KIDS AND COMMUNITY: A new way to abuse over-the-counter cold medicines

By: Judy Shepps Battle
   "Robo Fire."
   Sounds like the name of a child’s action figure or video game. But it is far from innocuous and definitely not a harmless activity.
   Robo Fire is the street name for the dangerous practice of combining cough medicine and cigarette lighter fluid to produce a quick hallucinatory high.
   Ingredients are fairly inexpensive and available at neighborhood convenience stores. Simple instructions for extracting a crystalline form of dextromethorphan (DXM) from cough syrup can be found on the Internet.
   The Ohio Early Warning Network recently issued a Robo Fire alert regarding abuse by Ohio youngsters of Robitussin, Coricidin HBP, DXM and other cough suppressants in combination with inhalants such as lighter fluid.
   It is naive to assume that this activity is limited to youth in Ohio.
   As soon as other states begin to survey this practice, I am sure we will find teens everywhere playing with this form of fire.
   And that they are getting seriously burned.

Over-the-Counter Drug Abuse

   The abuse of over-the-counter cold medication by teens is not new. An entire vocabulary exists regarding this phenomenon. Examples include:
   • Robo-ing — The consumption of DXM-containing cough syrup.
   • Robo-flipping — Being high on DMX.
   • Robotized — Combining an overdose of cough syrup and Dramamine.
   • Robo-tripping — Intentionally overdosing on over-the-counter cold medications such as Robitussin and Coricidin.
   • Triple Cs — Coricidin HBP Cold and Cough medicine (containing the highest level of DXM of the OTC medicines). The name comes from the "ccc"stamped on each tablet. It is also known as Skittles because it looks like the candy of the same name.
   In 2001, 14 people died from misusing cold medicine in the United States and several hundred were hospitalized.
   DXM is clearly a two-edged pharmaceutical sword.
Dextromethorphan (DXM)

   Taken in an appropriate dose, DXM is an effective non-narcotic cough suppressant. In large quantities it is said to have psychedelic qualities with users reporting feelings of euphoria, altered time perceptions, creative dream-like experiences, and hallucinations.
   However, DXM overdose may also include loss of balance, increased pulse, nausea, vomiting and lethargy. Cardiac dysrhythmia, seizures, hyperthermia, severe high blood pressure, loss of muscle control, mania, loss of consciousness, cerebral hemorrhages, stroke, coma, and permanent brain damage may also take place.
   There is more.
   Many medicines that have DXM also contain acetaminophen, pseudoephedrine, phenylephrine, and chlorophenirmaine. These can cause liver damage and serious heart problems when taken in the large amounts necessary to get the DXM high.
   For instance, if the wrong Coricidin product is purchased, an abuser may inadvertently poison himself or herself. That is, Coricidin HBP Cold and Flu also contains 325mg of acetaminophen and overdosing may cause irreversible physical damage.
   Finally, high doses of cough and cold medicines can be fatal when taken with monoamine oxidase inhibitors and selective serotonin reuptake inhibitors such as Prozac.
Adding the Fire

   The latest trend — Robo Fire — involves adding the huffing of inhalants such as lighter fluid to the DXM high.
   The Ohio Early Warning Network alert describes the mood-altering effects of Robo Fire as similar to those produced by crack cocaine or LSD:
   "Effects range from vivid, cartoon-like hallucinations to ataxia (inability to coordinate muscular movements), hyper-excitability, slurred speech, sweating, involuntary eye movement, hypertension and numbness. Brain damage, coma and death are also possible."
   Translated, this means that a novice user can die the first time DXM is mixed with huffing lighter fluid.
Education and Legislation

   The abuse of legal substances by teens is extremely hard to control.
   Discretionary money from an allowance or part-time job plus having access to transportation allows any adolescent to purchase OTC drugs containing DXM and lighter fluid. Many internet Web sites provide tutorial and peer support for this experience.
   I believe answers to this problem involve education as well as legislation.
   It is important that young people know the potentially fatal consequences of combining robo-tripping with huffing. Some of this education occurs in health education classes, but implementation of a community-wide prevention program centered on Robo Fire is important.
   Teacher and parent education regarding the signs of Robo Fire experimentation is critical. There is a strong ammonia smell produced when DXM is extracted from cough and cold medicines. The presence of empty bottles of cough syrup or lighter fluid in a child’s room is another red flag. Unusual lethargy should also not be ignored.
Ultimately

   But ultimately, we must ask why medicines containing DXM are able to be sold to minors. We must ask why they are placed on open shelves in easy shoplifting range.
   It is a simple act of legislation to back-shelf these products and require age-appropriate ID for purchase. We do it for narcotics and for tobacco products. Why not DXM?
   Such laws can be passed by our local community. We can petition our state and federal government to do the same.
   Education and legislation are the antidotes needed to put out the Robo Fire. Let us not wait until this blaze is too big to contain.
Judy Shepps Battle is a New Jersey resident, addictions specialist, consultant and freelance writer. She can be reached by e-mail at [email protected]. Additional information on this and other topics can be found at her Web site www.writeaction.com.