SmurfingSmurfing– groups of individuals that either send in multiple

purchasers into the same location or visit a large number of different locations to buy sub threshold amounts of pseudoephedrine

•Shelf SweepingShelf Sweeping– individuals or groups remove all the shelf stock and exit the

store, similar to a "smash and grab" shoplifting technique

•ShopliftingShoplifting– individuals remove stock from the shelves and exit the

store without paying

Making MethMaking Meth

•Pseudoephedrine Pseudoephedrine Meth Meth– 75% Yield for inexperienced cook75% Yield for inexperienced cook– Up to 100% yield for experienced or Up to 100% yield for experienced or

knowledgeable cookknowledgeable cook

Using MethamphetaminesUsing Methamphetamines

• In 2000 it was estimated that 8.8 million people In 2000 it was estimated that 8.8 million people had tried Meth at least oncehad tried Meth at least once

• Smoked or InjectedSmoked or Injected– ““Rush” or “Flash” intense sensation of pleasureRush” or “Flash” intense sensation of pleasure– High can last 4 – 8 hoursHigh can last 4 – 8 hours

• Oral useOral use– Longer lasting effects due to delayed absorptionLonger lasting effects due to delayed absorption

Effects of Meth UseEffects of Meth Use

• Short TermShort Term– AnxietyAnxiety– ParanoiaParanoia– HTNHTN– SOBSOB– ArrhythmiasArrhythmias– SeizuresSeizures– DeathDeath

• Long TermLong Term– AddictionAddiction– Psychosis (chronic Psychosis (chronic

use = use = schizophrenic schizophrenic state)state)

– Stroke Stroke – Weight lossWeight loss

SummarySummary

Be aware of OTC abuse, it is Be aware of OTC abuse, it is more common than most of more common than most of

us would like to admitus would like to admit