Giant to limit access to DXM Grocer joins effort to prevent abuse of cough medication

http://www.baltimoresun.com/business/bal-bz.cough16may16,0,6393827.story?coll=bal-home-headlines

Giant to limit access to DXM Grocer joins effort to prevent abuse of cough medication

By M. William Salganik
Baltimore Sun reporter

May 16, 2007


Joining other retailers and chain pharmacies, Giant Food announced
yesterday that it won't sell certain types of cough medicine to
customers under 18 because the products have been abused by teenagers.

Beginning Sunday, Giant and other grocery chains owned by Royal Ahold NV
will limit sales of products containing dextromethorphan (DXM), a common
ingredient in cough and cold syrups, lozenges and pills.

"It's similar to buying cigarettes - if the cashier has a question, we
will ask for verification," said Jamie Miller, manager of public affairs
for Landover-based Giant Food Inc., which has 186 supermarkets in
Maryland and nearby states.

Among more than 100 products containing DXM are Robitussin Maximum
Strength Cough Suppressant, Sucrets 8 Hour Cough Suppressant and Vicks
44 Cough Relief, according to the National Institutes of Health. Those
brands also have products that do not contain DXM.

The Food and Drug Administration issued a warning in 2005 that five
teenagers died in cases "that may be associated with the consumption of
powered DXM," although it said the ingredient, when used as directed, is
"generally safe and effective."

Concerns over DXM heated up this spring when drug counselors on Long
Island reported nine teenagers hospitalized in one month after abusing
over-the-counter cough medicines, according to Newsday.

The importance of the action against DXM is a reminder that legal drugs,
even over-the-counter drugs, aren't safe if they're misused, said
Michael M. Gimbel, director of substance abuse education for the
Sheppard Pratt Health System. "When I go out to talk to parents, I have
my bottle of cough medicine," he said. Pharmacies have also restricted
sales of products containing pseudoephedrine, an over-the-counter
decongestant that can be used in the manufacture of methamphetamines.

"It's a sad state of affairs," Gimbel said. "We're slowly but surely
emptying the shelves of our pharmacies of over-the-counter medicines."

"As soon as we find out what the kids are up to and do something about
it, three days later, they're onto something else," he said.

Gimbel, and state and Baltimore health officials, said there is no
indication that DXM use is a particular problem in this area.

Dr. Peter Cohen, medical director of the state health department's
alcohol and drug abuse administration, said the state did not have any
figures tracking DXM abuse in Maryland and that it was "not high
prevalence compared to other substances."

Dr. Joshua Sharfstein, Baltimore health commissioner, said he had talked
to police, school health staff and drug abuse treatment providers, and
"so far, in Baltimore, it's not hitting our radar screens."

Sharfstein added that the city health department, after consulting with
pediatricians, doesn't recommend cough medicines containing DXM for
children under age 6, even when used as directed, because "there is not
an adequate margin of safety and they are not effective."

Nationally, a survey released in December by the University of Michigan
reported that 4 percent of 8th-graders, 5 percent of 10th- graders and 7
percent of high school seniors said they had used cough or cold
medicines to get high.

Abuse can occur either by concentrating DXM into powdered form or by
taking large amounts of the cough syrups.

"It isn't someone taking a few more tablespoons or a couple more pills -
it's 25 to 50 times the recommended dose," said Elizabeth Funderburk,
communications director for the Consumer Healthcare Products
Association, the trade association for manufacturers of over-the-counter
medications.

Gimbel and Cohen said that in large doses, DXM can produce feelings of
euphoria, but also disorientation and hallucinations. They said DXM can
be particularly dangerous when combined with other drugs or alcohol or
if used while driving.

Several states - including Maryland - have considered legislation this
year limiting sales of DXM to adults, but none has yet done so,
according to Kevin Nicholson, vice president for pharmacy regulatory
affairs for the National Association of Chain Drug Stores. His trade
association is also supporting similar federal legislation.

While DXM sales are not restricted by law, most large chain stores have
imposed voluntary restrictions, Nicholson said.

Among the stores that restrict the sale of products containing DXM are
Rite Aid, Wal-Mart, CVS, Target, Walgreens, Brooks, Eckerd and Costco,
according to Nicholson, with most adopting the policies since the FDA
warning two years ago. Safeway put DXM age restrictions in place in
March, said spokesman Greg TenEyck.

Although there haven't been widespread reports of abuse in this area,
"We were kind of taking the lead from the Food and Drug Administration,"
said Miller, the Giant spokesman.