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."