Introduction
Drugs are chemicals or substances that, when taken, alter the normal functioning of the body. When prescribed by a physician, drugs can refer to medicine used to treat various diseases. Drug or substance abuse refers to using illegal drugs to create a pleasurable effect on the brain. It can also refer to using prescription or over-the-counter drugs in excessive amounts or for purposes other than those meant to be used (Diggs, 2022). Over-the-counter drugs are medicines bought without a physician’s prescription.
Prolonged intake of these drugs can lead to addiction, affecting men and women of all socioeconomic statuses. Among the most abused drugs in the United States are cocaine, alcohol, marijuana, weed, heroin, tobacco, methamphetamine, opioids, and over-the-counter medicines such as Dextromethorphan (DXM), Pseudoephedrine, and Dimenhydrinate, among others (Shi et al., 2021). These drugs are mainly available in liquid form, tablets, capsules, inhalers, and suppositories, and they get their way through the body via swallowing, inhaling, injection, smoking, and suppositories.
OTC Medicine- Dextromethorphan (DMX)
In the United States, A survey conducted by Pew Research Center found that 46% of adults revealed they have a relative or close friend who is addicted to drugs. These numbers are identically shared among men and women, democrats and republicans, with 46 % for each. The intensity of abuse in blacks read at 52 %, 46 % for whites, and 50% for Hispanics (Lopez-Quintero et al., 2021). In 2016, about 7.4 million (2.7 %) Americans aged 12 years and above reported illicit drug use disorder (Vaughn et al., 2021). Marijuana is the most used drug in the United States, where over 60% of the residents have had marijuana at least once, with Omaha being at the lead (Ludlum & Johnson, 2018). Cocaine was ranked second among the most used drugs in the U.S., with over 20% population having used it earlier, while heroin was third and ranked the most dangerous drug on the streets.
In both instances, Omaha again took the lead in usage hence being ranked the worst city for drug use in the U.S. On the contrary, Miami, FL, recorded the lowest drug use rate, with Washington, D.C., the first runner-up and Atlanta and Georgia in the third position. The disparity in drug usage among the cities can be attributed to the people and the socioeconomic activities carried out in those places. Omaha, for instance, is home to majorly black residents of segregated communities. The increased drug use can result from depression, anxiety, and general psychological distress due to poverty, unemployment, arrest, and neighborhood disorder.
In 2018, the number of people using drugs had alarmingly increased. About 164.8 million people (60.2 %) aged 12 years and older were in the past reported month as substance users (Rubin, 2019). Prevalence among young people is relatively high compared to older people. According to data released by National Survey on Drug Use and Health (NSDUH) in 2003, young people of age 18 to 25 years recorded the highest drug usage rating at 60.5 % over the past year (Shi et al., 2021). According to data recorded by Lopez-Quintero et al. (2021), 32.8 % were white young adults aged 18 to 25 years, 30.6 % were African- American, and 27.5 % were Hispanic young adults.
The popularity of patients prescribing medicines for themselves results in increased potential abuse of over-the-counter drugs. These drugs treat and prevent commonly encountered problems such as headaches, acne, tooth decay, itches, common colds, allergies, and heartburn (Diggs, 2022). Users, without knowing, get exposed to risks of improper diagnosis, inappropriate dosage, adverse drug reactions, and addiction when used for an extended period.
Prescription drug misuse is most prevalent among adolescents aged 12 to 17 and young adults aged 18 to 25. The high numbers are linked to concerning outcomes such as poor performance in academics, risky behavior, and psychopathology (Schepis et al., 2018). Higher numbers were also recorded in non-college-attending youths with at least or less than a high school degree compared to college-going youths in both females and males.
Dextromethorphan (DXM) is a widely abused OTC in the United States and the world. It is available in more than 140 over-the-counter preparations used for relieving coughs and colds commonly used among young people. This drug works by reduction of the activity in the part of the brain that causes coughing. It is a readily available antitussive that, when used in appropriate dosage, acts as an effective cough suppressor with minor side effects. However, when overdosed, DXM produces a hallucinogenic, intoxicating, and dissociative effect which can even result in death.
In the market, dextromethorphan is available under the following different brand names: Balminil DM, Benylin DM, Bronchophan, Buckley’s D, Calylin #1, Delsym, Koffex DM, Novahistex DM, Robitussin Lingering Cold Long-Acting Cough, Robitussin lingering Cold Long-Acting CoughGels, Children’s Robitussin Cough Long-Acting, and Sucrets 8 Hour Cough Relief D.M. Cough Formula. DXM interacts differently with various drugs. It has severe interactions with isocarboxazid, procarbazine, phenelzine, rasagiline, safinamide, tranylcypromine, and selegiline (Gussow, 2020) Dextromethorphan resembles a narcotic containing morphine derivatives structurally. However, it is a non-narcotic cough suppressant since it does not exhibit morphine-like effects.
A study published by the National Library of Medicine in 2013 associates the alarming abuse of these drugs with their easy availability, increased acceptance of sedatives, painkillers, and anti-anxiety medications by society, and ignorance among youths who assume that the drugs are always safe (Firdaus et al., 2019). According to a poll conducted in 2008 by the Substance Abuse and Mental Health Services Administration, more than 3.1 million Americans between the ages of 12 and 25 had used OTC cold and cough medications recreationally by the year 2006.
