Dextromethorphan is a cough suppressant found in several cold medications. Several U.S. states have begun regulating who, and under what circumstances, can purchase dextromethorphan containing products. Not all states have regulations documented at this time, but this article contains all the states that have documentation.
Alabama Code Title 20. Food, Drugs, and Cosmetics 20-2-2 only mentions dextromethorphan in relation to the fact that it is not defined as an opioid for the sake of regulation in this state. Alabama does not have any provisions about the regulation of dextromethorphan at this time.
Alaska House Bill No. 125 placed regulations on who can sell and who can buy products that contain any level of dextromethorphan. The provider must check the identification of a person wishing to purchase dextromethorphan-containing products to verify that the purchaser is 18 years of age or older. There is a stipulation that identification is not required if the provider could reasonably assume that the purchaser is 25 years of age or older based on appearance. A person under 18 years of age may purchase a product containing dextromethorphan if they have a prescription for said product from a licensed practitioner.
Nevada Senate Bill 159 states that it is prohibited to provide a dextromethorphan containing product to a person under the age of 18. A person under the age of 18 is prohibited from purchasing a product that contains dextromethorphan unless they have a valid prescription. The provider is required to obtain identification for proof of age unless the provider can presume that the purchaser is above the age of 18 by the purchaser's appearance.
Once the law takes effect, all vendors will have to check the buyer's identification if they appear under the age of 25. Those under 18 will only be able to purchase a product with DXM if they have a prescription.
The Consumer Healthcare Products Association reports that as many as 10% of U.S. teenagers are thought to have tried robotripping. DXM abuse is more common among this age group than cocaine, ecstasy, LSD or methamphetamine. According to the California Poison Control System, calls related to DXM abuse by children under the age of 17 have increase by 850% over the past decade.
The new California law, known as State Senate Bill 514, was unanimously passed by California lawmakers. Since 2004, laws related to the restriction of DXM sales have been introduced in the U.S. Congress and in several other states without success. Legislation has previously been opposed by manufacturers represented by the Consumer Healthcare Products Association, but that organization is now in favor of restricting sales of DXM.
Over-the-counter (OTC) medicines are those that can be sold directly to people without a prescription. OTC medicines treat a variety of illnesses and their symptoms including pain, coughs and colds, diarrhea, constipation, acne, and others. Some OTC medicines have active ingredients with the potential for misuse at higher-than-recommended dosages.
DXMShort-term effects of DXM misuse can range from mild stimulation to alcohol- or marijuana-like intoxication. At high doses, a person may have hallucinations or feelings of physical distortion, extreme panic, paranoia, anxiety, and aggression.
Loperamide misuse can also lead to fainting, stomach pain, constipation, eye changes, and loss of consciousness. It can cause the heart to beat erratically or rapidly, or cause kidney problems. These effects may increase if taken with other medicines that interact with loperamide. Other effects have not been well studied and reports are mixed, but the physical consequences of loperamide misuse can be severe.
As with other opioids, when people overdose on DXM or loperamide, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage and death.
Steele's bill wouldn't put the same restrictions on dextromethorphan that require cold medication pseudoephedrine to be limited and dispensed behind a pharmacy counter. Other states in the past two years have banned selling cough syrup to minors, among them California, New York and Louisiana, according to news reports.
Breastfeeding MothersCodeine and its active metabolite, morphine, are present in breast milk. A search of the medical literature1-19 for relevant data regarding codeine use during lactation revealed numerous reports of respiratory depression and sedation, including one infant death, especially in mothers who have the CYP2D6ultra-rapid metabolizer genotype.
Nevertheless, the fact remains that nonprescription insulins have been available only from pharmacies since their introduction in the 1920s. Wholesalers and other suppliers will not sell them to nonpharmacy outlets. Thus, they have been a valid third class of medications within the U.S. for decades.
Some states have created a third class of medications by allowing nonprescription sales of certain codeine-containing (C-V) products. These Schedule V products included now-discontinued anti-diarrheals such as Donnagel-PG and Infantol Pink. C-V cough preparations are sold as a third class of medications by such states as Oklahoma.7 In that state, prospective purchasers must sign a bound record book providing their name, address, and date, and a pharmacist must initial each purchase. The number of C-V cough syrups has slowly dwindled. Naldecon-CX, Robitussin AC, Novahistine-DH, and Cheracol have all apparently been discontinued, but a product known as Cheratussin AC is still available without a prescription.
Some jurisdictions have passed laws placing syringes in BTC status to control sales. For instance, San Francisco undertook syringe control in the 1990s to minimize the spread of HIV in the heterosexual community.8 Pharmacies registered under the program can sell or provide up to 10 syringes to individuals aged 18 years and above without a prescription. Syringes must be stored behind the counter, and the pharmacy must provide verbal counseling or written information regarding how to access drug treatment, how to access HIV and hepatitis screening and treatment, and how to safely dispose of used syringes.
To help control the growing problem of meth, state and federal authorities decided to pass laws that would restrict sales to pharmacies. Purchasers must show photo identification, have their transaction logged, and are subject to daily and monthly limits.
Pharmacists were chosen as the critical gatekeepers for PSE sales because they have the knowledge to determine whether sales are legitimate. They may ask you about such issues as other symptoms of a common cold to ensure that you have a medical need for a proposed purchase of PSE. If the pharmacist is not convinced that you have a legitimate need for PSE, he or she may ask you to visit a physician to determine whether a prescription product is more appropriate.
If you have any questions regarding nonprescription drugs or products that are only available BTC, your pharmacist will be there to address any concerns. Some pharmacies even provide pharmacy request cards in the aisle that you can bring up to the counter to help facilitate the sale.
In 2012, California became the first state to prohibit sales of DXM-containing products to minors. Since then, governors from Alaska, Arizona, Delaware, Florida, Kentucky, Louisiana, New Jersey, New York, Tennessee, Virginia, Washington, Nevada, Oregon, Colorado, and Wisconsin have all signed similar laws.
The Consumer Healthcare Products Association (CHPA), founded in 1881, is the national trade association representing the leading manufacturers and marketers of consumer healthcare products, including over-the-counter (OTC) medicines, dietary supplements, and consumer medical devices. CHPA is committed to empowering self-care by ensuring that Americans have access to products they can count on to be reliable, affordable, and convenient, while also delivering new and better ways to get and stay healthy. Visit www.chpa.org.
Though abuse of cold medicine is not common in adults who have legal access to other substances like alcohol, among kids, dextromethorphan has long been a resource for getting high. In large quantities, the substance can cause a euphoric effect among users. Kids may snort it, drink it, or inject it in order to experience that high.
Until the law is put into effect and as long as you have over-the-counter cough medications stored in your home, it is important to remain vigilant. There are a number of ways that you can help to prevent abuse of cough medicine, especially around the holidays when adults are often distracted with use of alcohol and family visits, and kids may be more likely to take advantage of the situation and abuse whatever substances they come across. You can:
A 2017 study in the Journal of Infectious Diseases looked at nearly 10,000 people with respiratory infections who were hospitalized for heart attacks. Participants were 72 years old on average at the time of their heart attacks and many had cardiovascular risk factors, such as diabetes and high blood pressure. Researchers found that people who used NSAIDs while sick were more than three times as likely to have a heart attack within a week compared with the same time period about a year earlier when participants were neither sick nor taking an NSAID.
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