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), an addictive substance, is the active ingredient in most over-the-counter (OTC) cough medicines sold in the U.S.
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Hallucinating on Cough Syrup

Dextromethorphan (DXM) abuse and addiction has turned into a trend that is prevalent among young people in the United States. It is available over-the-counter, and while many states have laws in place dictating how old a person has to be to purchase it, not all of them do.

 

Getting high on DXM is known as “robo-tripping.”

 

Teenagers easily learn online how to cheaply and effectively extract concentrated DXM from non-prescription cough medicines. However, many don’t know abusing DXM carries dangerous and life-threatening risks.

 

In fact, today, in America 2021, dextromethorphan (DXM) addiction is an ever-growing problem among our U.S. children and teenagers.

 

Read here to learn more about DXM and its potential for addiction.

 

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What is Dextromethorphan (DXM)?

 

Dextromethorphan (DXM) is the most widely used cough suppressant ingredient in the U.S. It was approved by the U.S. Food and Drug Administration (FDA) back in the 1950s, and can now be found in over 125 OTC cough medications currently being sold in pharmacies, corner drug stores, and grocery stores.

 

DXM can effectively (though temporarily) relieve a cough, but it does not treat the cause of the cough.

 

It is in a class of medications called antitussives, which work by inhibiting the cough center in the brain, elevating the threshold for coughing.

 

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 OTC medicine are included in the Active Ingredients section of the Drug Facts label printed on the package. DXM can be listed as:

 

  • Dextromethorphan
  • Dextromethorphan hydrobromide, or
  • Dextromethorphan HBr

 

Additionally, cough medications that contain DXM can also be easily identified by the black and white “Stop Medicine Abuse” icon (seen here on the side of the box):

 

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 far more likely to misuse drugs like OTC cough medicines because they are legal, and they can get them easily and, importantly, without a prescription.

 

They can easily learn where to buy DXM and how to use it to get high from their friends or online.

 

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

 

It has to be used in excessive amounts to achieve the desired euphoric and hallucinogenic effect – up to 25 times more or at 1,500mg per day.

 

DXM: How Does It Work?

 

DXM attaches to the specific receptors in the brain that attract the excitatory neurotransmitter NDMA (N-methyl-D-aspartate) neurotransmitter. DXM is an antagonist for NDMA, meaning it inhibits its actions and release; this is how the coughing reflex is suppressed.

 

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 “How To…” guides and videos about extracting DXM from cough medicines are easily found online, enabling adolescents to simply and cheaply create their own concentrated DXM powder.

 

They can then use the drug to get high at house parties, and there are numerous reports of teenagers robo-tripping before school.

 

The U.S. Drug Enforcement Administration (DEA) lists 4 different “dose-dependent plateaus,” as experienced by those who abuse DXM. The maximum recommended daily dose for DXM is 120 mg; more than this can result in intoxication and dangerous side effects:

 

  • 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 recreationally to get high, they can experience hallucinations and “out-of-body” sensations.

 

However, DXM misuse can also depress brain function, particularly the parts of the brain that control breathing and heart function. These effects can last up to 6 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.

 

For example, when DMX is taken with alcohol (probably the most common poly use reported in teenagers), it can become lethal.

 

MDMA (known as ecstasy or molly) and antidepressants combined with DXM also carry the same fatal risk, too.

 

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WARNING: Serotonin Syndrome

 

If you misuse or abuse DXM and are on antidepressants, you can develop Serotonin Syndrome, a serious and possibly life-threatening condition that requires immediate ER medical treatment.

 

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, around 1 in 4 American teens knows someone who has misused or regularly abused OTC cough syrups to get high.

 

Additionally, the 2019 Monitoring The Future study states “around 1 in 27 teens reports abusing excessive amounts of DXMto get high.

 

In 21 U.S. states, such as California, Tennessee, New Jersey, and most recently Ohio, age limit regulations have been introduced to prevent minors (teenagers under the age of 18) from purchasing DXM – however, this is clearly not the case everywhere.

 

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 (on eBay, for example), people misusing the drug can ingest enough to experience a life-threatening overdose.

 

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

 

Although a moderate overdose of pure DXM is free of serious adverse effects, approximately 5% of people lack the ability to metabolize the drug normally, leading to rapid acute toxic levels. A DXM overdose is medically described as dextromethorphan toxicity.

 

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.

 

However, misusing this drug for a long period of time can result in dextromethorphan use disorder (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 dextromethorphan use disorder (or DXM addiction) requires both professional detoxification and a professional addiction treatment program.

 

Trying to quit using DXM on your own when you are addicted to the drug is very difficult. You can experience both physical and mental symptoms which are highly uncomfortable, and can make many people simply start using again.