Figure 1 is a graphical representation comparing the trends in dextromethorphan abuse according to age for the cases reported to the California Poison Control System (CPCS) and the American Association of Poison Control Centers (AAPCC) during the study (Windhab et al., 2020). According to the study, there was an overall increase in dextromethorphan abuse among adolescents representing 74.5 % of all reported CPCS. DXM was highly abused among youths aged 15 and 16 in both CPCS and AAPCC databases.
According to the Drug Enforcement Administration, people who abuse DXM experience side effects proportional to their drug dose. The maximum recommended dose of DXM daily is 120 mg. Dosage beyond this results in mild side effects and intoxication (Ontiveros & Cantrell, 2022). A dose of 100-200 mg results in gentle stimulation and euphoria, whereas a dose of 200-400 mg results in hallucinations and stronger euphoria. According to Ontiveros & Cantrell, (2022), a 300-600 mg dose leads to visual distortion and loss of motor coordination, whereas 500-1500 mg results in out-of-body sensations.
Excessive doses of DXM are associated with problems such as difficulty in breathing, blackouts, muscle twitching, elevated drowsiness, heart palpitations, blood pressure variations, extreme body temperature, vomiting, rapid heartbeat, blurred vision, and brain damage. DXM interactions with other drugs can be lethal, with some resulting in the death of the users (Ontiveros & Cantrell, 2022). In a case reported on an adolescent death resulting from abuse of dextromethorphan, postmortem results showed markedly elevated concentrations of chlorpheniramine (CPA) and dextromethorphan (DXM) in the blood. In this case, the death was attributed to dextromethorphan toxicity or toxicity from dextromethorphan and other drugs.
After a long time of usage, patients willing to stop may encounter a series of withdrawal symptoms. The severity of the symptoms depends on the user’s physiology and the amount and duration of the drug taken (Range, 2020). Common symptoms of withdrawal are lack of sleep, restlessness, muscle aches, vomiting, diarrhea, cold flashes, and weight loss. During the withdrawal period, users also experience increasing cravings for the drug. The withdrawal duration also varies from one individual to another depending on the amount of drug in their system and the length of duration the drug was taken.
Recovery from dextromethorphan withdrawal symptoms is called detoxification. The detoxification process is the first step and can go on for a few days or weeks, after which the patient returns to the addiction recovery process. Treatment of dextromethorphan withdrawal can be done through two options. First, it can be on an inpatient basis at a rehab center or hospital, especially for people whose close relations are not effective enough in helping them not to go back to drug usage again. Secondly, a patient can enroll in an outpatient rehab program (Range, 2020). This is usually effective for people with less severe withdrawal symptoms who must maintain work and other family duties.
Dextromethorphan abuse drains the users and the people around them financially. The cost of purchasing the drug is quite high, as a 50 g bottle costs approximately €65. The cumulative cost tends to increase substantially for addicts and people taking relatively large amounts of DXM. In addition, some users may have already drained their finances, calling for support from family members and friends to seek rehab services. This drags the entire society to that mess and eventually drains their finances.
Conclusion
In conclusion, research has shown that abuse of over-the-counter drugs is at an alarming stage, and the world is on the verge of losing the young generation to drugs. Though significant research has been done on the same, the issue has not been fully addressed. This calls for researchers to dive deep into coming up with sufficient research on the level of drug abuse and re-evaluate the available interventions. The respective governments also need to develop policies intended to inform the general public of the effects of these drugs and set up regulations on the sale of the same.
References
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Gussow, L. (2020). Toxicology rounds: The enduring popularity of a DXM robotrip. Emergency Medicine News, 42(5), 14.
Lopez-Quintero, C., Warren, T., Falise, A., Sharma, V., Bares, C., & Oshri, A. (2021). Prevalence and drug use correlates of extra-medical use of prescription medications for sleep among adults in the United States: Results of the 2015–2018 National survey on drug use and health. Pharmacology Biochemistry and Behavior, 204, 173169.
Ludlum, M., & Johnson, J. B. (2018). Forget video poker: Sell marijuana on tribal lands. Southern Law Journal, 28(1), 85-116.
Ontiveros, S., & Cantrell, L. (2022). Fatal cold medication poisoning in an adolescent. The American Journal of Emergency Medicine, 52, 269-e1.
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Rubin, R. (2019). The use of illicit drugs continues to rise. JAMA, 322(16), 1543-1543.
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Schepis, T. S., Teter, C. J., & McCabe, S. E. (2018). Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in US adolescents and young adults. Drug and Alcohol Dependence, 189, 172-177.
Siste, K., Nugraheni, P., Christian, H., Suryani, E., & Firdaus, K. K. (2019). Prescription drug misuse in adolescents and young adults: An emerging issue as a health problem. Current Opinion in Psychiatry, 32(4), 320-327. Web.
Shi, M., Littlefield, A. K., & Stevens, A. K. (2021). Investigating differences in sex, race/ethnicity, and impulsivity across substance user profiles: A person-centered approach. Journal of American College Health, 69(7), 725-733.
Windhab, L. G., Gastberger, S., Hulka, L. M., Baumgartner, M. R., Soyka, M., Müller, T. J.,& Mutschler, J. (2020). Dextromethorphan abuse among opioid-dependent patients. Clinical Neuropharmacology, 43(5), 127-133.
Appendix 1: Graph showing the trends in Dextromethorphan abuse according to age
