Dextromethorphan Addiction

SpringBoard Recovery provides effective treatment for substance use & mental health disorders.

Evan Leonard

MS, MMS, PA-C

Dr. Leonard is a Doctor of Medical Science and a clinical anatomist. He has practiced in both internal and emergency medicine and has published several, peer-reviewed articles and a medical book chapter.

Dextromethorphan (DXM) is an active ingredient in most cough medicines sold in the United States. These medications do not need a prescription. They can be bought over-the-counter in many stores, including grocery stores.
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Robo-Tripping On DXM

Dextromethorphan (DXM) abuse has become a trend among teens in the United States. It is available over-the-counter. Many states have laws in place dictating how old a person has to be to buy it, not all do.

Teens can learn online how to get concentrated DXM from non-prescription cough medicines. Yet, many don’t know abusing DXM carries dangerous and life-threatening risks.

Dextromethorphan (DXM) addiction is a problem in the U.S. among children and teenagers. Getting high on DXM is called “robo-tripping.”

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What is Dextromethorphan (DXM)?

Dextromethorphan (DXM) is the most used cough suppressant ingredient in the United States. It was approved by the U.S. Food and Drug Administration (FDA) in the 1950s. It is in over 125 OTC cough medications.

DXM temporarily relieves a cough, but it does not treat the cause of the cough. It works by inhibiting the cough center in the brain.

DXM is a man-made chemical produced from levomethorphan. This is a synthetic opioid-like drug that mimics the behavior of opioids.

DXM became the active ingredient in many cough medications in the 1970s. The FDA outlawed the use of codeine, a synthetic opioid, in cough medications. DXM was the replacement.

DXM is in the morphinan class of drugs. This is a large group of psychoactive drugs that includes dissociative hallucinogens. This is the reason why teenagers choose to misuse and abuse these medications to get high.

An extra danger with DXM is it can be found in multi-symptom cold and cough medications.

Multi-symptom medications have other active ingredients such as:

  • Acetaminophen, a non-aspirin pain reliever
  • Antihistamines, which are drugs that relieve nasal congestion
  • Guaifenesin or another expectorant (a medication that clears phlegm from the airways)

Abusing multi-symptom cough medicine can lead to extra doses of the other ingredients. Excessive doses of the other ingredients can lead to nausea, anxiety, and organ damage.

DXM is an Opioid-Like Hallucinogenic Drug

DXM is a synthetic (man-made) chemical produced from levomethorphan – a synthetic opioid-like drug that mimics the behavior of opioids, such as heroin, morphine, or codeine.

DXM became the active ingredient in many cough medications in the 1970s when the FDA outlawed the use of codeine, a synthetic opioid, for this purpose.

Although it is not as potent as an opioid, DXM is in the morphinan class of drugs, a large group of psychoactive drugs that includes dissociative hallucinogens and opiate analgesics.

This is the reason why teenagers choose to misuse and abuse these medications to get high.

Over-the-counter Drugs: The Misuse of Dextromethorphan (DXM)

Video provided by Demystifying Medicine (December, 2019)

However, an additional danger with DXM is it can also be found in multi-symptom cold and cough medications, which contain other active ingredients, all formulated for the correct doses, such as:

  • Acetaminophen, a non-aspirin pain reliever
  • Antihistamines, which are drugs that block histamine, a chemical that causes nasal congestion, and
  • Guaifenesin or another expectorant (a medication that clears phlegm from the airways)

The use of excessive doses not only delivers high quantities of DXM –  it also delivers excessive doses of the other ingredients, which can lead to nausea, anxiety, and organ damage.

How Can I Identify a DXM-Based Cough Medication?

The ingredients in any medicine are listed in the Drug Facts label printed on the package.

DXM can be listed as:

  • Dextromethorphan
  • Dextromethorphan hydrobromide
  • Dextromethorphan HBr

Cough medicine that contains DXM will have a black and white “Stop Medicine Abuse” icon on the package. Store brands or generic brands contain the same ingredients, including DXM.

