Maya Gold was a remarkable girl.

At age 11, after a trip to an animal sanctuary near her home in New Paltz, N.Y., she began volunteering there, and became a vegan, too. A few years later, after visiting a school for girls in India with her parents, she started making plans to volunteer in Nepal before college, working with girls forced into the sex trade. She is remembered—by friends, family, teachers, neighbors—as a curious, caring, joyful girl.

So it was not just heartbreaking but inexplicable when, a few weeks after her 15th birthday in October 2015, Maya took her own life.

Maya’s descent into darkness “was so quick and unexpected that we could not grab her in time,” Jonathan Kligler, Maya’s rabbi, said in a eulogy that was later published in the tight-knit town’s newspaper.

SPECIAL REPORT: HOW TO TREAT A COLD OR THE FLU

Looking for answers, Maya’s parents—Elise Gold and Mathew Swerdloff—learned from her friends that their daughter had, just two weeks before her suicide, started experimenting with over-the-counter drugs that contain the cough suppressant dextromethorphan, or DXM.

They uncovered a stash of OTC cough and cold products in her bedroom, and discovered that she had been shoplifting the drugs from a local supermarket, taking higher than recommended doses to get high.

While generally safe, in high doses DXM can cause a range of dangerous side effects, including abnormal heartbeat and sedation. It can also create a sense of euphoria and hallucinations.

And while Maya’s parents acknowledge that other factors may have contributed to their daughter’s suicide, they believe she might not have made that fatal choice had she not been under the influence of a heavy dose of DXM.

Abuse of the drug is not new: There have been reports going back to the 1960s. The Food and Drug Administration says it recognizes the potential for abuse and requires that labels emphasize proper use. And the OTC drug industry and some states have responded to the problem through a variety of education programs and restrictions meant to make it more difficult for teens to get their hands on the medication.

But those measures are not standardized from state to state, says Barbara Young, Pharm.D., of the American Society of Health-System Pharmacists. And many parents remain unaware of the extent of the problem or how serious it can be, adds Sharon Levy, M.D., director of the adolescent substance use and addiction program at Boston Children’s Hospital and associate professor of pediatrics at Harvard Medical School.

Misuse of DXM still sends an estimated 6,000 teens to the emergency room each year, and it can be fatal. And while cases of suicide possibly linked to the drug are uncommon, any drug that causes psychotic symptoms such as hallucinations could contribute to the type of tragedy experienced by Maya Gold’s family, Levy warns.

Teens and DXM Abuse

Dextromethorphan is found in more than 100 OTC products, including those from major brands such as Mucinex, Robitussin, Theraflu, Triaminic, and Vicks. It also comes in a variety of forms: liquid, gelcaps, lozenges, and tablets.

Slightly more than 3 percent of American teens abuse OTC cold and cough medicines, according to the National Institute on Drug Abuse (NIDA), and about one in three teens knows someone who has abused those drugs.

Users of DXM report a range of effects. At doses three to four times higher than those recommended on the product labels, the effect can be similar to alcohol, Levy says. And at even higher doses, DXM can create highs similar to the drug PCP (phencyclidine): visual and auditory hallucinations, euphoria, dissociative thinking or out-of-body experiences, restlessness, and loss of concentration.

Many OTC drugs that contain DXM also contain antihistamines, decongestants, pain relievers, and other ingredients. High doses of these individual ingredients can pose their own risks. For example, doses just slightly above the allowed daily maximum for the pain reliever acetaminophen can seriously harm the liver.

And excessive amounts of combination products multiply the risk of harmful side effects, warns Ruben Baler, Ph.D., a health scientist at the NIDA.

But many people, including parents, are often unaware of the risks. “We would assume that this kind of medication, if you could just go to the store and purchase it without a prescription, it must be safe, right?” says Maya’s mother, Elise.

Teens are attracted to these drugs precisely because they are easier to get hold of than, say, alcohol or illegal drugs. And though many parents are unaware that these OTC medications are sometimes misused by teens, information about using them to get high is readily available.

Social media blogs and websites are home to a world of DXM information and misinformation. Older kids might search abuse recipes, using words like “robo-tripping,” “skittling,” or “sheeting,” which means to take a whole blister pack of medicine.

Levy warns of the power of the internet to influence children’s abuse. “I think this is like kind of the Wild West,” she says, adding that a child may discover online a dangerous behavior she had never considered. 

Stemming Abuse

“We take this problem very seriously,” says Anita Brikman, senior vice president for communications and public affairs at the Consumer Healthcare Products Association (CHPA), the national trade association for manufacturers and marketers of OTC medicines.

In 2008 the manufacturers of cough and cold medicines voluntarily placed this warning on packaging for their products: “PARENTS: Learn more about teen medicine abuse: www.stopmedicineabuse.org.”

In 2010 the industry enacted a three-pronged plan to mitigate abuse through parent education, outreach to at-risk kids, and support of limiting access. For example, the CHPA tracks internet search terms related to DXM abuse, and directs kids to information about its potential harms, at WhatIsDXM.com.

Since 2012, 14 states have enacted laws to limit the sale of cold and flu medicines containing DXM to anyone younger than 18, according to the CHPA, which supports such legislation. In these states retailers must require proof of age before selling DXM products and are subject to warnings and fines if they sell the products to minors. Some chain drugstores, including Rite Aid, Walgreens, and Walmart, told Consumer Reports they have voluntarily adopted those restrictions for their stores nationwide.

But kids can still get their hands on the drugs. For example, while New York does restrict the sale of the drugs to minors, Maya Gold shoplifted the medications.

After her death, Elise Gold said, one local drugstore moved DXM products behind the counter, so if anyone wants one of the drugs, they have to talk with a pharmacist or cashier first.

That’s a step that some other pharmacies around the country have taken, on their own, for DXM. And the Food and Drug Administration requires it, nationally, for pseudoephedrine, another drug included in many OTC cold and flu drugs, such as Sudafed, because it is used to produce the illegal drug methamphetamine, or crystal meth.

Maya’s mother and father are now working with local representatives to pass a similar law for DXM in New York state. “There are so many ‘if-onlys,’ ” Elise Gold says. “One of them is, if only medications containing the powerful, mind-altering dextromethorphan were not easily accessible, perhaps our precious Maya would still be with us and we would not be having this discussion. If this bill were passed, lives could potentially be saved.”

Taking Action

Even if DXM products go behind the counter, kids will probably always still be able to get the drug one way or another—often by simply going to the family medicine cabinet, cautions Levy, at Boston Children’s Hospital. So parents and families need to stay alert. Here’s how, according to experts CR consulted:

  • Monitor all meds in the home. Know what’s in your medicine cabinet, Brikman says. Don’t leave meds lying around where your teens and their friends could be tempted.
  • Look for signs. Teens are often surprisingly bad at covering their tracks, Levy says. If you find empty medicine bottles or packaging under the bed, start a conversation. And don't hesitate to get help from a pediatrician or counselor.
  • Watch for behavior changes. Irritability, change in mood, change in friends, and increased isolation can be associated with any substance use; it can also signal depression or a medical problem. Those kinds of signs should be never attributed to just normal adolescent development.
  • Report adverse events. If you or someone you know has a bad reaction to DXM, you can report it online to the FDA’s MedWatch program, or by telephone at 800-332-1088.
  • Help teens to help each other. As Rabbi Kligler said in Maya’s eulogy: “When you see a friend losing their balance and teetering at the edge of the darkness of drug and alcohol abuse, you must be brave and act. Reach out your hand, and tell us what is going on, so that we can help.”

Editor's Note: This article also appeared in the January 2018 issue of Consumer Reports magazine.