Over The Counter Doesn’t Mean “Safe”

There are actually people in southern California who complain about the winter. You have to get your jacket out of storage. It gets dark too early, but luckily some people start their night lives earlier.

There are flus and there are coughs.

There is cough syrup.

When I was in grade school, the only cough syrup our kindly family practitioner could give was something with codeine. I was a sick little girl who seemed to be allergic to everything she touched, so I got a little of some kind of precious substance when the winter snows hit New England, and my respiratory system remained intact with that little bit of codeine.

It was 1958 when dextromethorphan came out. Like every alternative to addictive drugs in my memory, it has turned out to be, in the hands of some, at least as dangerous as the things it was supposed to replace.

Guiafenesin, which is an expectorant (“Cough it up; get it out of your chest,dear!”) added to dextromethorphan, used as a cough suppressant, gives us Robitussin and all its clones and related products. These products help keep states like Maine and Minnesota breathing during the winter.

I have never seen anybody who was ONLY a Robitussin (or generic) abuser. I have seen people who make cocktails of all sorts of OTCs (over-the-counters).

Once I worked at a prison where an awful lot of people complained of coughs. People who are used to using chemicals to try to solve personal problems will always find one that will.  Everyone has their own inclination.

Some psychopharmacologists think that all that the world needs is good safe highs for all.  Some liked to sleep through jail. Cough syrups tend to be caramel colored (for adults). “Pruno” was a cocktail comprised of anything and everything someone in jail could get their hands on and mix together. I suspect the name had something to do with the fact it was kind of caramel colored. When I have sniffed that compound, it did smell a bit like cough syrup.

Dextromethorphan is a “dissociative” drug. That means, by virtue of its antagonism of a particular set of (stimulating) chemicals known as the NMDA receptor, it “dissociates” perception of the world from consciousness. This can mean some pretty powerful visual hallucinations the same way that sensory deprivation or dream trances can produce hallucinations.

It is also classed as a “psychedelic” drug. By now I think everybody knows what that means. You tend to see wild, surrealistic stuff.

I often wondered, when I worked in the prison system, how many people complained of non-existant coughs just to get enough dextromethorphan to contribute to the Pruno. The inmates did tell me that a couple of people had mild hallucinations and plenty had none. Of course, I always thought some of those guys had already done so much to their brains that I wondered what functional brain cells — if any — were left.

Dextromethorphan is also in Coricidin where it is coupled with chlorpheniramine, which is an anticholinergic drug. These drugs do a lot of things to the central nervous system and can be useful for treatment or have a lot of side effects.

Now here is the fact that confounds me. In 2002, the folks who make Coricidin took out the pseudoephrine — less dangerous but which could raise blood pressure a little — and started calling the drug “HBP” because it no longer had the stuff that raised the blood pressure (and from which crystal meth could be synthesized without too much trouble. I am not going to find that link for you on the internet — so there!)

Instead, they put in the chlorpheniramine, and believe you me, anticholinergics in higher doses can screw up practically every function in your body.

On top of that, both chlorpheniramine and dextromethorphan are metabolized by the same enzyme system in the liver. That means if you take them both together, and they are in the same pill so if you buy Coricidin this is a tough one not to do, they will raise each other’s concentration in the body.

I am not just playing with enzymes in my spare time. It’s easy for anyone to get OTC drugs and human nature seems to tend toward taking way too much of them and sometimes people get crazy and sometimes, they die.

It is very possible to die from legal,  easily available drugs. In middle America, they called it an “adolescent craze”.

Please allow me to belabor the obvious: School children are taking over-the-counter, legal cold medicine to get high, and some of them die.

My guess is that, like many things in pharmacology, people have different “threshholds.”

Just as  some prisoners could have hallucinated from the Pruno and some people did not, some children can take cold medicine with no ill effects — maybe even no “buzz” — and a small dosage can kill others.

If you have to take something for your cough, read the label and use your head, and never take more of any medicine than has been recommended as a safe dosage.

Over the Counter does not mean — and never has meant — “take all you want.”