Parents, look for the stop medicine abuse icon for products containing DXM. Visit stopmedicineabuse.org

Icon Awareness Social Graphic

Source: StopMedicineAbuse.org

IMPORTANT: Please remember that store brands, private label, or “generic” brands of these products contain the same ingredients as brand-name products, including DXM.

Most Popular Brands of OTC DXM-Based Cough Medications

(Source: Walmart, August, 2021)

  • Advil
  • Alka-Seltzer Plus
  • Benadryl
  • Chloraseptic
  • Claritin
  • Cold-Eeze
  • Coricidin
  • Dimetapp
  • Emergen-C
  • Equate
  • Great Value (Walmart)
  • Halls
  • Hyland’s
  • Mucinex
  • Pure Leaf
  • Ready In Case
  • Ricola
  • Sudafed
  • Spring Valley
  • Tylenol
  • Theraflu
  • Vicks
  • Zarbee’s
  • Zicam

All of these branded cough medications contain dextromethorphan HBr (DXM), and are available in one or more of the following forms taken orally:

  • Liquid-filled capsule
  • Chewable tablet
  • Dissolving strip
  • Liquid solution (liquid
  • Extended-release (long-acting) suspension (liquid)
  • Lozenge

You can access a complete list of all OTC DXM-Based Cough Medications available in the U.S. from the FDA website: https://www.accessdata.fda.gov/scripts/cder/ndc/index.cfm.

You will need to select the Nonproprietary Name option from the Type drop-down menu, and type “dextromethorphan” in the search field below.

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How is DXM Abused/Misused?

DXM became a popular drug for recreational misuse and abuse by teenagers in the early 2000s.

Teenagers are more likely to misuse drugs like OTC cough medicines. This is because they are legal and easy to get. They can learn where to buy DXM and how to use it to get high from their friends or online.

DXM can be used in its OTC form, as a syrup, capsule, or lozenge. It can also be extracted from cough syrup, and then made into a powder or capsule of pure DXM.

DXM has to be used in excessive amounts to get the euphoric and hallucinogenic effects. It would be 25 times more than the dose, or at 1,500mg per day.

DXM: How Does It Work?

DXM attaches to the receptors in the brain that attract the neurotransmitter NDMA. DXM is an antagonist for NDMA. This means it stops its actions; this is how the coughing reflex is suppressed.

When misused or abused, DXM triggers a flood of serotonin in the brain, creating a euphoric high. Serotonin is a hormone found in the brain. It is a neurotransmitter and a vasoconstrictor. A vasoconstrictor is a substance that causes blood vessels to narrow.

A lack of serotonin in the brain could be a cause of depression.

DXM can interact with psychiatric medications. This includes antidepressants like SSRIs, tricyclic antidepressants, and MAOI inhibitors.

These medicines change the levels of serotonin in the brain. Mixing DXM with antidepressants can be dangerous and possibly fatal.

Surge of Serotonin

However, when misused or abused, DXM triggers a flood of serotonin in the brain, creating the euphoric high. Serotonin is a hormone found in the brain. It acts both as a neurotransmitter and a vasoconstrictor (a substance that causes blood vessels to narrow).

A lack of serotonin in the brain is believed by medical experts to be a cause of depression.

It also means that DXM can interact with psychiatric medications, including antidepressants like SSRIs, tricyclic antidepressants, and MAO inhibitors.

These medicines are designed to change the levels of serotonin in the brain, they can be dangerous when mixed, and can be fatal when taken with too much DXM.

A Discussion On Over-The-Counter Cough Syrup Misuse

Featuring: Dr Bernard & Dr Sonal Jagasia (May, 2021)

Kids “Robo-Tripping” Before Class

Step-by-step guides about getting DXM from cough medicines can be found online. This allows adolescents to create their own concentrated DXM powder.

They can then use the drug to get high. There are many reports of teenagers robo-tripping before school.

The maximum recommended daily dose for DXM is 120 mg. This dosage is meant to be spread out throughout the day. More than this can result in intoxication and dangerous side effects.

There are four levels experienced by those who abuse DXM:

  • 100-200 mg causes mild stimulation and euphoria.
  • 200-400 mg causes a stronger euphoria and hallucinations.
  • 300-600 mg causes the loss of motor coordination and visual distortions.
  • 500-1,500 mg causes out-of-body sensations.

