Abusing Dextromethorphan (DXM)

Dextromethorphan (DXM) is an important ingredient in cold and flu medications. This drug suppresses coughing, providing relief from for those with a cold, flu, or other conditions that cause congestion and coughing. While this antitussive does not cure colds or flus, it binds to the part of the brain that controls the lungs and their coughing reflex.

Unfortunately, DXM has also become a serious drug of abuse. The chemical can cause intoxicating euphoria, sedation, and even hallucinations at various doses.

DXM Abuse

DXM is often seen as the replacement for codeine in cough, cold, and flu medications. Codeine is a mild opioid, and its inclusion in medications led to addiction for some people.

DXM was first approved by the U.S. Food and Drug Administration (FDA) in 1958. Reports of DXM abuse began soon after, in the 1960s. By 1975, dextromethorphan abuse was reported as a serious, large-scale societal problem.

DXM is in the same family as several dissociative anesthetics, like ketamine and PCP. This drug can cause hallucinations and sensory changes at high doses, along with other potent psychedelic effects.

People who abuse dextromethorphan report dose-dependent plateaus, where certain intoxicating effects like emotional dissociation, hallucinations, or euphoria kick in. There are four major plateaus reported in dextromethorphan abuse:

  • Plateau 1: At 100 to 200 mg, the person experiences euphoria and restlessness.
  • Plateau 2: Taking between 200 and 500 mg leads to exaggerated auditory or visual sensations, psychedelic effects, feeling dizzy or imbalanced, and closed-eye hallucinations.
  • Plateau 3: Taking between 500 and 1000 mg can cause visual and auditory hallucinations or disturbances, altered consciousness, delayed reaction times, mania, panic and paranoia, and partial dissociation from reality.
  • Plateau 4: At over 1000 mg, DXM can cause full psychotic symptoms, complete dissociation, and seriously impaired balance and physical coordination, which can lead to injury

Estimates of the prevalence of DXM abuse are hard to find, partly because this drug is sold over the counter at grocery and drug stores. The chemical was left out of the Controlled Substances Act (CSA) of 1970, while marijuana, heroin, and LSD (more potent intoxicants) were added. This allowed dextromethorphan to continue being manufactured by pharmaceutical companies and be widely distributed.

Why Is It Abused?

In medications, DXM is sold over the counter in chewable tablets, dissolving syrups, liquid solutions, gel capsules, extended-release capsules, and even in some lozenges. These drugs can be taken without a prescription, as needed. DXM lasts between 4 and 12 hours, depending on how much of the substance is in the medication.

When taken as recommended on the package, DXM drugs can cause some mild side effects.

  • Dizziness
  • Lightheadedness
  • Drowsiness
  • Nervousness
  • Restlessness
  • Nausea, vomiting, and other gastrointestinal issues

People who take medications containing DXM consume between 10 and 20 mg of the chemical every four to six hours, or 30 mg about every six to eight hours. In contrast, people who abuse dextromethorphan consume between 240 and 1500 mg in one dose. People who are addicted to DXM and abuse a lot of the substance have been known to consume as much as three or four bottles of cough syrup per day.

Dextromethorphan abuse is sometimes called robo-tripping.

It Is Easily Available

When dextromethorphan became a prominent substance of abuse in the mid-2000s, few local or state governments banned the substance. The federal government only released label requirements that made usage and safe doses clear.

DXM-based drugs are sold over the counter to anyone. Some states passed age limits on who could buy medications containing this substance, while other states imposed limits on how many DXM-containing medications a person could buy at once.

The National Institute on Drug Abuse (NIDA) found that about 3 percent of adolescents in the U.S. abuse OTC cough, cold, and flu medications. In 2017, about one in three teenagers report knowing someone who abused these drugs.

Often, people who want to be intoxicated, especially those who seek psychedelic, hallucinatory, or dissociative effects, seek out DXM drugs because they are easy to find and inexpensive.

Signs of Overdose

Overdosing on dextromethorphan is common among those who abuse the drug. It can occur by accident in people taking DXM-based medications to treat their cold or flu, especially if they mix and match over-the-counter drugs. But overdose is more likely among people who abuse DXM drugs to get high.

Signs of an overdose include the following:

  • Nausea, vomiting, and gastrointestinal distress
  • Drowsiness and trouble staying awake
  • Dizziness and unsteadiness
  • Changes in vision, like blurry sight
  • Difficulty, suppressed, or irregular breathing
  • Stopped breathing
  • Muscle twinges
  • Elevated body temperature, leading to tissue or organ damage
  • Very high or very low blood pressure
  • Rapid heartbeat
  • Hallucinations
  • Seizures

About 6,000 people are admitted to the emergency room every year because of DXM overdoses. Some of these are fatal.

Overdosing on drugs like dextromethorphan is serious and can lead to death. Call 9-1-1 immediately if someone near you overdoses on DXM.

Long-Term Effects of Abuse

Some people struggle with dextromethorphan addiction and physical dependence. When the substance is regularly abused, DXM can cause some symptoms like insomnia or dysphoria even though these are problems that the drug is designed to alleviate for people who are ill.

Long-term, high-dose DXM abuse causes toxic psychosis, a mental condition where the main characteristic is confusion about reality. There are other psychosis-related behavioral and mental problems, including paranoia and violence toward oneself or others.

Physical dependence on any drug will cause withdrawal symptoms if you try to quit using it. These withdrawal symptoms are associated with dextromethorphan:

  • Anxiety
  • Restlessness
  • Insomnia
  • Diarrhea
  • Vomiting
  • Gastrointestinal distress
  • Severe weight loss

Getting Help

Many reports suggest that dextromethorphan abuse peaked among adolescents and young adults around 2006, with 34,755 single-substance exposures reported by the National Poison Data System (NPDS). Since then, some restrictions have been put in place to reduce the risk of young people abusing this substance. Even so, abuse of this chemical is still prevalent in the U.S. because dextromethorphan medications are available over the counter.

Detox and rehabilitation programs can help people who struggle with DXM abuse and addiction. A medically supervised detox program helps to ease withdrawal symptoms and ensures your physical safety as you overcome dependence on the drug. Then, a rehabilitation program can employ several approaches to behavioral therapy, so you can learn skills to maintain sobriety.

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