After a targeted campaign designed to reduce teen abuse of over-the-counter (OTC) cough medicine was introduced, reported abuse by teens decreased 35 percent, a new study finds. The Consumer Healthcare Products Association (CHPA), which spearheaded the campaign, says while the study doesn’t prove the effort led to the decrease, it suggests it played a role.

“Before 2006, there were anecdotal reports about teens abusing cough medicine, but we were able to track it starting in 2006 when the Monitoring the Future annual survey of teens started asking about cough medicine,” said David Spangler, CHPA Senior Vice President of Policy, and General Counsel & Secretary. In 2010 the Food and Drug Administration announced an advisory committee to study the issue of abuse of cough medicine containing dextromethorphan (DXM), to determine if it should become a controlled substance.

An estimated 3 percent of teens abuse cough medicine, according to the 2015 Monitoring the Future survey. When first reported by Monitoring the Future in 2006, teen OTC cough medicine abuse was at just under 6 percent.

DXM is the active ingredient in most OTC cough medicines. According to CHPA, it is safe and effective when taken according to labeling instructions. However, when taken in excessive amounts higher than recommended doses, DXM can produce side effects including nausea and vomiting; stomach pain; confusion; dizziness; double or blurred vision; slurred speech; impaired physical coordination; rapid heartbeat; drowsiness; numbness of fingers and toes; and disorientation.

In addition, many medicines containing DXM may also contain other ingredients such as antihistamines, analgesics or decongestants. High doses of these combination medicines can greatly increase the harmful effects, such as potentially fatal liver injury, cardiovascular effects and over-sedation. Teens sometimes abuse DXM along with alcohol or other drugs, which can cause additional harmful effects, according to CHPA.

“We realized we needed to deal with cough medicine abuse with a systematic campaign and clearly defined goals and objectives,” Spangler said. Working with a number of groups including the Partnership for Drug-Free Kids and with member companies of CHPA that made cough medicine, the association developed a three-pronged campaign. It was designed to raise parental awareness of cough medicine abuse; increase teen perception of risk and social disapproval; and limit teen access to the products.

Designing the campaign was challenging on several fronts, Spangler noted. The association wanted to reach teens at risk of abusing cough medicine, without suggesting the idea to teens who might not otherwise have thought about trying it. The campaign did this in part by targeting websites likely to appeal to risk-taking teens.

And because cough medicine abuse is dangerous but in most cases not deadly, “we had to address the risk authentically in a way that suggested we weren’t trying to use scare tactics,” he said. The campaign included YouTube videos, Facebook and mobile app experiences, teen testimonial videos, and a website, all of which were tested with target teen audiences before launching. “The authenticity of these messages is intended to discourage teens from abusing DXM without turning them off from listening,” the researchers wrote in the journal Substance Abuse Treatment, Prevention, and Policy.

The campaign aimed to reach parents with the message that they should talk to their teens about DXM abuse, and to safeguard and monitor DXM-containing medicines in the home. “The conversation between a parent and their child is critical, as teens are up to 50 percent less likely to use drugs if they learn about the risks from their parents,” the study noted.

To restrict teens’ access to cough medicine, CHPA worked with a large number of retailers to voluntarily age-restrict cough medicine purchases to allow sales only to buyers 18 and older. In stores complying with the program, the system prompts the clerk to check the buyer’s age.

The association also has been advocating for state laws to restrict sales of OTC cough medicines containing DXM to minors. Florida and Delaware are the latest states to enact such legislation. The laws are designed to decrease the abuse rate of these medicines by teens, while maintaining access for legitimate consumers of these products. California was the first state to prohibit sales to minors in 2012. Other states that ban DXM sales to minors include New York, Arizona, Louisiana, Virginia, Kentucky, Washington, Tennessee, New Jersey and Alaska.

The CHPA campaign is ongoing. “We realize that every year there’s a new generation of teens coming who are engaging in risky behaviors, so we have to keep on top of this,” Spangler said.