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Objective: It has been suggested that TESS could serve as a surveillance monitor for emerging trends in drug abuse. Dextromethorphan (DXM) has been shown to be a preferred drug for teen abuse in Cincinnati. We sought to determine if the nationwide TESS database observed a month to month change in teen DXM product abuse that might provide a model of surveillance effectiveness. Methods: Query of TESS human exposures, 1997-2001, by month, intentional abuse or misuse, teen or ages 13y to 19y, for DXM containing products and Coricidin[R] branded products with DXM. Result: There was also a non-sustained blip in Coricidin[R] and Corcidin[R] as percent of all DXM in October/November of 1998. Coricidin[R] as percentage of all DXM began a sustained rise in April/May of 1999, not leveling off until February of 2001. Over a 6 month period starting in August 1999 DXM calls almost tripled and Coricidin[R] calls, after doubling each of two months in a row, increased to 10 times baseline. Over the next two years DXM calls doubled again and Coricidin[R] calls tripled. Conclusion: It is clear that a dramatic and sustained rise in reports was observed over a short period. That the reports were specific for teens and abuse/misuse suggests a real emerging pattern and the value of TESS subset analysis in detecting it. A TESS monitoring strategy looking for accelerated total reporting of specific substances or branded products, including subset trends (eg., abuse, teen) would have detected this. Early detection of OTC product abuse could lead to changes such as restricted 'in-store' availability. The data supplied to us do not allow us to understand whether the trend started in one or a few locations and increased dramatically in only those areas or if it started in one or a few areas and reports increased as it spread nationwide., Simone KL, Bond GR. Northern New England P C & Cincinnati Children's [...]

Objective: Using stimulant ADHD drugs as a model, this study sought to assess the ability of the AAPCC TESS data alone to track prescription drug diversion and abuse by teens over time. Methods: Query of TESS human exposure numbers for Adderall[R], Ritalin[R] and generic methylphenidate, 1997 to 2001 (by month, with site of call) meeting criteria: Teen or age 13y to 19y; misuse or abuse; and numbers for Adderall[R], all human exposures. Results: Over the period, total reports of teen abuse/misuse of these ADHD drugs were essentially unchanged. Calls related to Ritalin[R] or generic methylphenidate fell 57%, replaced by Adderall[R]. Between Jan-Jun 1997 and Jul-Dec 2001 Adderall[R] human exposures reported to TESS steadily rose 8 fold. Reports of teen misuse or abuse of Adderall[R] rose 13 fold (from 4% of all Adderall[R] human exposure calls to 7%). Reports from health care facilities and from homes rose in parallel. Conclusion: TESS data alone reveal that reports of teen abuse of ADHD agents are stable, but that there is growing teen diversion and abuse of Adderall[R]. However, it is not clear if or how TESS data lead, lag or parallel actual teen abuse/misuse of these products. To understand this and the relative influence of other factors on TESS reporting (change in market share, ADHD stimulant therapy market growth, increased availability of prescription amphetamines to teens, teen abuse preference shifts toward amphetamine, shifts to abuse of diverted prescription amphetamine from illicit amphetamine or physician familiarity managing teen ADHD abuse complications), non-TESS data are required. However, TESS outcome data can help assess the impact of this changing pattern of ADHD drug abuse and suggest the influence of outcome severity on reporting frequency (reporting bias)., Bond GR. Cincinnati Children's Hospital, Cincinnati, [...]

Background: Dextromethorphan abuse is well documented. Many abusers dislike taking available liquid preparations due to their relatively low concentrations, unpleasant taste and propensity to cause vomiting. In response to this aversion, underground chemists have developed an extraction technique called Agent Lemon. We report a case in which a patient inappropriately applied this method. Case Report: A 17-year-old male presented to the emergency department approximately 18hours after ingesting an estimated '2 cups' of a combination of dextromethorphan-containing cough syrup, lighter fluid and ammonia. Symptoms included hallucinations, ataxia and numbness. He denied vomiting. His urine toxicology screen was negative, Chem-7 was within normal limits, ammonia = 38 mcg/dl and chest x-ray negative. His mental status and gait returned to normal within 8 hours and he was discharged following a psychiatric consultation. Discussion: Detailed instructions for the Agent Lemon extraction method can be found at http://www.erowid.org/chemicals/dxm/faq/ dxm_chemistry.shtml. The process is described as a dual-phase acid-base extraction in which the dextromethorphan hydrobromide salt is converted to freebase (with the addition of ammonia), extracted into a non-polar solvent (with the addition of lighter fluid) and converted back to the acid salt, dextromethorphan hydrocitrate (with the addition of a citric acid). Conclusion: Poison control centers and emergency room physicians should be aware that such information exists on the Internet. The additional toxicity concerns of ammonia and lighter fluid make these dextromethorphan ingestions unique., Roll D, Tsipis G. Cincinnati Drug and Poison Information Center, Cincinnati Children's Hospital Medical Center, Cincinnati, [...]

