California regulates OTC cough and cold products to cut abuse by youths

California has become the first state to regulate dextromethorphan (DXM), an antitussive in Benylin, Pertussin, Robitussin, and dozens of other over-the-counter (OTC) cough and cold products. A state law that went into effect Jan. 1 prohibits sales of products containing DXM to anyone under the age of 18 without a prescription.

“DXM is a major drug of abuse,” said Fred Mayer, president of Pharmacists Planning Services, Inc., a pharmacy interest group that has been promoting DXM regulation for nearly a decade. “One in 10 teenagers admits to using DXM to get high, making it more popular than LSD, cocaine, ecstasy, or methamphetamine. Kids chug bottles of Robitussin all day and most adults don’t know what’s going on.”

What goes on is a heroin-like high that can lead to dizziness, lightheadedness, nervousness, unsteadiness, changes in vision, difficulty breathing, hallucinations, seizures, coma, and death.

Nonmedical use of DXM is responsible for about 6,000 emergency room visits annually in the United States. About half of these visits involve patients between the ages of 12 and 20. Calls to California poison control centers involving patients between the ages of 6 and 17 involving DXM increased 850% between 1999 and 2010, Mayer said.

As with laws regulating the sale of tobacco, pharmacies and other retail outlets that sell DXM products are required to check buyer identification and verify age. Selling, providing, or giving a DXM-containing OTC product to someone under the age of 18 without a prescription carries a $250 fine. Repeat offenders may be sanctioned by the State Board of Pharmacy.