A Bad Trip That Kills

Abuse of cough remedies can be lethal.
A state lawmaker hopes to ban sales to minors.
By Robert Salladay, Times Staff Writer

SACRAMENTO — Some users claim to see aliens conjured from the collective unconscious. Others temporarily lose their ability to walk. Some have written stories on the Internet: "I felt my soul being ripped from my body," and, "Are you a vampire? No, I just met God."

But it's not heroin or PCP they are taking. It's cough syrup.

An underground network of abusers — hooked on the potent ingredients in cough suppressants and cold remedies — is thriving in California and across the nation, while police and poison control officials report more and more young people getting high from what they call "robo-tripping" and "skittling."

Abusers have been getting high from cough syrup for five decades, ever since the main ingredient in modern cough medicines — dextromethorphan — was patented. But in recent years coroners have issued warnings about the practice and health officials have started tracking statistics on it for the first time as the stories stack up: a teenager commits murder and blames cough tablets; a mother loses her son and finds out too late he was a robo-tripper.

Poison control experts point to a four-fold increase in abuse cases since 2000, mostly among teenagers and young adults who have developed their own lingo for the culture — robo-tripping refers to the use of Robitussin to achieve a high and skittling is derived from Skittles candy, which resembles some cough tablets.

"We're now seeing it in middle schools. We're seeing it at an earlier age," said Det. Wayne Benitez of the Palo Alto Police Department. Authorities need to "make people aware this abuse is going on and that this is not just a passing fad," he said.

The situation is alarming enough to some California officials that legislation has been introduced to prohibit the over-the-counter sale of products containing dextromethorphan to anyone under 18 without a prescription.

No state has outlawed sales of cough medicine to minors so far, even though products containing dextromethorphan — and incidents of people abusing it — have been around since the 1950s. But this year, New York and California have started exploring a prohibition for minors. California law already prohibits the sale to minors of spray paint, etching fluid, glue and dietary supplements containing ephedrine.

Health officials estimate that at least a dozen people have died from dextromethorphan abuse in recent years. The statistics are compiled from news reports across the country about accidents, psychotic behavior and violence linked to abuse of the over-the-counter drug.

On July 16, Misty Fetko said, she entered her son's room like she always did — to kiss him awake and get him ready for the day. But he did not stir. He was dead.

Only after she received an autopsy report and read her son's computer journals did Fetko discover that he had overdosed on highly toxic levels of a prescription pain medication that, to her surprise, was a key ingredient of cough syrup. Except for one empty bottle of Robitussin found in his room the year before, there were never any signs of drug use.

Her son was 18, and on his way to college in just two days. Fetko said she had yet to discover how he came across the pain medication, Duragesic, but his journals indicated that he had tried robo-tripping several times.

"Carl was very artistic and very musically gifted, and I think some of the attraction," suggested in his writings, was that he thought it expanded his artistic ability and his creativity, said Fetko, who lives in Ohio but is working with two Southern California groups on the medication abuse issue.

In September, 19-year-old Nathaniel Bell was convicted of first-degree murder for stabbing Jose Felix-Martinez "amid a blaze of drugs in an apartment illuminated by only a strobe light," wrote the Wichita Eagle newspaper. Bell admitted to police that he had taken up to 16 Coricidin cold tablets, which contain dextromethorphan, also known as DXM, as well as beer and cocaine. Felix-Martinez was 22, and died of stab wounds.

In Pennsylvania, a 14-year-old boy killed his only brother by smashing his head with a claw hammer, then turned up the music in his room to muffle his brother's cries. The boy had been "eating pills" all day — Coricidin HBP Cough and Cold tablets, the Pittsburgh Tribune-Review reported. The boy was convicted of third-degree murder and is serving a 20- to 40-year sentence.

In rare cases, public health officials have reported deaths from DXM overdoses. But they usually have been attributed to mixing DXM products with other drugs. In late 2002, two central Ohio teenagers died within weeks of each other after ingesting Coricidin tablets and morphine. The Franklin County, Ohio, coroner issued a warning to parents saying the deaths "represented a new trend."