Background: There has been growing concern regarding the use of OxyContin as an opioid of abuse. Few studies have been published addressing the prevalence of OxyContin abuse in the general population and no studies have been published pertaining to the pediatric population. Our hypothesis is that there is significant OxyContin abuse in high school students. Methods: A 22-item survey adapted from the University of Michigan Monitoring the Future Project was administered at a single rural high school. Items surveyed included age of first use of OxyContin, number of times used, whether use had occurred in the past 30 days, and time of use. The targeted population of this study included all high school students. A research assistant administered surveys on a single day. This study received IRB approval. Only students with parental consent were allowed to partake in the study. Results: Of 780 students, 84 students received parental consent and completed the survey. Ninety-eight percent of these students had heard of OxyContin and 9.5% had tried OxyContin without parental knowledge. Of those that had used it, 50% had tried it more than 20 times and over half had used it within 30 days. Of the students that participated in the survey, 72% marked that it was 'not hard at all to get OxyContin.' Of those that responded that they used OxyContin, the majority marked that they had used it in the evenings and on the weekends. Conclusions: Though the capture rate was low in this pilot study due to lack of parental consent for student participation, the majority of students surveyed had heard of OxyContin and felt that it was not hard to obtain for use. In this sample, 9.5% of students claimed to have used OxyContin at least once in their lifetime. Physicians need to be aware of the risk of OxyContin abuse in this population., Holstege CP, Kell S, Baer AB, Fatovitch T. Blue Ridge Poison Center, University of Virginia, Charlottesville, [...]

Background: Drugs of abuse are an important cause of mortality in the young. There is little research in the UK literature relating to trends in enquiries concerning poisoning with drugs of abuse. The National Poisons Information Service (NPIS) accepts telephone enquiries from medical and paramedical staff about cases of suspected or actual poisoning. Methods: A retrospective audit of the enquiries to one of the NPIS Centres in the UK between 1990 to 2001. Details of cases involving drugs of abuse (amphetamine, butane, cannabis, cocaine, ecstasy, gamma hydroxybutyric acid (GHB), glue, heroin, khat, liquid lighter fuel, lysergic acid diethylamide (LSD) and Psilocybe semilancelata) were collated. Results: Total enquiries to the NPIS centre concerning actual or assumed self-poisonings has increased markedly from 5,602 in 1990 to 34,804 in 2001. Enquiries involving drugs of abuse increased from 97 (1.73%) in 1990 to 1,577 in 2001 (4.53%). Drugs used on the `club scene' have seen the biggest rise, with ecstasy increasing from 0.12% of enquiries in 1990 to 1.43% in 2001. The proportion of males was greater than females for each agent. The peak age of onset was 1-4 years for glue, 20-24 years for amphetamine and cocaine, but 15-19 years for the other agents. Conclusions: The total number of enquiries to one National Poisons Information Service Centre during this period has risen more than six-fold, with enquiries relating to drugs of abuse more than doubling during the same period., Freeman KG, Hutchings A, Thompson JP, Routledge PA. National Poisons Information Service (Cardiff Centre), Therapeutics and Toxicology Centre, University of Wales College of Medicine, Llandough Hospital, Cardiff CF64 2XX, [...]

Objective: The purpose was to describe trends in use of illicit substances by drivers < 21 years old in the IL Trauma Registry (ITR). Methods: The study was a descriptive analysis of the 1995 to 1998 ITR. Any detectable serum (>0.005 g/dL) and toxicology (tox) screens detecting cocaine, marijuana (THC), phencyclidine (PCP), and/or amphetamine were considered positive (+). Results: Of all 27,313 drivers, [EtOH] was measured in 13,642 (50%); 6,079 (45%) were > legal limit. Tox screens were obtained in 9,389 (34%); 2,383 (25%) were positive (see table). Of drivers < 21 years old with + serum [EtOH], 74% were > 0.08 g/dL and 81% were males. For those with a +tox screen, frequencies of drugs identified were: 1% cocaine; 17% THC; 65% PCP; 7% amphetamine; 9% mixed. Conclusion: In contrast to drivers of all ages, there appears to be a recent decrease in use of illicit substances documented in the ITR. Limitations of screening includes failure to detect new agents (e.g. GHB), variance due to analytical method, cross-reactions (e.g. PCP with diphenhydramine or dextromethorphan) and inability to distinguish prescribed from illicit drugs. Epidemiological data may support development and monitoring of injury prevention initiatives. (Conclusions are not necessarily those of IDPH.) 1995 1996 Detectable [EtOH] in drivers < 21 years 196 (11%) 178 (12%) (% of all drivers with [EtOH] > legal limit) Positive tox screen in drivers < 21 years 86 (17%) 87 (19%) (% of all drivers with positive tox screen) Positive [EtOH] and tox in drivers < 21 41 (48%) 23 (26%) (% of drivers < 21 years with positive tox) 1997 1998 Detectable [EtOH] in drivers < 21 years 189 (14%) 158 (11%) (% of all drivers with [EtOH] > legal limit) Positive tox screen in drivers < 21 years 120 (20%) 104 (13%) (% of all drivers with positive tox screen) Positive [EtOH] and tox in drivers < 21 55 (46%) 44 (42%) (% of drivers < 21 years with positive tox) Total Detectable [EtOH] in drivers < 21 years 721 (12%) (% of all drivers with [EtOH] > legal limit) Positive tox screen in drivers < 21 years 397 (17%) (% of all drivers with positive tox screen) Positive [EtOH] and tox in drivers < 21 163 (41%) (% of drivers < 21 years with positive tox) Abstract 104. Martens K, Hantsch C, Durazo-Arvizu R. Loyola University Medical Center, Maywood, IL, Martens K, Hantsch C, Durazo-Arvizu R. Loyola University Medical Center, Maywood, [...]