Misty Fetko, a mother of two teenagers, got up early to walk the dog before she roused her boys from bed one summer day in 2003. Her eldest, Carl, a gifted guitar player and award-winning artist at his Ohio high school, never woke up.
"His friends told me his smile made their day," Fetko said of her 18-year-old, who had just been accepted to Memphis College of Art.
In the past, she had found empty bottles of Robitussin in their suburban New Albany home, but she had no idea Carl had a 2½ year drug habit. Fetko's skills as an emergency room nurse were of no use when she entered Carl's bedroom and administered CPR. She discovered he had died in his sleep of an accidental overdose of the cough syrup Robitussin.
"There were no other signs," said Fetko, who since then has helped others as a spokeswoman for the Partnership for a Drug-Free America. "I think Carl and his friends were under the impression that it was harmless because it was not illegal. There is a false sense of security, and it's so subtle: no smell, no needles, no drug dealers, you don't need a lot of money to buy it and you can use it after mom and dad go to bed."
"Robotripping" -- getting a hallucinogenic high with cold and cough medicines like Robitussin -- has increased 10-fold since 1999, according to a California Poison Control Center study released this week. The trend is nationwide, according to the six-year study on over-the-counter drug use, published in the December issue of Archive Pediatrics and Adolescent Medicine.
In the three years since Carl's death, which was reported by ABC News, use among even younger teens has increased 15-fold, according to the study. An estimated 75.4 percent of all users were between the ages of 9 and 17.
From California to Massachusetts, poison control centers answer more calls for near-fatal overdoses among teenagers, and many cases go unreported. This week, in El Dorado, Calif., seven high school students were rushed to the emergency room after swallowing five to eight tablets each of the cold remedy Coricidin.
At Barnstable High School in Massachusetts in September, a 14-year-old began vomiting through her mouth and nose and her brown eyes turned black after she took up to 10 pills of Coricidin HBP Cough and Cold -- a medicine students call "Triple C," "skittles" or "Dex," according to a report in the Cape Cod Times.
The active ingredient that killed Fetko's son was dextromethorphan, or DXM, which causes out-of-body sensations and hallucinations. An earlier cough syrup, Romilar, was taken off the market in 1973 after abuses were discovered. The trend re-emerged in the late 1990s. Robotripping takes its name from Robitussin, the second most-abused cold medicine after Coricidin.
Users can suffer irregular heart beat, high blood pressure and seizures, as well as overdosing and death.
"Younger kids are abusing all drugs, some as young as 7 and 8," said Alfred Aleguas, clinical manager for the Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island. Last year, the center received 45 phone calls involving the intentional abuse or misuse of cold medicines among 11- to 17-year-olds.
Even as the popularity of illegal drugs like Ecstasy, LSD and the date rape drug GHB have dropped, abuse of over-the-counter medicines such as Coricidin pills, Robitussin syrup and other easy-to-buy products are on the rise, according to the Partnership for Drug-Free America.
According to a survey done by the group in May 2006, one in 10 U.S. teens abuse cough medicine to get high. Such abuse is on a par with illegal drugs such as cocaine/crack and methamphetamine. The group surveyed more than 7,300 teenagers in grades seven through 12.
Misty Fetko says teenagers like her son think cold medicines are safer than PCP and LSD. She later discovered in her son's online journals that he was drawn to the hallucinatory effect of DXM. Some users become agitated and others lethargic, confused, dizzy or act as if they are drunk.
"There's a lot of peer pressure and stress for kids," said Fetko, who thinks her son was experiencing tension at school and from a family divorce. "He wanted to drown it out and escape."
Because these drugs are sold in pharmacies around the country and sit in their parents' medicine cabinets, teenagers believe experimentation is harmless, according to the Partnership for Drug-Free America.
The organization claims more glamorization of drug use in television shows, and music is partially to blame. "Perception that drug use has self-medicating benefits has risen significantly since 1998," reported the group in its 2005 tracking study.
The Internet also gives teenagers easy access to information on DMX use. Teens can use online calculators -- plugging in the brand of medicine and the "plateau" of the high they want to achieve -- to determine the right dosage.
What those sites don't tell teenagers is that when taken in large quantities DXM can cause the heart to race and blood pressure to climb, causing life-threatening side effects like seizures and elevated body temperature.
For Carl, the combination of the painkiller Fentanyl, marijuana and Robitussin caused his breathing to stop. The DXM, which is an opioid, can suppress respiratory function when taken in large doses.
Fetko was ignorant of her son's abuse. She had approached Carl a year earlier when she found marijuana in his room. At the time, he told his mother he and his friends had been experimenting.
"I'm not doing hard drugs, so don't worry," Carl told his mother. But he had been surfing the Internet for several years, showing an interest in other drugs as well as DMX.
In response to this growing trend, pharmacies like Walgreens, Rite Aid and Wal-Mart have voluntarily restricted sales of products that contain DMX to children younger than 18.
In 2004, Walgreens banned sales of more than three packages of Coricidin HBP to any age group; in 2005, the company put age limits on the sale of Robitussin, according to corporate spokesman Carol Hively.
"A lot of our stores have removed this medicine from the shelves so they are not shoplifted," she said.
Under federal law, pharmacies require signing for cold medicines like Sudafed that contain pseudoephedrine to control the production of methamphetamine. Prompted by teen overdose deaths in Florida, Washington and Virginia last year, the House is expected to vote this week on legislation that would restrict the sale of DXM powder to researchers, drug makers and other legitimate users.
After Carl's death, Fetko approached the administration at her son's parochial school to see if it was aware of this kind of drug abuse.
"I knew Carl couldn't be the only one," she said. "They said they had no idea there was a problem."
She spoke to Carl's senior class and since the tragedy holds an annual workshop for parents.
"I had a lot of trust and faith in Carl," said Fetko. "What I learned is every kid is vulnerable. Parents need to be aware of what is in the medicine cabinet at home. I work as a nurse in a large emergency room in central Ohio. I should have been right on the pulse of this culture of drug use, but I wasn't aware."