DXM Street Names

Most people refer to dextromethorphan as DXM, but it has a number of well-known street names, too:

  • Skittles
  • Robo
  • Candy
  • Drank
  • Red devils
  • Triple C
  • CCC
  • DX
  • Tussin
  • Vitamin D
  • Poor Man’s PCP
  • Dex
  • Drex
  • Velvet
  • Orange Crush

Getting high on DMX is often referred to as “skittling,” “dexing” or “robo-tripping.”

DXM: Side Effects

When people misuse DXM to get high they can have hallucinations. They may also experience “out-of-body” sensations.

DXM misuse can also depress brain function. It can strongly affect the parts of the brain that control the heart and breathing. The effects can last for six hours.

The dangerous side effects upon the brain and the body of DXM misuse can include:

Psychoactive Effects on the Brain

  • Agitation and restlessness
  • Spontaneous laughter
  • Confusion
  • Euphoria
  • Paranoia
  • Hallucinations
  • “Out of body” experiences

Physical Effects on the Body

  • Lethargy
  • Loss of motor control
  • Excessive sweating
  • Blurred vision and slurred speech
  • Nausea and / or vomiting
  • Irregular heartbeat (tachycardia)
  • High blood pressure

Serious & Life-Threatening Side Effects

  • Loss of consciousness
  • Seizures
  • Hypothermia (extreme high fever)
  • Coma
  • Death

DXM Poly Use

Poly use is when drugs are combined recreationally to feel the effects of each drug at the same time. Ultimately, this increases the risks associated with each drug.

When DMX is taken with the following substances it can become lethal:

  • Alcohol
  • MDMA
  • Antidepressants

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WARNING: Serotonin Syndrome

If you take antidepressants and misuse DXM you can get Serotonin Syndrome. This is a serious condition that needs medical treatment right away. Serotonin Syndrome can cause death.

Mild symptoms include high blood pressure, an irregular heartbeat, tremors and severe sweating. However, more symptoms can develop and rapidly worsen.

Serotonin Syndrome: Moderate to Severe Symptoms

  • Involuntary eye movements
  • Irregular pulse rate
  • Muscle rigidity
  • Renal failure
  • Hyperthermia greater than 41.1°C
  • Death

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DXM Misuse & Addiction in the U.S.

According to one 2014 study, 1 in 4 teens knows someone who has misused or abused OTC cough syrups to get high.

The 2019 Monitoring The Future study states 1 in 27 teens reports abusing DXM to get high. In 21 U.S. states, age limit regulations are in place to prevent minors from purchasing DXM.

Today’s teens can buy pure DXM powder online in much larger quantities. For example, you can buy it on eBay. However, this creates another problem. Authorities have found DXM tablets with pseudoephedrine or methamphetamine mixed in.

DXM Misuse & Addiction in the U.S.

Additionally, today’s teens can purchase pure DXM powder (in multiples of 1 gram) online in much larger quantities.

For example, you can buy it on eBay. However, this creates another problem. U.S. authorities have uncovered DXM tablets where the drug has been mixed with pseudoephedrine and/or methamphetamine.

As you can see from recent results of the National Institute on Drug Abuse’s (NIDA) annual “Monitoring The Future” study, the misuse of OTC cough medications remains an issue, and among 8th Graders, it continues to worsen year-on-year:


Drug


Time Period


8th Graders


10th Graders


12th Graders

 

 

 

 


2017


2018


2019


2020


2017


2018


2019


2020


2017


2018


2019


2020


OTC Cough /
Cold Medicine


Past Year


2.1


2.8


3.2


4.6


3.6


3.3


2.6


3.3


3.2


3.4


2.5


3.2

Can You Overdose on DXM?

Yes, you can overdose on an excessive quantity of DXM. Because it is easy to buy pure DXM powder online, people misusing the drug can ingest enough to overdose.

Someone who overdoses on DXM risks brain damage or seizures, and, again, can die.

A moderate overdose of pure DXM does not have serious adverse effects for most people. Approximately 5% of people cannot metabolize the drug normally. This causes rapid acute toxic levels.

