Is taking cough syrup someone’s idea of fun?
Makers and sellers of the Double Cup brand of e-liquid products — which contain nicotine and are used in e-cigarettes — seem to think so.
The packaging for “Double Cup Liquids Spritech Lemon Lime E-Juice Syrup” and “Double Cup Liquids Pineapple Phantom Flavor E-Juice Syrup” mimics that of cough syrup bottles.
Officials at the Food and Drug Administration (FDA), however, don’t like the association between the two, so they’ve issued a
“By deliberately making or selling e-liquid products that look like prescription cough syrups, these companies are putting adults and children at risk of nicotine poisoning,” said Dr. Scott Gottlieb, the FDA’s commissioner, in a
The warning criticized
“The products not only use labeling with statements, representations and graphical elements that imitate legitimate cough medications, but they also have a list of ingredients that mimics a Drug Facts label,” Gottlieb said.
Experts told Healthline the situation is a serious matter.
“Ingesting rather than vaping these liquids is extremely dangerous and potentially fatal, especially for children,” said Linda Richter, PhD, director of policy research and analysis at the Center on Addiction.
The center’s research has found that about 75 percent of reports to poison control centers for exposure to e-cigarette products are among children 5 years and younger.
“The colorful [Double Cup] packaging and sweet smell of the liquids suggest that the product is a type of candy, syrup, or juice that can be ingested,” Richter told Healthline.
“When the product packaging literally shows a picture of a cup and mimics the appearance of a cough medicine — which is meant to be drunk — the risk of confusion and therefore ingestion is magnified, especially among young children,” she said.
Narcotic cough syrup is among the many legal drugs misused by adolescents and adults.
“Purple drank” is a street name for mixing cough syrup, carbonated drinks, and candy to get high.
Experts say that may explain the unusual cross-branding strategy of Double Cup.
“It could be a marketing ploy directed at kids, as adults are not and never have been ‘robotripping,’ but interestingly the percentage of kids misusing cough syrup with dextromethorphan has dropped precipitously over the past five years or so,” Sue Thau, a public policy consultant with Community Anti-Drug Coalitions of America (CADCA), told Healthline.
“So, if that’s the demographic they are going for with this tactic, I am not sure they will have a big market,” she said.
Overall, about 4 percent of people ages 12 and older in the United States have misused cough or cold medicine, according to the most recent data from National Survey on Drug Use and Health.
“In addition to potentially appealing to those interested in the illicit use of cough syrup, the packaging can make it easy to mistake the product for medicine more generally, which might also be a subtle way of conveying that they are somehow good for the user,” Richter added.
On April 4 the FDA sent letters to
The agency said the enforcement action was to protect children from tobacco-related products as well as preventing accidental overdoses.
The FDA has previously issued
“While the FDA continues to mull greater action with regards to tobacco product flavoring, they’ve been playing whack-a-mole with lots of questionably marketed products,” Andrew Romero, director of the Geographic Health Equity Alliance at CADCA, told Healthline.
The Double Cup Liquids Spritech Lemon Lime E-Juice Syrup packaging is apparently modeled after Actavis’ promethazine with codeine cough syrup. Double Cup Liquids Pineapple Phantom E-Juice Syrup mimics Hi-Tech promethazine hydrochloride and codeine.
Even exposure to relatively small amounts of the nicotine contained in these products “could result in acute toxicity,” according to the FDA.
“Severe harms can occur in small children from ingestion of liquid nicotine, including death from cardiac arrest, as well as seizure, coma and respiratory arrest,” the FDA warning states.
Mike Makhani, CEO of EZFumes, told Healthline that his company had Double Cup products “listed on our website for sale, along with several other e-liquid brands, and it has since been removed in order to maintain compliance.”
“We are internally auditing all of our products for sale online to ensure they are in line with regulations,” he added.
Officials at Undisputed Worldwide said they agree with the FDA warning and stopped production of these products two years ago.
“We understand that it is our duty to contact all vendors that still have our product listed online to take down these products,” said a statement from the company sent to Healthline. “We totally understand the issue regarding the FDA warning letter and we are with the FDA on this specific issue, which is why in 2017 we chose to discontinue the product. We are no longer EJuice manufacturers and hope that we can continue to keep bringing awareness to the Vape community.”
Richter says that Double Cup is reflective of the irresponsible and largely unregulated marketing of vaping and e-cigarette products as a whole.
“There is little to no regulation by the government of the advertising and marketing tactics of companies that sell these products, which increasingly are run by the big traditional tobacco companies who have decades of experience in cleverly marketing their products to maximize their appeal to young people,” Richter said.
“The products come in thousands of flavors, are typically mislabeled so that the consumer has no idea which toxic chemicals or how much nicotine are in them, and they are packaged to look like exactly like well-known candy products that directly appeal to children.
“The FDA recently has offered tough words and warnings to crack down on these companies but essentially has let the industry police itself,” she added.
As a result, instead of an “entire generation of young people who were on the cusp of being the first generation to reject tobacco product use,” the United States now has “an acknowledged epidemic of vaping among teens and young adults; a generation that is now hooked on nicotine, at increased risk of smoking, and more open than ever to using vaping devices and liquids to ingest not only nicotine but marijuana, alcohol, and other drugs as well,” Richter said.