Cough syrup now in FDA’s line of fire

Common cough syrups and other cold remedies that contain the ingredient dextromethorphan, are being considered for prescription status by the feds.

As if dealing with a still-unresolved national salmonella outbreak tied to eggs in Iowa, and preparing for the new flu season lurking just around the corner were not enough to keep the folks at the FDA busy, their concerns are now shifting at least in part to teenage abuse of cough medicine. 

Currently, there is no federal law that requires purchasers of cough medicines containing dextromethorphan to have a prescription, or to show an ID card proving they are at least 18 years of age.

In order to address the problem of teen abuse of products containing dextromethorphan, which has been in widespread use since the 1950s and is found in almost every popular cough medicine, some are advocating that the products be subject to prescription. This would be an unnecessary overreaction.

As many doctors, pharmacists and other healthcare experts know, once it becomes common knowledge among teens that a particular substance can lead to a “high,” young people will find some way of obtaining it; regardless of whether access is restricted. Parents of teens, including those not trained in medicine or pharmacology, know this to be the case. With cough medicines, the perceived “high” reportedly is neither intense nor easy to achieve — requiring the ingesting of a whole bottle or more of the liquid. Still, the problem persists and, while dextromethorphan is not an addictive substance, it can lead to habitual use, and many of its adherents abuse other, more dangerous substances as well.

The problem then becomes, what reasonable steps can be taken to limit the harm to young people by abusing otherwise popular products that are used by millions of adults and children alike on a regular basis for a legitimate reason?

Moving products containing dextromethorphan behind the prescription counter almost certainly will significantly reduce sales of such products, since many adults will decide to forego the hassle and added expense of seeing a physician simply to obtain a prescription for cough syrup, in favor of other remedies, or none at all. Manufacturers of the products will suffer financial losses, as will drug stores. 

Whether this example of “throwing the baby out with the bathwater,” and inconveniencing millions of adult users and parents who need cough syrup for their kids, in order to slow the abuse by some teens (estimated at five percent of teens in the country), will be recommended to the FDA at the September 14th Advisory Committee meeting remains to be seen. There are much more reasonable and less intrusive solutions already on the table. Sen. Richard Durbin (D-IL), for example, has introduced the “Dextromethorphan Abuse Reduction Act,” which would require identification and includes other regulatory and legal provisions, but would not mandate prescriptions.

On balance, it is apparent that the vast majority of parents, cold sufferers, drug manufacturers, pharmacists and doctors would hope for a more reasonable decision by the FDA; as well they should.  

Barr is a former member of the House of Representatives.