• Dextromethorphan: Preventing Teen Cough Medicine Abuse

    CHPA supports legislation that would prohibit the sale of over-the-counter (OTC) cough medicines containing dextromethorphan to teens under the age of 18.

    DXMKidsDextromethorphan (DXM) is a safe and effective ingredient found in more than 100 over-the-counter (OTC) cough and cold medicines. First approved by the U.S. Food and Drug Administration (FDA) in the 1950s, it is a non-narcotic cough suppressant that works by raising the coughing threshold in the brain. It has no pain-relieving properties and is not addictive.

    While millions of Americans use DXM safely each year to relieve cough symptoms due to the common cold or flu, data released in December 2016 by the National Institute on Drug Abuse (NIDA) annual Monitoring the Future survey shows that approximately 3 percent of teens (1 in 30) admit to abusing OTC cough medicines containing DXM to get high.

    To address this issue, CHPA has collaborated with established and trusted leaders that specialize in substance abuse prevention and community mobilization as well as makers of OTC cough and cold medicines containing DXM to engage in efforts aimed at curbing abuse for over a decade. We’ve highlighted the results of this case study on targeted interventions below and in a short video here.

    Federal and State Congressional Activity

    CHPA supports federal and state legislation to ban the sale of OTC cough medicines containing DXM to minors (those under the age of 18) and to ban the sale of raw, unfinished DXM to ensure only entities registered with the FDA – such as scientists, researchers, and manufacturers – have access to this form of the ingredient. A nationwide ban on sales of cough medicine to minors would lead to a greater decrease in the abuse rate of these medicines by teens, while also maintaining access for the millions of legitimate consumers of these products each year. To complement our educational efforts, we continue to advocate for both federal and state legislation.

    States Taking Action to Prohibit Sales to Minors

    • California became the first state to prohibit sales to minors when Governor Jerry Brown signed S.B. 514. State Sen. Joe Simitian (D-Palo Alto) sponsored the bill, which took effect January 1, 2012.
    • New York Governor Andrew Cuomo signed into law AB 933-B and SB 696-B. Sponsored by State Asm. Ellen Jaffee (D- Suffern) and State Sen. Mark Grisanti (R-Buffalo), respectively. The law took effect on March 26, 2014.
    • Arizona Governor Jan Brewer signed H.B. 2086, which was sponsored by State Rep. Heather Carter (R-Cave Creek.) The law took effect July 24, 2014.
    • Louisiana Governor Bobby Jindal signed H.B. 514, which was sponsored by State Rep. Cameron Henry (R-Metairie.) The law took effect August 1, 2014.
    • Virginia Governor Terry McAuliffe signed into law H.B. 505, which was authored by State Del. Keith Hodges (R- Urbanna). The law took effect January 1, 2015.
    • Tennessee Governor Bill Haslam signed S.B. 45, which was sponsored by State Rep. William Lamberth (R-Cottontown) and State Sen. Ferrell Haile (R-Gallatin). The law took effect January 1, 2016.
    • Kentucky Governor Steve Beshear signed H.B. 24, which was sponsored by State Rep. Fitz Steele (D-Hazard). The law took effect June 24, 2015.
    • Washington Governor Jay Inslee signed 2S.H.B. 2163, which was sponsored by State Rep. Paul Harris (R-Vancouver). The law took effect July 1, 2015.
    • New Jersey Governor Chris Christie signed A.B. 622, which was sponsored by State Sen. Peter Barnes (D-Edison) and State Asms. Paul Moriarty (D-Gloucester), Patrick Diegnan, Benjie Wimberly, Valerie Vainieri Huttle, Reed Gusciora and Shavonda Sumter, Mary Pat Angelini and Nancy F. Muñoz. The law took effect February 1, 2016.
    • Florida Governor Rick Scott signed S.B. 938, which was sponsored by State Sen. Lizbeth Benacquisto (R-Fort Myers) and State Rep. Doug Broxson (R-Gulf Breeze). The law took effect January 1, 2017.
    • Alaska Governor Bill Walker signed H.B. 125, which was sponsored by House Majority Leader, Rep. Charisse Millett (R-Anchorage). The law took effect June 3, 2016.
    • Delaware Governor Jack Markell signed H.B. 329, which was sponsored by State Rep. David Bentz (D-Newark) and State Sen. Nicole Poore (D-New Castle). The law took effect June 16, 2017.
    • Nevada Governor Brian Sandoval signed S.B. 159, which was sponsored by State Sen. Patricia Farley (I-Las Vegas). The law took effect October 1, 2017
    • Oregon Governor Kate Brown signed S.B. 743. The law will take effect January 1, 2018.


