Dextromethorphan Addiction: Facts, Symptoms Of Abuse, And Treatment

Last Updated: June 16, 2020

What is Dextromethorphan? DXM is an over-the-counter cough suppressing medication. It is a reasonably affordable drug with narcotic properties in high doses, which increase a high potential for abuse with every year. The biggest problem of this medication is that a good number of youngsters turn to abuse dextromethorphan cough syrup in the USA. This happens because DXM produces euphoria-like and psychoactive effects when taken overprescribed.

An active ingredient Dextromethorphan belongs to morphinan class but works very differently from other drugs with similar morphine structure (which has powerful pain-relieving agents). DXM may act as a dissociative anesthetic in very high doses. This pushes people to experiment with the amount of the drug and very often leads to DXM abuse and addiction.

What Is DXM?

Dextromethorphan is found in cough suppressants in two forms: Dextromethorphan Hydrobromide and Polistirex. Because it is frequently used in a complex with other medications to treat the flu and associated symptoms, including allergies, people often wonder if dextromethorphan is an antihistamine. But it is not an antihistamine and has no antihistamine properties.

The dextromethorphan mechanism of action works as NMDA Receptor Antagonists and the opioid sigma 1, and sigma 2 receptors antagonist. When nerves in the airways and lungs detect an irritating substance or fluid, they send a chemical signal to the brain’s medulla oblongata where the cough reflex is initiated.

Robitussin dextromethorphan is among the popular dextromethorphan based drugs. Other dextromethorphan brand names are Vicks, Triaminic, Coricidin, and NyQuil. DXM street names include: Dex, Tripple C, Skittles, Orange Crush, Red Devils, Sizzurp or Purple drank. Over the counter, it is usually found in the form of syrups, lozenges, tablets, gel capsules, and sprays.

taking cough medicine

At the physician prescribed dosages, dextromethorphan is relatively safe, but people who use it recreationally, usually take up to ten times the recommended dosages. At such dosages, both physical and psychological dextromethorphan addiction may occur.

DXM Abuse Statistics

According to the DEA, dextromethorphan is now a “drug of concern” due to high dextromethorphan dependence and abuse rates. It is challenging to have the full picture of dextromethorphan abuse because the drug has legitimate medicinal uses; abuse only occurs when dextromethorphan dosage is exceeded. Mostly, statistics are sourced from emergency visits to the ER or from self-reported surveys which may not give the real picture.

In 2006, the National Survey on Drug Use and Health (NSDUH) Reported that approximately 3.1 million people aged between 12-25 have abused DXM. This survey also indicated that in adults, more men than women were prone to abuse this drug.

Other reports also indicate that dextromethorphan drug addiction sends approximately 6,000 teenagers to the ER each year. Most of these cases happen due to DXM and alcohol interaction in order to get intoxicated faster. Dextromethorphan interactions with other drugs may cause severe side effects that may also be contributing to the high incidence of DXM related ER visits.

In 2008, the Consumer Healthcare Products Association ordered to place a warning icon on the packages of DXM products in the United States. This way, they wanted to warn people about issues associated with abusing this drug and prevent the addiction spread. In 2012 the CHPA launched a propaganda campaign on the Internet, that distributed video materials explaining the negative effects and the possible adverse consequences of the abuse of dextromethorphan.

How Does DXM Addiction Develop?

Is DXM addictive? In spite of the good and safety profile of this drug, it can be addictive when abused.

In some rare cases, the individual may establish physiological dependence as well. When this happens, the person will experience DXM withdrawal symptoms such as insomnia, restlessness, upset stomach, weight loss, and anxiety. The individual may also develop DXM serotonin syndrome when they mix dextromethorphan with meds such as procarbazine (monoamine oxidase inhibitors).

Dextromethorphan tolerance develops after regular and frequent abuse of the drug, which means that a person will require more and more of it to get the desired effects. If initially, they would get euphoria with 600mg of cough suppressant dextromethorphan, now they may need to take 1000mg to achieve a similar high.

Warning Signs And Symptoms Of DXM Abuse

The medicine is frequently abused, but it is hard to identify if it’s being abused immediately. Unlike opioids and other hard drugs, finding open bottles of DXM cough syrup will not raise the eyebrows of many people.