A DXM overdose can have a wide range of adverse effects, including:

  • High blood pressure (hypertension)
  • Extreme high fever (hyperthermia)
  • Seizures
  • Irregular heartbeat (tachycardia)
  • Psychosis, and
  • Rhabdomyolysis (described previously)

In the event of a DXM overdose, you should call 911 immediately.

Can You Become Addicted to DXM?

Yes, it is possible to become addicted to DXM. Many people assume DXM is a safe drug because it is sold over the counter, and, in the correct doses, DXM is safe.

But, misusing this drug for a long time can result in dextromethorphan use disorder. Dextromethorphan use disorder is the medical term for DXM addiction.

As with all SUDs, signs and symptoms of an addiction to DXM can include:

  • Denying you have a problem with DXM
  • Using the drug to feel better about yourself
  • A strong desire or compulsion to take DXM
  • Reduced ability to control the use of the drug
  • Physical withdrawal symptoms when attempting to stop or reduce DXM use
  • Tolerance to dextromethorphan
  • Use of higher amounts to achieve the same effect
  • A pattern of use that causes you to neglect of other areas of life

What’s the DXM Trip Like?

Featuring: CG Kid (August, 2017)

Treating DXM Addiction

Treating DXM addiction requires detoxification and a professional addiction treatment program. Trying to quit using DXM on your own is very difficult. You can experience both physical and mental symptoms which are uncomfortable. This can make many people start using it again.

DXM addiction requires a treatment program for a long-term and sustainable recovery.

Many people misuse medications and illegal drugs because they are self-medicating. It could be for a mental health disorder, trauma, or a behavioral issue.

Some teens abuse DXM out of curiosity or because their friends and peers are pressuring them to try it. Once they realize they enjoy the effects of misusing DXM they want to experience them again.

DXM: Medical Detox

Someone with DXM addiction should go through detox at an accredited facility. This type of facility can provide medicine to make withdrawal symptoms less severe.

The symptoms of DXM withdrawal can include:

  • Tremors
  • High blood pressure
  • Tachycardia (irregular heartbeat)
  • Nausea and vomiting
  • Sweating
  • A state of agitation
  • Anxiety, and
  • Intense cravings for the drug

A professional detox will remove any traces of DXM from your system. It will also get rid of any toxins from your body created by DXM misuse.

DXM: Drug Rehab & Treatment

Professional DXM addiction treatment can be provided by an intensive outpatient program (IOP). One of the best options is an accredited drug and alcohol rehab facility. The program will treat the addiction and any co-occurring disorder.

What is Co-Occurring Disorder?

A co-occurring disorder is the combination of an addiction and a mental health issue.

Co-occurring disorders can be an addiction with any of the following:

  • PTSD
  • Depression
  • Bipolar disorder
  • Generalized anxiety disorder
  • Binge eating disorder
  • Anorexia Nervosa
  • Bulimia Nervosa
  • ADHD
  • Schizophrenia
  • Borderline personality disorder

The NIDA reports as many as 50% of all people who go to drug rehab will need treatment for the co-occurring disorder. Dual diagnosis treatment is recommended to ensure that both are treated at the same time. Some people turn to substance abuse because of mental health issues.

SpringBoard Recovery Treats DXM Addiction

At SpringBoard Recovery, we understand how serious DXM addiction can be. We offer personalized treatment plans for each individual.

Our intensive outpatient treatment program for DXM addiction includes many therapy options:

  • One-on-one Counseling
  • Group Counseling
  • Cognitive Behavioral Therapy (CBT)
  • Accelerated Resolution Therapy (ART)
  • Therapeutic Activities
  • Nutritional Counseling
  • Case Management

All of our intensive outpatient treatment programs provide the following benefits:

  • Address underlying psychological conditions and past traumas
  • Learn how to identify and avoid high-risk situations, triggers, and relapses
  • Develop a new lifestyle that doesn’t depend on substance use
  • Receive treatment at our facility and continue living at home
  • Maintain school and family commitments while receiving treatment

Sober Living Homes

At SpringBoard Recovery, we also offer sober living homes. A sober living home is specifically for people in addiction recovery. There are no drugs or alcohol allowed in the home.