    Comprehensive Efforts to Curb DXM Abuse

    The leading makers of OTC cough medicines have also engaged in educational efforts to curb abuse for a number of years. Our efforts include:

    • Educating and engaging parents and community members via the Stop Medicine Abuse campaign. In 2009, CHPA launched StopMedicineAbuse.org after manufacturers voluntarily placed an icon the packaging of DXM-containing cough medicines, pointing parents to the website. The Stop Medicine Abuse campaign aims to educate parents and spur them to action – to educate themselves, to talk with their children, to safeguard their medicines, and to spread the word to other parents. Today, StopMedicineAbuse.org is a hub of prevention-related information and a host of free resources.

      One of the campaign’s features is the Stop Medicine Abuse Blog, which leverages parent, community member, and stakeholder voices where authors discuss preventing teen medicine abuse and other risky behaviors. The campaign is also active on Facebook, Twitter, and YouTube.
    • Informing and supporting retailers in states that have enacted laws preventing minors from purchasing medicines containing DXM. The retailer initiative includes a Pharmacists & Retailers page on StopMedicineAbuse.org that features a suite of “Check Before Checkout” content to support retail employees’ understanding of the sales law and provide guidance around the actions they need to take before selling these products. Additionally, the page provides informational handouts retailers can give to consumers purchasing these medicines.
    • Directly reaching teens looking to abuse with provocative content that intercepts their searches to abuse cough medicine. In May 2012, CHPA joined forces with The Partnership for Drug-Free Kids to launch a digital and social media-based prevention initiative targeting those teens actively searching online for information on how to abuse DXM or chatting about abuse. We reach teen “likely triers” where they hang out online with dissuasive, peer-to-peer messaging and imagery. Our goal is to increase teen perception of risk and social disapproval, two proven ways to reduce abuse. We’ve validated the approach through extensive research and are monitoring and measuring impact.

      Elements of the teen campaign include:

    • Collaborating with established and trusted leaders that specialize in substance abuse prevention and community mobilization and have access to parents, educators, healthcare providers, and community leaders.
      • The Partnership for Drug-Free Kids
        CHPA and the Partnership for Drug-Free Kids began joint work in 2003 to ensure that adults with influence and oversight over young people are aware that teens may be considering abusing DXM. CHPA currently works with the Partnership on a DXM teen initiative targeting those teens actively searching online for information on how to abuse DXM.
      • Community Anti-Drug Coalitions of America
        CHPA and the Community Anti-Drug Coalitions of America (CADCA), which represents over 5,000 community coalitions nationwide, have partnered to help coalition and prevention leaders mobilize their communities and educate key stakeholders about the dangers of OTC cough medicine abuse. Additionally, CHPA and CADCA support the designation of October as National Medicine Abuse Awareness Month. As part of these efforts, CHPA supports CADCA’s Dose of Prevention Challenge, an initiative designed to encourage coalitions to take action around combating medicine abuse.
      • National Association of School Nurses
        CHPA and the National Association of School Nurses created Home to Homeroom, an educational program that teams up parents with the medical expert in their teen’s school — the school nurse — to help prevent and address teen medicine abuse.
      • Others
        Additionally, CHPA reaches out to a variety of organizations, including parent groups, education associations, health professional societies, law enforcement, the retail community, pharmacists, and others to raise awareness on the issue.


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