When you think of substance abuse or drug problems, you may think of alcohol, cocaine, and other unlawful drugs. But legal and available drugs can also pose problems and become drugs of misuse. As MedlinePlus explains, dextromethorphan (DXM) is an example of an over-the-counter medication that has become a popular drug of abuse.

DXM is an opioid found in various cough syrups, such as Robitussin DM, DayQuil, and NyQuil, among others. According to New York’s Office of Alcoholism and Substance Abuse Services (OASAS) reports of misuse of DXM have been documented since the 1950s.

Thankfully, treatments for DXM dependency and abuse are available. 

What Is DXM?

DXM is found in as many as 120 over-the-counter cough medications available in drugstores across the country. DXM is considered safe when taken as directed. 

The University of Buffalo says DXM was approved for use as a cough medication in 1958. It was thought that its bitter and unpleasant taste would prevent misuse, especially since it is combined with ingredients that often induce vomiting when taken in large doses.

According to MedlinePlus, DXM can ease the discomfort of a cough, but it does not treat its underlying causes. Various over-the-counter medications containing this ingredient are available for people who have a cold, the flu, or other conditions that cause a cough. 

DXM is often combined with other ingredients, such as decongestants, expectorants, and sleeping aids. It is available as a liquid, tablet, liquid-filled capsule, and lozenge. Directions often instruct users to take DXM-containing medications every four to 12 hours. 

Always read labels carefully if you take more than one cough or cold medication at the same time. They may contain the same ingredient and cause you to unintentionally overdose. Thoroughly read labels if you are about to give medication to a child. 

Children under age 4 should not be given DXM. Children between ages 4 and 11 must receive the appropriate amount of medication to prevent serious side effects. Consult with your child’s pediatrician if you are unsure about the correct dose.

Making Sure You Take DXM Correctly

Not everyone who gets high from DXM or overdoses on the medication intends to do so. A few common errors when taking DXM are:

  • Using a spoon to measure your dose instead of the measuring implement enclosed with the medication
  • Not chewing tablets properly
  • Not shaking the bottle to ensure an even dosage when taking a liquid
  • Taking DXM for longer than seven days

How DXM Is Abused

The 1990s was crucial to the rise in DXM’s popularity. The medication was available in gel caps for the first time, and this new format had a role in the increase of DXM misuse over the years. Internet forums and personal websites were also influencing the rise in DXM’s popularity.

For the first time, DXM users were able to post tips for how to optimize their high. The internet also brought online shopping, faster ways to invent slang associated with DXM consumption, and ways to share music that references the abuse of cough syrup.

DXM is often not taken seriously because it is legal and cheap. It does not help that pop culture often makes DXM seem like a harmless experimental drug. In a Reddit thread, fans of the TV series South Park discuss an episode in which some of the show’s characters misuse DXM.

Various hip-hop groups also started mentioning DXM in their songs. The same fan thread explained that the TV show House featured an episode with a patient who was addicted to this substance.

Understandably, these depictions could influence impressionable young people who might be duped into thinking DXM abuse is harmless.

In 2011, the Dallas Observer compiled a list of hip-hop artists who wrote songs referencing cough syrup misuse. Some songs are very explicit in their explanations for how rappers abuse cough syrup and even include references to mixing cough syrup with soda, in a concoction known as purple drank

Recreational misuse of DXM is referred to as robotripping, skittling, dexing, and robofizzing. Poison Control says that people misuse DXM by taking more of the medication than indicated on the product’s label. 

People may inadvertently misuse DXM by taking more than one medication that contains it at the same time. Often, people take DXM-containing medication along with acetaminophen or other substances. Taking DXM with alcohol and other drugs is dangerous. 

Misuse Statistics

The University of Buffalo says that DXM abuse reached its peak in 2006, and rates of abuse have remained steady and even decreased somewhat over the years. During the height of DXM misuse, 3.1 million Americans between the ages of 12 and 25 reported having misused DXM at least once to get high. 

Other findings from the University of Buffalo include:

  • Approximately 33 to 50 percent of people who try DXM a few times later start abusing the medication.
  • About 50 percent of emergency room visits related to misuse were for people between the ages of 12 and 20.
  • DXM misuse was linked to 17 deaths between 2000 and 2010.
  • DXM was the third most commonly misused substance in 12th-graders in 2010.

How Do I Know If Someone Is Abusing DXM?

People of any age can misuse DXM, but Poison Control says that parents of teens and young adults should take extra time to educate their children on the perils of misusing the substance. 

The following are common signs of DXM abuse or misuse in adolescents:

  • Empty cough medication containers
  • Decreased academic performance or declining grades
  • Medicinal scents
  • Less interest in activities or hobbies that were once important to them
  • Signs of DXM toxicity, including difficulties with coordination, irritability, hallucinations, and slurred speech

NIDA says that many DXM users may not take the medication seriously and often mix it with other substances, like cannabis or alcohol. OASAS says that some websites teach people to mix various cough syrups to make it easier to engage in robotripping.

Risks of DXM Misuse

DXM is an opioid. Abusing it could cause you to become dependent and eventually addicted.

Using high amounts of DXM could lead to overdose. Symptoms to look out for in the event of a DXM overdose include the following:

  • Nausea
  • Vomiting
  • Changes in blood pressure Add UI Elements
  • Muscle spasms
  • Palpitations (pounding heartbeat)
  • Rise in body temperature
  • Constipation
  • Hallucinations

You should not attempt to treat a DXM overdose at home. Call Poison Control at 1-800-222-1222, or 911. 

Treatment Options

Treatment options are available for those who misuse DXM. NIDA reports that teenagers can greatly benefit from interventions performed by experts. 

Most studies show that treatment begins to benefit adolescents in as little as 12 to 16 weeks, but decisions must be made with the person’s needs in mind. Some teens may benefit from a longer course of treatment.

Commonly employed methods can include:

  • Therapy. NIDA reports that therapy can benefit teenagers by teaching them skills that can help them stay away from drugs and teaching them what triggers them to use drugs. 
  • Addressing other possible mental health issues. This is especially important for adults and teens who may already have come into contact with the criminal justice system. 
  • Involuntary treatment. Parents and other family members can support a teen dealing with problematic drug use by issuing family sanctions. According to NIDA, teens are less likely to see a problem with experimenting with drugs. Providing incentives for them to stop can have a positive effect. 

A 2016 case study published in Substance Abuse Treatment, Prevention, and Policy encourages parents and adults to prevent drug abuse before this starts. 

  • Parents should educate themselves about DXM misuse and factors that could contribute to a teen’s decision to experiment with it. Then they can watch for warning signs.
  • Intervening in the early stages of experimentation can benefit teenagers, as their brains are still developing and more vulnerable to drug use of any kind.
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