Dextromethorphan, or DXM, is a common over-the-counter cough suppressant medication contained in many cold and flu preparations, such as:
- Triaminic DM
- Robitussin DM
- Dimetapp DM
- Tylenol Cold
- Alka-Seltzer Plus Cold and Cough
Antitussive medications containing DXM are relatively safe when taken as directed, but in large amounts they can produce euphoric and even hallucinogenic effects, making them popular drugs of experimentation and even abuse for adolescents and young adults.
The National Institute on Drug Abuse (NIDA) reports that DXM cold and cough products are among the most commonly abused over-the-counter (OTC) drugs. According to the 2015 Monitoring the Future survey published by NIDA, almost 5% of high school seniors had abused OTC cough medications in the past year. Results published in the journal Clinical Toxicology show that teenagers between the ages of 15 and 19 are the most likely age group to abuse DXM medications, as indicated by a large number of poison control center calls resulting from DXM abuse.
These products can be purchased at the local drug store, meaning that they may be readily accessible. Although national legislation may be in the works to restrict the sale of DXM-containing products, of which there are more than 100, the Consumer Healthcare Products Association (CHPA) reports that several states now ban the sale of these products to minors.
Abuse of DXM-containing medications is often referred to as skittling, dexing, robo-fizzing, robo-dosing, or robo-tripping. Abusing DXM products may create a number of behavioral, emotional, social, and physical health problems, including addiction.
Effects of DXM
The drug is also known by the following names:
- Triple C
- Orange crush
- Red devils
When used recreationally, dextromethorphan may produce different effects depending on how much was taken. For instance, in small doses, it may produce a pleasant “high,” as well as psychedelic and mild stimulating effects, while in higher doses, a kind of dissociation from the self may occur. In even larger doses, sensory perceptions are altered and full-blown psychosis may occur, the journal Primary Psychiatry reports. DXM may mimic the dissociative drug PCP (phencyclidine) when taken in large amounts.
DXM products are generally taken orally in liquid or tablet form. They are quickly absorbed through the gastrointestinal system with effects typically lasting about 6 hours, the Journal of the American Board of Family Medicine (JABFM) publishes.
Signs of DXM intoxication may include:
- Elevated mood
- Dream-like state
- Dilated pupils
- Dissociation from body and mind
- Altered sense of time
- Enhanced sensory perceptions
- Distortion of reality
- Slurred speech
- Impaired motor coordination
- Impaired memory
- Difficulties with sexual performance
Abusing a drug like DXM changes the way the brain feels pleasure by temporarily increasing the amount of the neurotransmitter dopamine along the central nervous system. DXM may also increase blood pressure and heart rate. These changes may be particularly alarming in young people, as the regions of the brain that are involved in reward processing, willpower, emotional regulation, and decision-making abilities may be negatively impacted by DXM abuse before these parts of the brain are fully developed.
The National Survey on Drug Use and Health (NSDUH) reports that a greater percentage of adults aged 18 and older who battle illicit drug or alcohol abuse or dependency began abusing a substance, such as alcohol or marijuana, prior to age 15 than those who were aged 18 or older before abusing substances. Abusing DXM even once can have negative side effects, and abusing it more often creates numerous risk factors.
Hazards of DXM Abuse
Potentially 2 of the biggest concerns of DXM abuse are the risk for a life-threatening overdose and the development of an addiction to the drug. An overdose occurs when levels of the drug reach toxic amounts in the bloodstream, and the body can no longer metabolize it, which may result in serious health problems or even death. Symptoms of a DXM overdose include:
- Nausea and/or vomiting
- Nystagmus (uncontrolled and involuntary eye movement)
- Dilated pupils
- Difficulties breathing
- Bluish tint to fingernails or lips
- Ataxia (loss of muscle control)
- Blurred vision
- Rapid heart rate
- Rash and/or itchy skin
- Hot and cold flashes
- Muscle spasms
- Constipation or diarrhea
- Retention of urine
The National Capital Poison Center (NCPC) reports that DXM abuse results in around 6,000 emergency department visits each year, and half of these visits are for individuals between the ages of 12 and 25 years old.
DXM may be hazardous to abuse on its own, but when mixed with other substances, the risk factors increase. Adding other drugs or alcohol may greatly enhance the chance for an adverse reaction or life-threatening overdose. Products containing DXM may also contain other substances, such as acetaminophen, a pain reliever may cause liver damage with regular use. Individuals with underlying mental health concerns may have symptoms increased by DXM abuse as well.
Addiction and dependence are potential consequences of long-term DXM abuse. People who compulsively use large amounts of DXM cough syrup to achieve the desired effects may spend most of their time trying to get it, using it, or recovering from its use. They may not have control over the amount, or duration, of their drug abuse. DXM use may take the place of other activities. Social withdrawal, erratic behavior, mood swings, increased secrecy, denial that a problem exists, lack of interest in most things, dipping grades or drop in work production, increased risk-taking behaviors, and an inability to count on that person to fulfill their obligations are common indicators of addiction. Changes in physical appearance, like weight gain or loss, lack of interest in personal hygiene and changes in sleeping and eating patterns, may be additional signs of addiction to DXM or other drugs if the person is mixing DXM with other substances.
Help for Abuse and Addiction
As a dissociative drug, DXM addiction may be initially treated through medical detox. During detox, medications may be used to help alleviate symptoms of withdrawal or other medical complications. Individuals who have been abusing large amounts of DXM for a significant amount of time, who have a family history of substance abuse or addiction, as well as those who may abuse additional mind-altering substances or battle mental illness, may be more severely dependent on DXM and benefit greatly from medical detox.
Once a level of physical stabilization has been reached, the psychological aspects of addiction and substance abuse can be identified and addressed. Treatment for DXM abuse or addiction may be either residential or outpatient. Since no two people will experience addiction in exactly the same way, what works for one person may not be as effective for someone else. For example, an individual who is not dependent on DXM and who has a strong support system at home may do well in outpatient treatment while someone else may benefit from the more comprehensive nature of residential treatment.
Both outpatient and residential substance abuse treatment are likely to include group and individual therapy sessions, counseling, support group meetings, educational opportunities, life skills training, and alternative or holistic treatments. Behavioral therapies work to understand the causes of substance abuse and help a person make positive changes for a sustained recovery. Peer groups and 12-step programs often provide a supportive network that can extend throughout recovery. There are several options for treating DXM abuse and/or addiction, and trained professionals can help families and loved ones choose the optimal level of care for a healthy and happy future.
- NIDA. (2017). Drug Facts: Over-the-Counter Medicines.
- NIDA. (2015). Monitoring the Future 2015 Survey Results.
- Wilson MD, Ferguson RW, Mazer ME, Litovitz TL. (2011). Monitoring trends in dextromethorphan abuse using the National Poison Data System: 2000-2010. Clin Toxicol (Phila).
Lachover, L. Deciphering a Psychosis: A Case of Dextromethorphan-Induced Symptoms. Primary Psychiatry. 2007;14(1):70-72
- Al-Kuraishy HM, Al-Gareeb AI, Ashor AW. Effect of a single dose of dextromethorphan on psychomotor performance and working memory capacity. Indian J Psychol Med. 2012;34(2):140–143.
- Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD.
- National Capital Poison Center. (n.d.) Dextromethorphan: What’s the problem?
- FDA. (2009). Acetaminophen: Avoiding Liver Injury.