There's no cough, cold or flu — just a desperate need for a high. And so, a mixture of diphenhydramine (DPH), white rum, icy mint candy and clear carbonated soda to make a high-inducing drink is a fairly new deleterious trend among young people that has given health officials another need to worry after the Jamaica Observer's recent disclosure of growing use of mood-altering party drug Molly on the island.
A Sunday Observer investigation has uncovered widespread use of the DPH, white rum, icy mint and Sprite concoction since the emergence of the novel coronavirus pandemic.
Now, pharmacists are warning against reckless and repeated consumption of DPH, an over-the-counter medicine.
Mischa Christie, a registered pharmacist working at Sunshine Pharmacy in May Pen, Clarendon, told the Sunday Observer he is aware of the new trend and explained that it may cause adverse reactions.
"I've heard of that one recently, and it's quite puzzling. In any case, you should not be mixing alcohol with any medication. In this case, it's a little extra on the dangerous side, because DPH is a sedative and alcohol can make that worse. Not to mention if someone is using a type of DPH that has multiple drugs in it that will have their own effect when mixed with alcohol," he warned.
Christie added that there are various types of DPH, and if individuals experiment with one that has a cough suppressant, then they can get drunk to the point of passing out.
"That is likely due to the DPH and alcohol tag-teaming them to go to sleep and should they vomit, they can choke from that due to the lowered ability to cough and rid the airway of any invading products, which can cause asphyxiation and death. This can even happen without the DPH added, let alone now," he said.
"Also, alcohol and DPH can both act to dehydrate the body, which means an even worse hangover. In all seriousness, people should refrain from this or any other trend encouraging them to mix recreational substances with medication," Christie advised.
The Sunday Observer spoke with three men who have been using the concoction as what they call a "vibes builder". Speaking on condition of anonymity, they shared that it is something they do frequently.
The first man said he mixes the DPH with a popular powdered drink mix and clear carbonated soda.
"Sometimes mi add mint ball to give it the kick. The main ingredient is the DPH. A foreign style, enuh, but a after COVID start dem [Jamaicans] really pick up pon it. COVID make it more known, but before that mi used to have a friend in St Elizabeth who used to do it. We used to do it hard like a regular, everyday thing. COVID just hype it up. A one of the nicest thing," he said.
Just last week Health and Wellness Minister Dr Christopher Tufton noted that since the onset of the pandemic, several risk factors were quickly identified and efforts have been made to mitigate against them.
In 2019 there were 52 calls to the National Council on Drug Abuse (NCDA) helpline, which is primarily for individuals who are either struggling with substance abuse or who wish to seek help for addicts. By 2020, calls spiralled to 361.
Last Thursday, another man who uses the concoction told the Sunday Observer: "Is about $650 fi one DPH and mi normally use like two cork of it in half a cup of soda. If mi a use the full [bottle of soda], mi use half of the DPH and then mi put in the icy mint or [drink mix] fi give it dah flavour deh. But you have to be careful with the DPH. You haffi ready fi stay home or don't do no driving. Yuh cyaan operate no machine. It's a vibe."
Pharmaceutical Society of Jamaica Secretary Kevar Bennett said while he was unable to give figures, there has been an increase in demand for cough mixtures and other agents that contain precursor chemicals such as phenylephrine and ephedrine.
"DPH has oral preparations on the market such as pills and cough mixtures which contain phenylephrine and dextormethorphan. DPH is an antihistamine that can be used to treat allergy, cough, colds and induce sedation or sleeping," he said.
Phenylephrine is a medication primarily used as a decongestant, to dilate the pupil, to increase blood pressure, and to relieve haemorrhoids, and dextormethorphan is a medication most often used as a cough suppressant in over-the-counter cold and cough medicines.
"Overuse of these agents may lead to a stimulated central acting feeling which may cause you to have a euphoric, high feeling. DPH can mimic the high feeling caused by some recreational drugs due to feelings of extreme drowsiness. Large doses of DPH can also cause confusion and memory loss and lead to an overdose," Bennett explained.
