DXM stands for dextromethorphan, a cough suppressant found in over-the-counter cough, cold, and flu medicines. It is often found in both gel capsules and cough syrups. It is a dissociative anesthetic at very high doses, producing psychedelic effects. At low, OTC doses, however, it suppresses cough and creates some sedation, which helps people who are sick to relax, get rest, and experience fewer coughing fits. The chemical is found in over 120 OTC medicines.
The antitussive was developed as a replacement for codeine, which is an addictive opioid drug; however, DXM itself has now become a drug of abuse. Although it is still available over the counter, many states have enacted legislation to limit how much DXM-based product a person can buy at one time or require that sellers check the ID of a person purchasing these medicines to make sure they are a legal adult.
How Is DXM Abused?
Recommended doses for DXM, as stated on the labels of cough or cold products containing this ingredient, are between 10 and 20 milligrams every 4-6 hours, or 30 mg every 6-8 hours. Servings are measured differently depending on whether the product is a liquid cough syrup or a capsule.
People who abuse these drugs for nonmedical reasons, however, take between 240 and 1,500 mg per recreational dose. Reports of heavy DXM abusers suggest that some people consume three or four bottles of cough syrup per day to maintain a high. While this induces euphoria and psychotropic effects, there are many other chemicals in cough and cold medicines; consuming large quantities of any substance, including OTC medications, is extremely dangerous.
The Drug Enforcement Administration notes that DXM produces different, specific effects at different doses. The scale they report shows the following effects with specific doses:
- 100-200 mg: mild stimulation
- 200-400 mg: euphoria and hallucinations
- 300-600 mg: distorted visual perceptions & loss of motor control
- 500-1500 mg: dissociative sedation
Effects from DXM typically begin within 15-30 minutes after the substance is ingested. Euphoria, hallucinations, and negative side effects can last for several hours, usually between three and six hours.
In 2006, 3.1 million Americans between the ages of 12 and 25 reported recreational abuse of DXM at least once in their lives, and 1 million reported abuse in the past year. Adolescents ages 12-20 make up 51 percent of hospitalizations from DXM overdose. Although some states prevent adolescents from purchasing cough or cold medicines due to DXM abuse problems, this age group is the most likely to abuse this substance. Nearly every household has DXM products in the medicine cabinet. The Monitoring the Future Survey from 2011 reported that 2.9 percent of 8th graders, 4.3 percent of 10th graders, and 5 percent of 12th graders abused DXM cough and cold medicines that year.
In addition to legal sales over the counter, DXM is also found in high-dose, illicit forms online. Powders, pills, and capsules specifically created for recreational abuse can be found on many sites. These forms are very dangerous, and they can lead to addiction, dependence, withdrawal, overdose, and death.
Side Effects from DXM Abuse
Taking DXM for nonmedical reasons for a long time or in large amounts can cause various side effects, such as:
- Hot flashes
- Rashes or red, blotchy skin (not an allergic reaction)
- Nausea and vomiting
- Loss of coordination
- Slurred speech
- Impaired judgment
- Reduced cognitive ability
- Nystagmus, or rapid eye movements
- Visual disturbances
- A sensation of floating
- Panic attacks
- Hypertension, or increased blood pressure
- Tachycardia, or increased heart rate
- Dissociation from the body
- Altered perception of time
- Hallucinations, typically visual or auditory but sometimes tactile
People who abuse DXM regularly are likely to develop physical tolerance to, and dependence on, the drug. They may also develop an addiction, leading to compulsive consumption of DXM products. Physical dependence and tolerance can lead to withdrawal symptoms when the person does not consume DXM, making it more likely that they will take the substance to avoid these sensations. Chronic abuse of DXM can even induce psychosis.
Withdrawal from DXM
Symptoms of DXM withdrawal include:
- Nausea or vomiting
- Upset stomach
- Weight loss
While these symptoms are not physically dangerous, they may be uncomfortable. People who try to stop taking DXM without medical supervision to ease withdrawal symptoms are more likely to relapse, which can lead to overdose.
Although DXM is easy to find and legal to purchase for adults, high doses of the drug can cause an overdose. The American Association of Poison Control Centers reported that, in 2014, there were 45,748 cases of DXM poisoning (some of which were accidental); 33,811 single exposures to the drug; and six deaths from DXM abuse.
- Breathing problems, usually irregular, shallow, or depressed breathing
- Bluish tint under the fingernails, on the tip of nose, or on the lips
- Blurred vision
- Drowsiness and dizziness
- Changes in blood pressure, either high or low
- Muscle twitches and twinges that are involuntary
- Nausea, vomiting, and stomach or intestinal spasms
- High body temperature, or hyperthermia
People who struggle with DXM addiction can get help. Medical professionals can monitor the detox process, ensuring that symptoms like discomfort and nausea are eased with small, temporary doses of medicine. There is no medication replacement therapy for DXM addiction, as there is with opioid addiction, but working with therapists and doctors will help during the detox process as symptoms can be treated on an as-needed basis.
Once physical dependence has ended, the person will generally begin therapy. Therapy may take place in a group or individual setting. Various forms of therapy may be used, depending on which is best for the individual, but all will attempt to help the client understand their addiction, address behaviors related to addiction, and build a social support network to help them avoid relapse.