Dextromethorphan: a successful example of monitoring for emerging abuse using the toxic exposure surveillance system

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 [...]