When a person is abusing DXM, there are a few pointers that can sell them out. These are some of the signs of DXM abuse that need to be carefully tracked:

  • Loss of interest in social activities such as sports
  • The appearance of being unkempt
  • Eating poorly
  • Changes in sleeping patterns
  • Reduced performance
  • Chronic lateness
  • Acquiring new friends
  • Aggressive behavior

girl needs help

Apart from the signs,  many dextromethorphan addiction symptoms can also be observed in a person abusing it. They include:

  • Looks intoxicated, but without the smell of alcohol
  • Slurred and incoherent speech
  • Taking cyclical or repetitive actions such as walking to the room, putting the lights on, walk out, then come back and repeat the same action
  • Doing the “robo-walk,”  this is a rigid and uncoordinated movement named after Robitussin
  • Lack of situational awareness

Risks And Effects Of Abusing Dextromethorphan

DXM addiction comes with many adverse DXM effects and risks. Taking too much dextromethorphan can significantly damage the nervous system, so that one may get a chemical psychosis. This may result in mental imbalance that may require hospitalization. Poor judgment, visual distortions, and irrational behavior may also occur, putting the individual at high risk for causing or being involved in an accident. This may lead to a DXM hangover, and this soon becomes a vicious cycle. Death is rare but the most significant risk which may appear because of abusing DXM.

When the DXM plateaus phases are over, the victim is usually left battling several long term effects. According to the National Institute on Drug Abuse (NIDA), excessive consumption may lead to the following dextromethorphan abuse long-term effects:

  • Liver toxicity
  • Respiratory system depression on rare occasions
  • Depression and mania
  • Impaired memory
  • Delusions
  • Cognitive impairment
  • Inability to focus
  • Panic attacks
  • Failure to make long term goals

Dextromethorphan Abuse Among Teens

A six-year retrospective review study conducted in California in 2008 showed a ten-fold increase in teen DXM addiction rates from 1999 to 2004. In spite of government efforts to the abuse of dextromethorphan cough syrup by teenagers, it is easily accessible through stores and online sources. DXM extraction from syrups at home for getting its pure form is also relatively easy even for adolescents, making it even harder to control its abuse among teens.

DXM is safe for teens, but here are a few things a parent can do to prevent their teen from abusing DXM:

  • Educate teens about the dangers of abusing dextromethorphan
  • Regularly inspect rooms for any empty medicine boxes or strange powders
  • Monitor online purchases
  • A parent can do a DXM drug test for a teen to confirm or rule out suspicions of abuse

DXM addiction is real and may lead to severe effects such as liver damage and respiratory complications. Furthermore, teenagers may use it as a gateway to hard drugs.

DXM Addiction Treatment And Recovery

For anyone suffering from DXM addiction, there is much that can be done to remedy the situation. As much as there is no pharmaceutical treatment dextromethorphan addiction, there are alternative therapies that work effectively.

DXM Abuse Treatment

Dextromethorphan addiction treatment focuses on dealing with the immediate effects of addiction. This may include treating withdrawal symptoms as well as reducing psychological dependence to allow one to resume a healthy lifestyle. Some approaches that may be effective include:

  • Professional detox. Here, the individual is guided by a qualified professional through a detoxification process. The aim is to pump out dextromethorphan from the individual’s system. Detox needs to be followed up with other addiction treatments; otherwise, it will result in relapse.
  • Cognitive-behavioral therapy. This educates the individual on how to avoid situations that expose them to addiction. This may include having alternatives such as using cold medicine without dextromethorphan when treating a cold.
  • Contingency management. Here the individual is rewarded for abstinence to encourage them to stick through with the addiction treatment program.
  • Group therapy, where individuals meet up with people with the same or similar addictions to encourage each other in their addiction recovery journey.
  • Long-term follow up to prevent relapsing back to addiction.

Rehabilitation For DXM Abuse

Once a person has received treatment for dextromethorphan addiction, they will need recovery to resume a healthy lifestyle and keep away from abusing this drug. Dextromethorphan rehab combines cognitive behavior therapy with psychological counseling. The individual is made to understand the situations that lead to the abuse of dextromethorphan. The rehabilitation center will also offer education on the potential dangers associated with using dextromethorphan while pregnant.

healthy teens

Family therapy for DXM addiction may also be used to ensure that the individual has a good support network. Checking into a suitable rehab center may help keep the individual away from external influences that may trigger relapse back to addiction. Some inpatient facilities offer a holistic approach to DXM recovery. This may include activities such as meditation, yoga, dance, or art therapy.

The Benefits And Harm Of Dextromethorphan

The risks of the dextromethorphan OTC include both long and short term effects that extend to all age groups. When buying DXM for cough treatment, make sure to consult with a physician, who will consult in avoiding any drug interactions that may trigger severe side effects.

In spite of all the risks associated with dextromethorphan abuse, it is a useful medicine that can be used to suppress stubborn coughs.

Page Sources

  1. National Survey on Drug Use and Health (NSDUH-2006). Substance Abuse & Mental Health Data Archive. 2006.
  2. Drugs of Concern. United States Drug Enforcement Administration.
  3. Jodi K. Bryner, Uerica K. Wang, Jenny W. Hui, Merilin Bedodo, Conan MacDougall, Ilene B. Anderson. Dextromethorphan Abuse in Adolescence. 2006.
  4. David C. Spangler, Catherine M. Loyd, Emily E. Skor. 2016.

Published on: August 6th, 2019

Updated on: June 16th, 2020

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.


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