The California legislation emerged from a "There Oughta Be a Law" contest sponsored by Assemblyman Joe Simitian (D-Palo Alto), who asked his constituents to suggest problems that should be fixed. This is the third year for his contest, which has prompted hearings on high gas prices and a new law, effective this year, requiring car headlights to be turned on whenever windshield wipers are used.

Benitez and a colleague, Lt. Ronald Lawrence, convinced Simitian the issue was important after uncovering a suicide pact by three students who had planned to overdose on cough tablets. Benitez would write his master's degree thesis on robo-tripping.

In large amounts, cough suppressants can cause extreme anxiety, hallucinations and misperception about the outside world. Some users have likened it to opium or PCP overdoses, depending on the level ingested.

Dextromethorphan can be purchased through the Internet in powder form, but most people obtain the drug by buying or stealing medications that contain DXM — an array of more than 125 products such as cough drops, syrup and tablets. State poison control experts consider the most dangerous in large amounts to be Coricidin HBP, which contains an additional antihistamine that makes abuse far riskier than with other DXM products.

Even though the first DXM product was introduced five decades ago, California poison control officials recently started tracking abuse cases reported through their hotline. The California Poison Control System said among patients ages 6 to 19, there were 58 cases of DXM overdoses in 2000; that jumped to 284 last year.

Dr. Ilene Anderson, a clinical toxicologist and pharmacist with the California Poison Control System, called DXM abuse among teenagers "a serious problem. We've seen a significant increase in the abuse and overdose of DXM-containing cold products in the last four years."

A survey taken over the last decade by the Drug Abuse Warning Network, a federal monitoring agency, has shown a steady number of DXM abuse cases over the years. In 1994, there were 2,274 overdose cases of cough suppressants reported by emergency room doctors, compared to 2,311 reported in 2001. Newer figures were not available.

The abuse of cough syrup appears to come and go in cultural waves, from bored Utah teenagers littering school fields with empty bottles to hard-core punk rockers taking a "vacation" from reality. Others have sought out specific hallucinatory plateaus — there are four, depending on the dosage — where reality distorts, reaching a point where sometimes aliens appear, or the user hears voices.

On one Internet site devoted to DXM, "Raoul" wrote: "I got caught in a nasty time-loop. I experienced Hell. I thought that my basement was the only existent Universe and Jason and I were doomed to live it out in this horrible state for all eternity. God was finally punishing us for our foolish sins."

Brad Strode, a 22-year-old from West Memphis, Ark., said he visits the chat rooms to warn people about some of the dangers of DXM. Strode said he started taking DXM pills a few years ago, enough to get on the fourth plateau where he heard voices talking to him

"I just tell them it's not something you want to take," Strode said. "It's not something that is going to make you a better person. It's going to end up with long-term damage. Ten years down the road, you aren't going to have a heart left."

Simitian's bill, AB 1853, passed its first Assembly committee hearing last week on a 11-4 vote, suggesting that it will receive support as it makes its way through the Assembly and state Senate, which are controlled by Democrats. Gov. Arnold Schwarzenegger, a Republican, has not taken a position on the measure.

Drug companies and store owners oppose the Simitian bill, arguing that it would keep legal products from people who need them. Pharmaceutical firms, such as Schering-Plough, which makes Coricidin HBP, have been working with the federal Partnership for a Drug Free America on DXM-abuse education programs for teenagers, including an Internet site on its dangers.

Drug firms say they would like to see drug and grocery stores voluntarily put DXM products behind the counter if they notice a problem.

"It's sort of a sporadic thing that has peaks and valleys — very small peaks," said Virginia Cox of the Consumer Healthcare Products Assn., the industry trade group in Washington, D.C. "We don't have any data on the problem, and I think that is something we need more information on."

A Los Angeles police detective who works on juvenile narcotics cases said he has not noticed a dramatic increase in DXM abuse, mainly because parents usually call poison control centers or take their child to an emergency room rather than call police. Det. Eric Sage said he has been disturbed by recent TV media reports that he said is hyping the problem of DXM abuse among teenagers.

"I hate to see too many laws thrown down," Sage said. "When people ask me why kids use drugs, there are a number of different reasons. It's rebellion. It's curiosity. It's boredom. If we start putting too many laws and you say, 'You can't do this,' the first thing they think is, 'Bet me.' I think the best way is to limit sales, which makes it harder for them to get it."

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