Misuse of Cough Suppressant Prompts Effort to Restrict Access, Monitor Sales

Andrew Kitchenman | June 11, 2014 | Health Care
Pharmacy owners say it's impractical to lock up drug, track purchases; advocates cite dangerous hallucinations from excessive doses

cough medicine pills
Dorothy Rasmussen’s son began to abuse the cough-suppressant dextromethorphan in college, developing tremors and panic attacks. She recalled an incident in which he became disoriented, called her — and didn’t know where he was. Rasmussen drove around until she found him.

The Metuchen councilwoman has become one of the biggest supporters of a pair of bills that would limit the sale of dextromethorphan, also known as DXM.

While the bills are the latest in a series of proposals over the past decade resulting from misuse of the drug by young people, pharmacy owners say the restrictions would be difficult to implement.

Rasmussen emphasized that high school and college athletes use DXM, since it isn’t detected in drug tests.

“You can buy it anywhere and no one questions how much you take,” Rasmussen said, adding that frequent users can spend nearly $500 a month for 70 bottles at $7 per bottle.

It is contained in more than 100 different drugs, including versions of such medications as Alka-Seltzer Plus, Robitussin, Tylenol Cough and Cold, and Vicks DayQuil and NyQuil.

One bill, S-1726 and A-1469, would require pharmacies to keep medications containing DXM in a locked, inaccessible area — such as behind the counter — and keep a log of all sales of the medications.

The other bill, A-622, would bar the sale of DXM medications to anyone younger than 18.

Abuse of the drug was first recognized as early as 1975, 17 years after it was approved, according to the Center for Substance Abuse Research at the University of Maryland. Drug companies originally made DXM products foul-tasting to discourage misuse, but later produced versions that had appealing flavors, according to the center.

The bill requiring pharmacies to log all sales is similar to a federal law enacted in 2005 that applies to pseudoephedrine, a nasal decongestant that can be used to make methamphetamines.

But restricting DXM sales presents practical challenges for pharmacies, particularly small drug stores. Resistance from pharmacies has prevented action on previous versions of the bill banning sales to minors, beginning in 2004.

Independent Pharmacy Alliance lobbyist John Covello said many stores don’t have computer systems that can flag all of the different medications that contain DXM, making it nearly impossible for store personnel to know which products to restrict.

He also noted that the U.S. Food and Drug Administration decided against requiring prescriptions for DXM after weighing the public benefits and costs of such a move. It would be “difficult if that’s a mandate that you’re putting on everybody,” Covello said of logging all sales.

Covello added that if the Legislature were to enact any restrictions on sales to minors, it should consider exemptions for minors who are ill and would benefit from the drug but who don’t have an adult to but it for them.

This point resonated with Assembly Health and Senior Services Committee Chairman Herb Conaway Jr. (D-Burlington), a doctor, who noted that he has seen instances in which a minor needed pseudoephedrine but had difficulty getting it. His committee discussed the bills at a hearing last week.

Pharmacy advocates also said it would be virtually impossible to bring all of the DXM drugs behind the counter, due to the large number of products and space constraints.

The issues facing retail chains are somewhat different, according to John Holub, executive director of the New Jersey Council of Chain Drug Stores. Many chains have already instituted electronic systems in which they track sales of DXM-containing drugs. But they join smaller stores in opposing any more rules, such as requiring them to lock up the drugs and keep them behind a counter.