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DXM (Detromethorphan) Abuse, Addiction, And Treatment Options

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

April 23, 2019

Abusing cough medicine containing dextromethorphan (DXM) can cause hallucinogenic and dissociative effects similar to PCP.

What Is DXM?

DXM is the abbreviation for dextromethorphan, an over-the-counter cough suppressant. DXM is found in more than 100 cough, cold, and flu medicines. At suggested doses, it provides relief and light sedative properties. When taking at excessive doses DXM may cause psychedelic experiences.

Originally, DXM was considered a ‘safe’ alternative to codeine, another cough suppressant. Codeine is an opioid, and not approved for use in children, so medications containing DXM quickly became an acceptable, readily available replacement.

Due to the increase in rates of DXM abuse and DXM addiction, sales have become monitored and regulated in some areas. In these states, identification with proof of age is required for purchase, and there is a limit on how much a person can purchase at one time.

Common OTC medications that contain dextromethorphan (DXM) include:

  • Robitussin DM
  • NyQuil
  • Vicks Formula 44
  • Sudafed
  • Dimetapp DM
  • Triaminic
  • DayQuil LiquiCaps

DXM Abuse

Therapeutic doses of DXM range between 10mg and 20mg every four to six hours, or for extended-release forms the dose is usually 30mg every six to eight hours. Individuals abusing DXM generally take much higher doses.

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Reports have indicated that some individuals that abuse DXM have consumed up to four bottles of cough syrup over the course of a day. The range of a recreational dose of DXM is between 240mg to around 1,500mg.

Abusing DXM at these extreme doses can lead to feelings of euphoria, hallucinations, and other psychotropic effects. Unfortunately, there are several other ingredients in these cold and cough medications that can cause extremely dangerous consequences.

The effects of abusing DXM change the more a person takes, and this range is explained as follows:

  • 100mg-200mg – increased feelings of stimulation
  • 200mg-400mg – hallucinations and intense euphoria
  • 300mg-600mg – extreme visual distortion, hallucinations, and motor control problems
  • 500mg-1,500mg – dissociative sedation

DXM is fast-acting, and these effects usually start within 15 to 30 minutes after consumption. The effects of DSM can last up to six hours. Some people also consume alcohol with DXM, in an attempt to intensify the effects of the drug.

DXM abuse is more common among young teens and adults under 25. According to the National Institute on Drug Abuse, at least one in 30 teens abuses the antitussive DXM. Nineteen states prohibit the sale of dextromethorphan (DXM) to minors, as of 2018.

Dextromethorphan (DXM) can be purchased online without proof of age. DXM is sold illegally at extreme doses from some online retailers and designed specifically for recreational use. These forms can be quite harmful and lead to addiction, overdose, or death.

Dextromethorphan is known by several street names, including skittles, red devil, triple c, vitamin D, dex, and robo. The recreational use of DXM is often referred to as ‘robo-tripping’, and those who abuse dextromethorphan have been referred to as ‘syrup heads’.

Dextromethorphan Abuse Effects

Recreational use of DXM produces hallucinations, euphoria, sedation, and dissociation, but it also can lead to a number of unwanted side effects that the individual is not aware of.

This is a list of some of the side effects that commonly occur with DXM abuse:

  • dilated pupils
  • blotchy skin
  • involuntary movements
  • depression
  • problems speaking
  • itching
  • fatigue
  • numbness
  • vomiting

More serious side effects include:

  • tachycardia
  • psychosis
  • hyperthermia
  • respiratory depression or failure
  • liver failure
  • brain lesions
  • seizures
  • coma
  • death

Abusing DXM is not without consequence. Just because this medication is available without a prescription, does not mean it is safe to use recreationally. It can cause irreversible physical and mental harm.

Additionally, similar to other psychotropic drugs of abuse, DXM can cause what is referred to as a ‘bad trip’. A person who is having a ‘bad trip’ may not experience any of the desired effects and instead have hours filled with panic, paranoia, delusions, and uncontrollable emotions.

Dextromethorphan Addiction

Addiction is characterized by a common set of behaviors that a person displays that show an unhealthy preoccupation with a substance of abuse. An individual may begin to ignore responsibilities, avoid once enjoyed activities, abandon old friends for new friends that also abuse substances, and become obsessed with finding and using DXM.

Individuals who are addicted to dextromethorphan may steal bottles of cough syrup or cold pills from friends or family. It is also common to find empty packaging in the trash or hidden in their bedroom. These individuals may also appear intoxicated, slur their words, have a high fever, or seem very confused while under the influence of DXM, and become hostile without it.

The person may believe they need to continue to take DXM in order to function or abuse DXM to avoid responsibilities. Another red flag is if the person realizes they have a problem and are unable to stop abusing DXM, or if they experience withdrawal symptoms if they attempt to stop.

Being aware of the abuse and addiction signs of DXM can help a person struggling with DXM abuse get the help they may otherwise not ask for themselves.

Dextromethorphan Overdose

Taking excessively high doses of DXM puts a person at risk for overdose. If a person is suspected of abusing DXM and is displaying the following symptoms, call 9-1-1 immediately:

  • irregular or stopped breathing
  • high fever
  • involuntary muscle twitches
  • blood pressure changes
  • seizures
  • coma

DXM Withdrawal

A person who stops taking dextromethorphan after taking it for some time will likely experience symptoms of withdrawal, such as cramping, vomiting, diarrhea, nightmares, exhaustion, inability to sleep, cravings, panic and anxiety, memory problems, and even flashbacks.

It is important that a person seek assistance when trying to stop taking DXM, a medically supervised detoxification program can help ease the symptoms of withdrawal from dextromethorphan.

Dextromethorphan Addiction Treatment Options

Substance abuse treatment for a DXM addiction usually begins with a medically supervised detoxification program. This allows a person to have round the clock care while the dextromethorphan leaves their system. Medical professionals are available to provide medications and other interventions to ease the symptoms of withdrawal and make all attempts to avoid relapse.

Upon completion of detox, it is generally encouraged that residents continue to a substance abuse treatment program to explore the reasons behind their addiction and rebuild coping skills to help maintain sobriety.

If you suspect a loved one, or if you yourself, are struggling with a DXM abuse or addiction, contact us today. We are here to help you forge the path into the sober future you deserve.

Consumer Heathcare Products Association - 2018 Wisconsin DXM Bill

National Survey Results On Drug Use - 2018 Review - Key Findings on Adolescent Drug Use

National Institutes on Drug Abuse - Monitoring the Future

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