Trends in dextromethorphan cough and cold products: 2000–2015 National Poison Data System intentional abuse exposure calls

<p><b>Context:</b> Recent restrictions in access to and availability of dextromethorphan (DXM) cough and cold medications may correlate with changes in abuse exposures.</p> <p><b>Objective:</b> To extend and update existing knowledge about DXM abuse, we describe recent trends and patterns of calls to poison control centers involving DXM abuse, by demographics, geography, common brands, and medical outcomes.</p> <p><b>Methods:</b> We utilized data from the National Poison Data System (NPDS) maintained by the American Association of Poison Control Centers (AAPCC), which captures data on calls to U.S. poison centers on a near real-time basis. We analyzed demographic, geographic, brand and medical outcome data for single-substance DXM cough and cold product intentional abuse exposure calls in multiple age groups reported to NPDS from 2000 to 2015.</p> <p><b>Results:</b> The annual rate of single-substance DXM intentional abuse calls tripled from 2000 to 2006 and subsequently plateaued from 2006 to 2015. The highest abuse call rate was observed among adolescents 14–17 years old, where the mean annual number of calls was 1761 per year, corresponding to an annual rate of 103.6 calls per million population. From 2006 to 2015, the rate for single-substance DXM abuse calls among adolescents 14–17 years decreased by 56.3%, from 143.8 to 80.9 calls per million population.</p> <p><b>Conclusion:</b> DXM intentional abuse exposure call rates have declined among adolescents 14–17 years, since their peak in 2006. The observed decline in DXM abuse call rates corresponds to a period of growing public health efforts to curtail the abuse of over-the-counter (OTC) DXM containing products, particularly among adolescents. Further evaluation of state-level sales and abuse trends among adolescents would be valuable to better understand how restricted availability of OTC DXM cough and cold products and other efforts may affect abuse rates.</p

Baseline characteristics of men, ATBC Study.

<p>Medians (25^th, 75^th percentiles) are reported unless otherwise indicated.</p>*<p><i>P</i>-value for contrast between cases and controls by Wilcoxon rank sum test (medians) and Chi-square test (proportions).</p>†<p>Skin behavior in prolonged direct sunlight (self-reported).</p>‡<p>Light months = May–October, dark months = November–April.</p><p>Information on skin behavior and sun exposure was ascertained from a follow-up questionnaire which was missing for some men.</p

Adjusted odds ratios of melanoma by categories of serum 25(OH)D levels.

<p>OR, odds ratio; CI, confidence interval.</p><p>Conditional logistic regression models adjust for age at randomization, date of blood draw, height, weight, dietary cholesterol, and skin behavior (e.g., skin burns easily in prolonged direct sunlight (no/yes/missing)).</p><p>Darker months = November–April; lighter months = May–October.</p>*<p><i>P</i>-values based on test for trend.</p

Age-adjusted characteristics across quintiles of the deprivation index (Men, N = 233,205).

<p>Data are given as mean value or percentage of participants. Generalized linear models were used to estimate age-adjusted mean values for continuous variables and logistic regression for proportions within each deprivation quintile. There were approximately 3720 census tracts within each deprivation quintile.</p

Characteristics of patients undergoing radical prostatectomy.

<p>BMI, body mass index; PSA, prostate-specific antigen; SD, standard deviation.</p

Association between deprivation index and all-cause or cause-specific mortality.

<p>HRs (95% CIs) are reported.</p><p>Deprivation quintile 1 = least deprived, quintile 5 =  most deprived.</p><p>Multivariable models were adjusted for age, education, race, marital status, family history of cancer (cancer mortality model), physical activity, smoking, self-reported health status, BMI, energy, cholesterol (CVD mortality model), alcohol use, fruit, vegetables and meat intakes, and vitamin use. Models for women were additionally adjusted for menopausal hormone use.</p

Distribution of PFP quartiles by obesity.

<p>Distribution of PFP quartiles by obesity.</p

Clinical and pathologic tumor characteristics according to obesity.

<p>BMI, body mass index; PSA, prostate-specific antigen; PFP, progression-free probability.</p><p><i>P</i> value based on χ² test unless otherwise indicated.</p>†<p>Wilcoxon rank sum test;</p>‡<p>Student's t-test.</p

Age-adjusted characteristics across quintiles of the deprivation index (Women, N = 176,570).

<p>Data are given as mean value or percentage of participants. Generalized linear models were used to estimate age-adjusted mean values for continuous variables and logistic regression for proportions within each deprivation quintile. There were approximately 3720 census tracts within each deprivation quintile.</p