DrugMonkey just had an interesting post about the potential influence of cocaine use trends following the 1986 death of Maryland college basketball player, Len Bias, just days after his being selected in the NBA draft by the Boston Celtics. DM’s post and the ensuing discussion got me thinking tonight about a variety of issues in substance abuse, realistic assessment of risk and, ultimately, parenting.
In the comments, I mentioned that Heath Ledger’s recent death might be a trigger for pop culture to pay more attention to the risks of recreational use of prescription and over-the-counter drugs as the attitudes toward illegal substances have grown less favorable.
Related to the DrugMonkey post, PharmGirl just tipped me off to this Benadryl nightmare at the Sweet Hill (OR) High School. Students have turned up in local emergency rooms after having taken 20 to 30 of the tablets, each containing 25 mg of diphenhydramine HCl.
At high doses, diphenhydramine’s central antimuscarinic effects become apparent as hallucinations but this is a terribly risky approach. Suppression of parasympathetic drive to the heart can cause tachycardia and lead to fatal cardiac arrhythmias. The story is deeply concerning:
Anastasia Park, 15, said she decided to try Benadryl after hearing about it from a friend. I took 30 the first time and 20 the second time,” Park said. “I got sent to the (emergency room) both times.”
Yes folks, she ended up in the ER once and still tried it again, this time taking “only” 20 tablets.
To their credit, the school district is educating students on the risks of ODing on Benadryl/diphenhydramine and sent letters home to parents advising them of this dangerous trend.
While on this topic, I thought I’d say a few words about a couple other drug trends among adolescents and young adults. A common practice among high school and college kids is Robotripping, taking high doses of dextromethorphan-containing cough syrup with the intent of drifting off into a dissociative mental state. While dextromethorphan, or DXM, can have its own toxic effects the dangers of robotripping can also result from other drugs present in OTC cough syrups.
According to my University of Florida pharmacy colleague Paul Doering from an interview late last month:
[R]obotripping is another example that teens regularly “find new and creative ways to hurt themselves. They have a crazy notion that if something is in a drug store, it has to be safe. That’s what is driving this trend among teens and young adults away from street drugs and to prescription or over-the-counter drugs.”
Doering said the ingredient dextromethorphan, also known as DXM, can drastically increase heart rate and blood pressure and can induce life-threatening effects such as seizures and elevated blood pressure. Other ingredients in cough and cold medicines also can create serious problems. For example, large doses of pseudoephedrine and antihistamines can cause high blood pressure and seizures, and acetaminophen can cause liver failure.
Sippin’ Syrup: Purple Drank
In the southern and southwestern US, codeine-containing prescription cough syrups have been popularized since the beginning of the decade by rap artists who often sing/sang of “Sizzurp,” “Lean,” or “Purple Drank,” the latter in reference to the purple-colored label or dye present in these products. These syrups often also contain antihistamines like promethazine (to offset the nausea-inducing effects of the opiate in sensitive individuals).
Houston-based rapper, Pimp C (Chad Butler), was found dead in his Los Angeles hotel room last December at age 33 from partaking in a codeine-containing cough syrup which, together with his history of sleep apnea, led to fatal respiratory depression. The Dallas Morning News noted that the bottle of syrup found in Pimp C’s hotel room did not contain a prescription label – not a surprise, as they report:
Houston has dealt with an epidemic of the illegal use of cough syrup for several years. In 2006, four local pharmacists were found guilty of drug conspiracy for selling more than 2,500 gallons of it to people without prescriptions.
Pimp C was not the first high-profile cough syrup-related casualty in the rap community: he was preceded in death by other Houston rappers, DJ Screw and Big Moe.
This discussion thread from 2004 (still live at faqs.org) gives some sobering insight on the rap community’s syrup scene.
Telling kids the truth
As DrugMonkey co-blogger PhysioProf noted,
Kids try to get high on Robitussin!? What the fuck ever happened to just raiding your parents’ liquor cabinet and smoking some doobs?
Kids are always going to, as Prof Doering said, “find new and creative ways to hurt themselves.” And kids are always going to experiment with various mind-altering substances, but there are some that can hurt much, much more than others. As a parent of someone who is not yet of that experimenting age, I often think about how we will negotiate these challenges in a very few short years.
Adopting a parental attitude of complete substance abstinence is likely to be as successful as endorsing sexual abstinence, but condoning any substance use in minors will get you thrown in the slammer and have your kids taken away. Of course, you’d love for your kids to stay clean and not use alcohol until they are 21. You want to tell your kids how cough syrup can kill you and how huffing solvents will give you extremely serious brain damage.
But it’s stepping over the line to tell them if they’re going to choose any illicit behavior, there are far safer alternatives.
How do other parents ethically approach this conundrum?
Addendum: Frequent and thoughtful commenter, DuWayne Brayton, expounds at his blog Inalienable Rights on “Drugs and Children, the Conversation that Never Ends.”