If you live in the United States today, you probably grew up with ads for popular over-the-counter cough and cold medicines such as Robitussin DM, NyQuil, DayQuil, Theraflu, and other syrups, lozenges, and capsules.
These over-the-counter medications contain the ingredient dextromethorphan (DXM), a medication that acts as a cough suppressant. When used as directed, DXM-containing medications can help people get through the day.
Some medicines are combined with additional ingredients to assist with fever, pain, and other maladies.
Not everyone uses DXM as directed. Recreational use of cough medicines containing DXM is popular.
A 2013 case study from the Clinical and Research Institute on Addictions at the University of Buffalo estimates that 1 out of 20 teenagers has experimented with DXM.
The National Institute on Drug Abuse (NIDA) says DXM is commonly abused by:
The case study also says that teens and young adults between the ages of 12 and 20 years old make up 51 percent of emergency room patients because of DXM intoxication.
In street slang, using cough medication recreationally is known as “robotripping.” Other nicknames for this practice are:
Nicknames for gel capsules and cough medicine that are used to get high are:
Teenagers and people in other age groups may see the appeal in abusing DXM because it is legal and cheap. It may already be available in their homes and using it raises little suspicion.
Like any other substances, regular use of DXM could lead to misuse and even overdose.
The National Capital Poison Center (Poison Control) says the U.S. Food and Drug Administration approved dextromethorphan for use in over-the-counter medication in 1958. Manufacturers began including warnings on their product packaging to raise awareness about the dangers of DXM abuse.
Despite good intentions on the part of cough medicine makers, teenagers found that they could use medication with DXM to get high.
NIDA mentions that recreational use of DXM can cause effects such as:
Teenagers and young adults who experiment with substances are usually just trying to have fun. Often, a teen may think they will not suffer the consequences of using drugs. They should be aware that DXM — even on its own — causes negative side effects.
Public health officials have also noticed that abuse of DXM also includes taking it with other substances.
Various DXM-containing medications also have other ingredients. Multisymptom over-the-counter medication may contain decongestants, antihistamines, and acetaminophen. NIDA warns that taking products with acetaminophen could result in liver damage.
Even so, some people mix products that contain DXM along with other substances, including:
NIAAA states that a person can also experience the harmful effects of alcohol and dextromethorphan even if they are taken at different times. Alcohol affects the following populations differently:
Per NIAAA, women have less water in their bodies and may become intoxicated faster than men.
DXM abuse is rare among older people, but this group is more likely to require medications of various types. Taking alcohol along with any medication is more harmful to senior adults because age slows down a person’s metabolism. Alcohol remains in their body longer, and this could make DXM use riskier for them, even when they do not intend to abuse it.
Regular ingestion of DXM, or consistent misuse of products that contain DXM, leads to short-term and long-term effects.
Short-term effects of DXM include:
Cough syrups may sometimes include expectorants that cause vomiting, as mentioned by the Clinical and Research Institute on Addictions.
KidsHealth mentions that DXM may result in loss of motor control and even psychosis, which could result in reckless behavior.
Other short-term effects are:
The long-term effects of DXM abuse still need to be studied, but DXM misuse can be fatal and result in brain damage. Overdosing on DXM is also possible.
Recognizing the signs of DXM misuse is key to finding help for a friend or loved one who may need it.
Dextromethorphan (DXM) abuse is not always taken seriously considering the necessity of cold and cough medicines. Monitoring possible signs of abuse of DXM is important.
On a positive note, a 2016 study published in Substance Abuse Treatment, Prevention, and Policy mentions that DXM abuse went down by 35 percent between 2010 and 2015.
Like any other substance, abuse of DXM is a concern, especially since teens are more likely to abuse the substance than other age groups.
As mentioned by NIDA, signs that a teen is misusing substances include:
Similar signs in adults may be:
Exhibiting these signs might show that DXM abuse is part of a person’s life, and their misuse is serious. Thankfully, some treatments could help people who want to quit using DXM.
NIDA states that it is possible to treat people who misuse DXM, but currently there are no approved medications that can assist with this.
Some people may need to detox from DXM. When they attempt to stop using the drug, they may experience the following withdrawal symptoms:
NIDA mentions the following treatment approaches might be helpful for teens, but these principles can also assist adults:
Working with a psychologist could help teenagers change their attitudes and learn the skills needed to make better choices. Therapy often teaches skills that assist in staying away from drugs and handling cravings without the use of drugs. This may include:
This is often a way to continue applying skills learned in treatment for addictions. It may include:
These therapies involve the family in a teen’s recovery, including siblings and even close friends. It may involve a close look at:
Treatment can also help a teenager who may be combining substances with DXM and can assist them in dealing with this as well.
Individuals do not always intend to misuse drugs, even drugs as easy to find as medication with DXM. Parents can still take steps to prevent a teen’s use or misuse of DXM by:
(September 2017) Dextromethorphan overdose. MedlinePlus. from https://medlineplus.gov/ency/article/002628.htm
Dextromethorphan What's the Problem? National Capital Poison Control Center. from https://www.poison.org/articles/2015-sep/dextromethorphan
(September 2015) Cough and Cold Medicine Abuse. KidsHealth. from https://kidshealth.org/en/parents/cough-cold-medicine-abuse.html
(December 2017) What are over-the-counter medicines? National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines
(June 2016) Dextromethorphan: a case study on addressing abuse of a safe and effective drug. Substance Abuse Treatment, Prevention, and Policy. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918034/
(April 2013) DXM (Cough Suppressant) Abuse. University at Buffalo Clinical and Research Institute on Addictions. from http://www.buffalo.edu/cria/news_events/es/es7.html
(2014) Harmful Interactions: Mixing Alcohol With Medicines. National Institute on Alcohol Abuse and Alcoholism. from https://pubs.niaaa.nih.gov/publications/Medicine/Harmful_Interactions.pdf
(March 2018) What are the effects of mixing marijuana with alcohol, tobacco or prescription drugs? Centers for Disease Control and Prevention. from https://www.cdc.gov/marijuana/faqs/mixing-marijuana-with-alcohol-tobacco-drugs.html
(January 2014) Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/frequently-asked-questions/what-are-signs-drug-use-in-adolescents-what-role-can-parents-play-in-getting-treatment
(January 2014) Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Evidence-Based Approaches to Treating Adolescent Substance Use Disorders. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/evidence-based-approaches-to-treating-adolescent-substance-use-disorders