Yet another addictive over-the-counter drug is endangering youths in Bangladesh just as the government appeared to have brought the phensedyl menace under a semblance control.
Dextromethorphan (DXM) is an active ingredient in many different widely available cough syrups. While it is an effective cough suppressant in small doses, moderate to high doses can have psychoactive effects similar to ecstasy, ketamine, or PCP, according to a US Drug Enforcement Administration (DEA) fact sheet.
Three undergraduate students in Dhaka recently told this newspaper they had developed a habit for drinking DXM after realizing that taking more than the doctor prescribed dose made them “tipsy.” They often mix it with fruit juice and sleeping pills, calling the concoction the “poor man’s alcohol.”
One of the three said he could no longer stop drinking DXM even if he tried. Moderate doses (200-400mg) give a feeling of euphoria and cause some hallucinations, while doses higher than that can lead to an out-of-body experience.
Dr Md Sohel Rana, professor at the department of pharmacy of Jahangirnagar University, told Dhaka Tribune there are many cough syrups available these days that have less side effects than those that contain DXM.
“Dextromethorphan is a bit outdated and, as far as I know, not many doctors prescribe it to their patients, particularly children,” he added.
The professor suggested making prescriptions mandatory for the sale of cough syrups that contain DXM, since the substance is prone to abuse.
“DXM is not as addictive as heroin or meth, but it can be abused in high dosages,” he said.
Available and accessible
Some cough syrups that contain DXM can be brought for Tk25 to Tk50 at drug stores in different parts of Dhaka city. Most of the stores did not ask for a prescription when this correspondent asked to buy the cough syrups.
Dextromethorphan has been termed as the “The Poor Man’s Psychosis” in an international publication at the US National Library of Medicine - National Institutes of Health in 2017. The researchers found that dextromethorphan was prone to being abused.
“When consumed at inappropriately high doses (over 1500 mg/day), DXM [ dextromethorphan] can induce a state of psychosis characterised by Phencyclidine (PCP)-like psychological symptoms, including delusions, hallucinations, and paranoia,” the report states.
Another paper titled Dextromethorphan Abuse in Adolescence states that taking large amounts of OTC cough and cold products for the DXM content also poses serious risk of toxicity from the hidden ingredients, such as pseudoephedrine, acetaminophen, and antihistamines.
High doses of acetaminophen may result in delayed liver failure, the paper mentioned.
A danger to children
In December last year, three children died in India allegedly after consuming DXM-containing cough syrup that was prescribed by doctors.
According to Indian officials, Kalawati Saran Children's Hospital reported 16 cases of dextromethorphan poisoning among children aged between one and six from June 29 to November 21 last year, reports NDTV.
The Print reported that India’s apex child rights body, the National Commission for Protection of Child Rights (NCPCR), asked the Delhi government to ensure that DXM is not supplied or used in the city after the incidents.
Mojibul Islam, managing director of Amico Laboratories Ltd, told Dhaka Tribune that Amico has stopped producing Coldflu syrup, which contains DXM, since medicines with the substance require clearance from the narcotics department.
“We did not want to go through the hassle, and therefore we stopped Coldflu production,” he told Dhaka Tribune.
Mojibul Islam, who is also a member of the Bangladesh Association of Pharmaceutical Industries, added that the real problem is the abuse of medicine, not the medicine itself.
“This particular cough suppressant should not be an over-the-counter drug. If pharmacies stop selling this drug without prescriptions, it would go a long way towards solving the problem,” he said.
Directorate General of Drug Administration (DGDA) Director Md Ayub Hossain told Dhaka Tribune that the DGDA restricts or bans any drug if the narcotic department alerts them to it being prone to abuse.
“It is not like we impose a ban or recall a medicine right away after the narcotic department’s call. We sit and talk to the experts and then come to a decision,” he told the correspondent.
He said he had not yet received any alert on DXM, but pharmacies should be careful about selling medicine that can lead to addiction.