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Limit Access. Reduce Misuse.

What are Over-the-Counter medications?
Over-the-Counter (OTC) Medications are medicines used for many illnesses and ailments that do not require a prescription to obtain.

Growing concerns:
According to the National Institute on Drug Abuse 4.6 percent of eighth graders misused cough or cold medication in 2020. There has been an increase of OTC medication misuse among children and young adults recently, this can result in toxic or fatal reactions. Using these medications at a higher dosage then recommended can result in many dangerous side effects.

Slang terms to be aware of:
(Note: This is not a complete list)

As parents/guardians there are some common terms that children and young adults are using for OTC medications that you should listen out for.

Candy- typical slang for pills or medication

Skittles- similar to candy

Dex- abbreviation for dextromethorphan which is a common chemical in cough suppressants.

Drank- a mixture of codeine and promethazine, typically mixed with sprite and hard candy for flavoring. This concoction is known for its common purple coloring. Other terms for this are “lean”, “purple drank”, “sizzurp”, and “dirty sprite”. While this concoction is not new there has been a spike in social media buzz on these terms in recent years.

Robo- short for robitussin or other medications containing DXM.

Robotripping- drinking excessive amounts of robitussin and being under its influence.

Tussin- short for Robitussin

Triple C- Coricidin cough and cold is a medicine containing acetaminophen for pain, DXM for cough suppressant, and pseudoephedrine for nasal decongestant, when used in high dosages it can be very dangerous and typically results in hallucinations and dissociation.

Proper drug disposal:
Proper disposal of medications can limit access and lead to a reduction in medication misuse. The Virginia Department of Behavioral Health and Developmental Services has compiled a detailed report on “How and Why to Dispose of Medication” (https://www.dbhds.virginia.gov/assets/doc/OIH/drug-disposal-alert-detailed.pdf)

There are a few options on how to safely dispose of medications at home.

Flushing medications is a common way that individuals choose to dispose of medication, while this is one way to dispose of some medications we do need to be cautious of this. Some medications can contaminate local water sources if they are flushed. Before you flush your medication read the attached leaflet with the specific medication. You can also check with the FDA if the medication is safe for flushing. You can find a list of flushable medications at https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines#FlushList.

If you are unsure if you cannot flush a medication, it is better to not flush.

Medications can also be disposed of in the trash. Here are some ways to avoid improper drug disposal when you choose to discard of them in the trash.

Remove medication from original containers and mix them with something unappealing, such as dirt or cat litter. Contaminating medication like that will possibly deter someone from taking the disposed medication.

Put the medication in a new sealable container to prevent leakage.

Throw the container away.

Note: Be sure to scratch out or delete any personal information from medications. You can also purchase “confidentiality” stamps that you can use to cover your information, like the ones found here.

Prescription pain medications (opioids such has hydrocodone and oxycontin) can be discarded by using a specially designed disposal pouch. You can receive these pouches at no cost from NRVCS by emailing info@nrvcs.org – or through the New River Health District.

Medication disposal pouches are easy to use. Once you dump your expired or unused prescription opioid into the pouch, you simply add a small amount of warm water and give it a shake. After several seconds, the carbon-based product in the pouch helps to effectively deactivate the medication. Simply discard in the trash at that point.

Permanent ‘drop boxes’ in the New River Valley:

Several law enforcement agencies in the New River Valley have permanent ‘drop boxes’ on site, providing a safe way for residents to dispose of their unused or expired medications (pills only), including:

– Radford Police Department
– Dublin Police Department
– Giles County Sheriff’s Office
– Pulaski County Sheriff’s Office

Mike Wade, Coordinator of Community Wellness & Outreach, (left) and Dublin Police Chief Dennis Lambert pose with the permanent drop box purchased through NRVCS’ State Opioid Response funding. This drop box is located at the Dublin Town Hall.

Other drug disposal sites in the New River Valley:

There are many designated drug disposal locations throughout the state of Virginia, here are five within the New River Valley.

Community Pharmacy and Medical Supply 
2900 Tyler Road Christiansburg VA 24153 
540-639-1647
(Med safe box in lobby no sharps, preferably no liquids

CVS #07543
550 North Franklin St. Christiansburg 24073 
540-381-1153
(Med safe box located in Pharmacy)

CVS #10440
709 East Main Street Floyd, VA 24091
540-745-2177

The Pharm House
311 East Main Street
Floyd Va 24091
540-745-3333
(Take back to pharmacy. No restrictions. No sharps.)

Walmart 10-1292
2400 North Franklin Street
Christiansburg VA 24073
540-381-0882
(Take to Pharmacy)

Side Effects of OTC Medication Misuse:

According to the United States Drug Enforcement Administration (DEA) the effects of over-the-counter medications vary on dosage and individual.

When we look closely at DXM (commonly found in over-the-counter cough suppressants) we see levels of abuse resulting in a plateau of side effects.

The first plateau results in stimulant effects when about 100-200 mg of DXM is consumed. Mind you a recommended dosage of Robitussin is 20 ml which contains only 20 mg of DXM.

The second plateau occurs with DXM dosage of 200-400 mg in this plateau euphoria and visual hallucinations begin.

The third plateau (300-600 mg) includes visual hallucinations, euphoria, imbalance, issues with motor coordination, and issues with visual perception.

The highest level and fourth plateau are when an individual uses 600+ mg of DXM (this is the equivalent of drinking at least five four oz. bottles of Robitussin, 20 total oz.) At this level individuals can experience sedation, hallucination, and even dissociation.

Possible other side effects include liver damage, brain damage, and substance use disorder, according to the American Addiction Center.

DXM is not the only OTC medication that is misused or that results in side effects but it is the one commonly misused among children and young adults.

Why education on OTC medication misuse is important:

Over-the-counter medication misuse is more common among youth so education is vital to prevention of misuse. It is important for parents/guardians to have conversations with their children about dangers of overtaking or misusing medications.

Treatment and Hotlines:

Treatment of OTC misuse is very similar to that of typical substance use disorder treatment programs.

To learn more about treatment and support available to residents of the New River Valley through NRVCS, visit http://newrivervalle.wpengine.com/addiction/.

Additional resources:

The American Addiction Centers 24/7 hotline is (888) 971-0927.

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides online treatment information at their website, http://www.samhsa.gov/. Their hotline number is 1-800-662-HELP (4357). This helpline is 24/7/365 and available for individuals and their families.