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DXM Abuse & Addiction- What Are the Signs & Symptoms?

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.

Abuse of DXM

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:

  • Taking large doses of over-the-counter (OTC) medication that includes DXM as an ingredient
  • Mixing DXM with alcohol
  • Purchasing DXM powder to inject intravenously, snort, or mix with soda or alcohol

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:

  • Skittling
  • Dexing

Nicknames for gel capsules and cough medicine that are used to get high are:

  • Red hots
  • Rojo
  • Candy
  • Skittles
  • Red devils

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.

How Dextromethorphan (DXM) Is Abused

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:

  • A spike in blood pressure
  • Difficulty speaking
  • Stomach pain
  • Fatigue
  • Loss of coordination
  • Hyperactivity
  • Increased sweating

Public health officials have also noticed that abuse of DXM also includes taking it with other substances.

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What Happens If DXM Is Mixed With Other Things?

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:

  • Alcohol. As described by NIDA, DXM is often combined with alcohol. Poison Control states that mixing alcohol with a product containing DXM and acetaminophen is dangerous. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) states that using alcohol with DXM-containing medicine, such as Delsym, could cause dizziness and even overdose.
  • Marijuana. The U.S. Centers for Disease Control and Prevention (CDC) warns that taking marijuana with prescription medications may change how those medications work. They do not mention DXM, but it is unwise to mix marijuana with DXM. Even on its own, a person may react differently depending on their health, genes, or the strength of the marijuana strain consumed. This implies that mixing marijuana and DXM could result in a negative experience.

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:

  • Women: Per NIAAA, women have less water in their bodies and may become intoxicated faster than men.
  • Senior adults: 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.

Short-Term and Long-Term Effects

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:

  • Vomiting. Cough syrups may sometimes include expectorants that cause vomiting, as mentioned by the Clinical and Research Institute on Addictions.
  • Impaired judgment. 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:

  • Redness
  • Dizziness
  • Itchy skin
  • Paranoia
  • Seizures

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.

DXM Abuse: A Few Statistics

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.

  • Poison Control estimates about 6,000 emergency room visits are related to DXM per year. Most who visit the ER for DXM abuse are teens and young adults between the ages of 12 and 25.
  • About 33 to 50 percent of those who experiment with DXM misuse it regularly, per the Clinical and Research Institute on Addictions
  • NIDA cautions that it is possible to overdose on DXM intentionally and by accident.

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.

Signs of Abuse

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:

small measuring cup of cough syrup

  • Changes in academic performance
  • Differences in appetite
  • Changes in sleeping patterns
  • Hanging out with different peers
  • Decreased interest in past hobbies
  • Increased tension with family and friends

Similar signs in adults may be:

  • Changes in appearance
  • Decreased productivity at work

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.

Treatment for Abuse

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:

  • Problems sleeping
  • Nausea and vomiting
  • Cravings for DXM
  • Goosebumps
  • Cold flashes
  • Bone and/or muscle pain
  • Restless legs

NIDA mentions the following treatment approaches might be helpful for teens, but these principles can also assist adults:

  • Behavioral therapy: 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:
  • Individual therapy, such as cognitive behavioral therapy
  • Group therapy, which may include participation in 12-step programs such as Narcotics Anonymous and attending peer counseling groups
  • Recovery therapy: This is often a way to continue applying skills learned in treatment for addictions. It may include:
  • Assertive Continuing Care (ACC), which involves attending group therapy
  • Recovery high schools specially tailored for adolescents who need additional support in their recovery. They are usually separated from students at a regular high school or may be a part of an alternative school.
  • Peer recovery support services, which involve participation in community centers for people in recovery (This allows clients to meet people who understand their path to sobriety, and it can even involve social activities that are free of drugs.)
  • Family-based therapies: These therapies involve the family in a teen’s recovery, including siblings and even close friends. It may involve a close look at:
  • Family communication styles that may have facilitated a teen’s previous drug use
  • The family’s overall mental health
  • Repairing relationships within the family

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:

  • Having honest conversations with their teens about the dangers of misusing drugs of any kind.
  • Keeping cough medicines out of the house or buying them only as needed (no stocking up).
  • Monitoring their teen’s internet use and making sure they are not looking through websites that sell DXM or provide pointers on how to misuse it.
  • Recognizing common signs of DXM use, side effects, or overdose.

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