 

Treatment for DXM addiction also requires a professional addiction treatment program to fully prepare someone for a long-term and sustainable recovery from their DXM use disorder.

 

It is well-known that many people, including teenagers and young adults, misuse or abuse OTC and prescription medications and illegal drugs because they are “self-medicating” for another problem, such as trauma, a mental health disorder or a behavioral issue.

 

In addition, while many people – especially teenagers – may be hesitant to admit it, there are reasons why they chose to misuse DXM. Some do so originally out of teenage curiosity or because their friends and peers are pressuring them to try it.

 

However, once they do, they realise they enjoy the effects of misusing DXM and want to experience them again.

 

DXM: Medical Detox

 

It is advisable to have a professionally supervised detox within a clinical setting, such as an accredited drug rehab facility. This type of detox can also provide prescription medicines to make these 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 not only remove any traces of DXM from your system, it will also remove any dangerous toxins from your body created by the DXM misuse.

 

DXM: Drug Rehab & Treatment

 

Professional DXM addiction treatment can be provided by an intensive outpatient program (IOP) at a professionally recognized and accredited drug and alcohol rehab facility. The program will address and treat the addiction, along with any other contributing issues, such as co-occurring disorder or other behavioral condition.

 

What is Co-Occurring Disorder?

 

When someone has a substance use disorder (SUD or substance addiction) and a mental health disorder or issue at the same time, this is known as co-occurring disorder or dual diagnosis.

 

The NIDA reports as many as 50% of all people who go to drug rehab will need treatment for co-occurring disorder. Dual diagnosis treatment is recommended to ensure that both are treated simultaneously, and any underlying reason for the person’s DXM misuse is properly addressed.

 

SpringBoard Recovery Treats DXM Addiction

 

At SpringBoard Recovery, we understand how serious DXM addiction can be, and we know the best ways to treat it. We also  offer personalized treatment plans and services targeted to our patient’s specific needs.

 

Our intensive outpatient treatment program for DXM addiction includes the following evidence-based therapies, counseling, and therapeutic activities, plus many other therapeutic modalities and services:

 

  • 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

 

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

  1. U.S. National Library of Medicine: “Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis.” September, 2017. Available at NLM.NIH.gov.
  2. U.S. National Library of Medicine: Compound Summary: Levomethorphan. 2004. Available at NLM.NIH.gov.
  3. Stop Medicine Abuse. Safeguard Your Medicine. 2021. Available at StopMedicineAbuse.org.
  4. Stop Medicine Abuse. Icon Awareness Social Graphic. August, 2021. Available at StopMedicineAbuse.org.
  5. U.S. Food & Drug Administration: National Drug Code Directory. August, 2021. Available at FDA.gov.
  6. 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.
  7. U.S. National Cancer Institute: Serotonin. August, 2021. Available at Cancer.gov.
  8. ResearchGate: Recommended Therapeutic Doses and Maximum Daily Doses of Dextromethorphan. September, 2007. Available at ResearchGate.net.
  9. U.S. Drug Enforcement Agency: Dextromethorphan. December, 2019. Available at USDoJ.gov.
  10. 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.
  11. U.S. National Library of Medicine: “Serotonin Syndrome.” Winter, 2013. Available at NLM.NIH.gov.
  12. U.S. National Library of Medicine: “Myoglobinuria.” May, 2021. Available at NLM.NIH.gov.
  13. Penn Medicine, University of Pennsylvania. Metabolic Acidosis. September, 2019. Available at PennMedicine.org.
  14. U.S. National Library of Medicine: “Disseminated Intravascular Coagulation.” October, 2019. Available at NLM.NIH.gov.
  15. AFP Journal, Association of American Family Physicians (AAFP). Rhabdomyolysis. March, 2002. Available at AAFP.org.
  16. Partnership for Drug-Free Kids. “The Partnership Attitude Tracking Survey: Teens & Parents, 2013.” 2013. Available at DrugFree.org.
  17. 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.
  18. U.S. National Library of Medicine: “Pseudoephedrine.” August, 2021. Available at NLM.NIH.gov.
  19. National Institute of Drug Abuse (NIDA): Monitoring The Future: 2020 Survey Results. January, 2020. Available at DrugAbuse.gov.
  20. World Health Organization: “Dextromethorphan Pre-Review Report.” June, 2012. Available at WHO.int.
  21. U.S. National Library of Medicine: ““Dextromethorphan Toxicity.” August, 2021. Available at NLM.NIH.gov.
  22. National Institute of Drug Abuse (NIDA). Over-the-Counter Medicines DrugFacts. December, 2019. Available at DrugAbuse.gov.
  23. National Institute of Drug Abuse (NIDA). Comorbidity: Substance Use & Other Mental Health Disorders. August, 2018. Available at DrugAbuse.gov.
  24. 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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