This can be an important step in addiction recovery. Sometimes a person may not feel ready to go home after rehab. They might be afraid they will start using again.

A sober living house gives people a safe place to stay while getting used to normal life outside rehab. Spending time in a sober living home increases the success level of recovery.

While living there people do still need to attend outside therapy. A twelve-step support group can count as therapy. Each sober living home may have its own rules.

At SpringBoard Recovery, we work with most major health insurance companies. We can check your benefits to make sure you get all the services available to you.

Do you have questions about dextromethorphan (DXM) addiction? Would you like to know more about our outpatient addiction treatment program? Please contact us today.

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External Sources

  • U.S. National Library of Medicine: “Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis.” September, 2017. Available at NLM.NIH.gov.
  • U.S. National Library of Medicine: Compound Summary: Levomethorphan. 2004. Available at NLM.NIH.gov.
  • Stop Medicine Abuse. Safeguard Your Medicine. 2021. Available at StopMedicineAbuse.org.
  • Stop Medicine Abuse. Icon Awareness Social Graphic. August, 2021. Available at StopMedicineAbuse.org.
  • U.S. Food & Drug Administration: National Drug Code Directory. August, 2021. Available at FDA.gov.
  • U.S. National Library of Medicine: “The Effect of the Preemptive Use of the NMDA Receptor Antagonist Dextromethorphan on Postoperative Analgesic Requirements.” March, 2001. Available at NLM.NIH.gov.
  • U.S. National Cancer Institute: Serotonin. August, 2021. Available at Cancer.gov.
  • ResearchGate: Recommended Therapeutic Doses and Maximum Daily Doses of Dextromethorphan. September, 2007. Available at ResearchGate.net.
  • U.S. Drug Enforcement Agency: Dextromethorphan. December, 2019. Available at USDoJ.gov.
  • U.S. National Library of Medicine: “Ten Years of Robotripping: Evidence of Tolerance to Dextromethorphan Hydrobromide in a Long-Term User.” July, 2017. Available at NLM.NIH.gov.
  • U.S. National Library of Medicine: “Serotonin Syndrome.” Winter, 2013. Available at NLM.NIH.gov.
  • U.S. National Library of Medicine: “Myoglobinuria.” May, 2021. Available at NLM.NIH.gov.
  • Penn Medicine, University of Pennsylvania. Metabolic Acidosis. September, 2019. Available at PennMedicine.org.
  • U.S. National Library of Medicine: “Disseminated Intravascular Coagulation.” October, 2019. Available at NLM.NIH.gov.
  • AFP Journal, Association of American Family Physicians (AAFP). Rhabdomyolysis. March, 2002. Available at AAFP.org.
  • Partnership for Drug-Free Kids. “The Partnership Attitude Tracking Survey: Teens & Parents, 2013.” 2013. Available at DrugFree.org.
  • National Institute of Drug Abuse (NIDA): Monitoring The Future: National Survey Results on Drug Use, 1975-2019 – “Key Findings on Adolescent Drug Use, 2019 Overview.” January, 2020. Available at MontoringTheFuture.org.
  • U.S. National Library of Medicine: “Pseudoephedrine.” August, 2021. Available at NLM.NIH.gov.
  • National Institute of Drug Abuse (NIDA): Monitoring The Future: 2020 Survey Results. January, 2020. Available at DrugAbuse.gov.
  • World Health Organization: “Dextromethorphan Pre-Review Report.” June, 2012. Available at WHO.int.
  • U.S. National Library of Medicine: ““Dextromethorphan Toxicity.” August, 2021. Available at NLM.NIH.gov.
  • National Institute of Drug Abuse (NIDA). Over-the-Counter Medicines DrugFacts. December, 2019. Available at DrugAbuse.gov.
  • National Institute of Drug Abuse (NIDA). Comorbidity: Substance Use & Other Mental Health Disorders. August, 2018. Available at DrugAbuse.gov.
  • National Institute of Drug Abuse (NIDA): Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – “Evidence-Based Approaches to Drug Addiction Treatment.” January, 2018. Available at DrugAbuse.gov.

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