The third man who shared his experience with the Sunday Observer said the concoction is preferred over liquor.
"Sometimes we use [soft gummies] too… but it haffi dissolve inna it. Not even liquor nuh nice so. A it mek wi have fun and enjoy wi self. We use it at party too, but me use it a my yard when me a hang out with mi friend dem and play music," he said.
"When my friend dem come a my yard a DPH alone dem want — no liquor. A it a the future. DPH a di future," he claimed.
Bennett, though, said that frequent users of DPH can develop a dependence on the medication, just like the people hooked on opioids.
"Ingesting alcohol or taking other drugs along with DPH can intensify the experience of being high, but it's extremely dangerous. The sale of other cough and cold preparations that contain precursor chemicals is increasing, possibly due to the fast movement of these agents and the demand by patients. From time to time we tend to see an upsurge in prescriptions from doctors for cough mixtures. Sometimes manufacturers are not able to supply the demand. Even now, we are out of Bromhexine and Tuscosed cough mixtures," Bennett said.
He told the Sunday Observer that he has had to deal with people who come to buy the medication for reasons outside of having a cold or flu.
"Patients come in all the time and ask for [DPH] for sleeping. Sometimes they say it knocks them out and they feel good. In cases where they are restless, having insomnia and have anxiety, we have to utilise our pharmaceutical counselling skills and let the patient know that overuse of this can cause dependence and stimulation, especially if it is induced with alcohol," Bennett said.
"One can overdose on DPH. Large doses of Benadryl can also cause confusion and memory loss, and lead to a benadryl overdose. As with some opioids, frequent users can even develop a dependence on the drug. Ingesting alcohol or taking other drugs along with diphenhydramine can intensify the experience of being high, but it's extremely dangerous," Bennett warned.
Christie, meanwhile, noted that DPH moves off the shelves quickly.
"The last time I was in the dispensary, back in May, DPH was always a fast-moving product. Fast-moving meaning it's a high-demand product. Being an allergy medication that can help with sleep, a lot of people tend to stock up, especially since flu or allergies tend to be a year-round issue in Jamaica," he said, noting that some people buy DPH for insomnia as well, which is still somewhat in the range of acceptable use.
"But, as pharmacists, we are aware that some people may try to get the type of DPH that can be mixed with another chemical to produce an illicit drug. The type of DPH that can be used to get an illicit drug is always kept behind a counter in all pharmacies, so a customer can never just take it up off the shelf like regular and other types of DPH. So, they'd always have to come in contact with someone before they get it," Christie said.
"You have DPH that just helps with runny nose and allergies, another helps with coughing and flu symptoms, some can help with stuffiness, and some help with productive coughs," he explained.
Christie said there's really no procedure or system in place to find out why someone may go into a pharmacy asking for DPH.
"To be honest, it's nothing specific, but the way someone asks for the product can be telling. For example, more than likely someone will ask for a product for their symptoms and then we'll recommend that. If someone comes asking for it by name, that can be a telltale sign. But then we would investigate further and ask them what they are experiencing to see if they actually need it for an acceptable use," Christie said.
Dr Adella Campbell, dean at the College of Health Sciences at the University of Technology, Jamaica, told the Sunday Observer that she believes the separation of care for individuals who abuse substances should be part of the mainstream health-care system, "Thereby making care more accessible at health-care facilities. Currently, if individuals are found to be delinquent or abusing substances, they are referred to agencies such as the National Council on Drug Abuse, and Alcohol Anonymous, inter alia. Individuals who abuse substances often interface with the health-care system for overdose or other physical health issues, rather than for mental health conditions."
"Despite this phenomenon, however, health professionals such as nurses, pharmacists and allied health practitioners are exposed to the area of substance abuse during their training. It is taught as part of some modules, such as mental health, and in all courses of study that address developmental issues, especially as it relates to children, adolescents and young adults."
In July, the Sunday Observer highlighted the growing use of Molly pills at parties, speaking to three users and a dealer of the drug. Health professionals had pointed out that use of the drug poses serious threats to the heart and the brain.