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DXM Abuse

Over-the-counter medications containing dextromethorphan (DXM) have long been used to treat common ailments like coughs and colds safely. In the past decade, however, DXM has also earned a reputation as a cheap, easy-to-find hallucinogenic drug, especially among young people.

DXM abuse can be dangerous and deadly with effects ranging from euphoria and hallucination to coma and seizures.

What Is DXM?

Dextromethorphan (DXM) is a synthetic substance found in some over-the-counter treatments, such as cough suppressants.

It is most notoriously available under the brand-name cough suppressant Robitussin, as well as in other expectorants, flu, and sinus treatments. There are more than 70 dextromethorphan-containing products available in U.S. drugstores.

Taken at the suggested dosage, these products are considered very safe and effective.

Effects at High Doses

When taken at higher doses, however, dextromethorphan can produce psychedelic effects. For this reason, its illicit use has become popular. Many looking for an extreme drug experience have sought out DXM-containing products to go “robo-tripping” — a term used for the psychedelic experience of taking a high dose of dextromethorphan.

In high doses, DXM is considered a dissociative anesthetic. It is often compared to PCP and ketamine.

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Dextromethorphan may appeal to many as a cheap or easy high because of its availability and affordability.  It may even appear safer because it’s so widely accessible in the aisles of popular stores.

When taken in high doses or combined with other drugs, DXM can be incredibly dangerous, resulting in long-lasting health problems or even death.

How Is DXM Abused?

While it’s suspected that some DXM is being sold on the black market (most likely online) in powder or pill form, most illicit users of the drug are taking incredibly high doses of the over-the-counter medications available in most stores. This is usually in cough syrup or liquid form.

The suggested use for most DXM-containing products, like cough syrup and suppressants, is generally around 10 to 20 mg every four to six hours, or 30 mg every six to eight hours.

Illicit users, however, may use up to 240 to 1500 mg in a single dose. Some extreme or experienced users may use even up to three or four entire bottles of cough syrup per day.

Who Is Using DXM?

While there is limited research available on which populations and age groups are using DXM and with what frequency, there are indications that the drug is most popular among adolescents and young people, perhaps because of its availability and low cost.

In a 2004 report, the frequency of DXM-related calls to the California Poison Control System increased 10-fold. About 75 percent of these calls were related to DXM taken by people ages nine to 17. The highest frequency of DXM abuse was reported by adolescents 15 to 16 years old.

The Plateaus of DXM Abuse

Medical professionals and DXM users have described four behavioral phases of illicit DXM use that will vary with use and/or drug tolerance.

  • Phase 1ecstasy-like effects: Users may feel stimulated, with rushes of energy and feelings of euphoria.
  • Phase 2-intoxication: Users report effects similar to being drunk or high on marijuana, but with a greater level of motor skill dysfunction. Users may lose cognitive skills and experience errors in perception. They also may experience mild hallucinations in this phase.
  • Phase 3-disassociation: Users experience disassociation and stronger hallucinations. Some compare the effects in this phase to those experienced while taking the animal tranquilizer (and dissociative drug) ketamine. 
  • Phase 4-out-of-body experience: Users who have taken a high dose may feel completely separate from their body, as though they are in a trance.

Side Effects 

Depending on the dosage of DXM and the individual taking it (their drug tolerance, body weight, and age), the effects of dextromethorphan generally last about six hours. They can range from mild to life-threatening. They may include the following:

  • Confusion
  • Euphoria
  • Feeling hyper and giddy
  • Slowed breathing and/or shortness of breath
  • Nausea
  • Nervousness
  • Agitation and bizarre behavior
  • Unsteadiness or loss of balance
  • Impaired motor skills
  • Problems forming sentences or thinking cohesive thoughts
  • Changes in vision, including blurred vision
  • Slowed or increased heart rate
  • Hallucinations
  • Distorted perceptions
  • Seizure
  • Coma

Short-Term Dangers 

In terms of erratic and risk-taking behavior, some of the most dangerous adverse effects of DXM relate to the feelings of disassociation it creates in the user as well as the loss of perception. The drug may also give users a false sense of supernatural power or strength. This can cause users to injure themselves or participate in dangerous and out-of-character behavior.

Physiologically, the most dangerous effects of DXM include slowed or stopped heart rate, slowed or stopped breathing, and seizures. These can all stop oxygen flow to the brain and result in coma, brain damage, and death.

These dangers are increased when dextromethorphan is taken in combination with other drugs or substances, like MDMA, opioids, and benzodiazepines. All these substances can further slow heart rate or breathing, and this can result in death.

The cough syrup with DXM that many people abuse to get high typically contains decongestant and/or antihistamine substances that can produce their own dangerous effects when taken in high doses. These effects include sleepiness, dizziness, increased heart rate, and loss of motor skills.

Dangers of Long-Term Use

Continuous use of DXM can result in addiction, with withdrawal symptoms that can include anxiety, restlessness, insomnia, diarrhea, and upset stomach. Severe withdrawal may cause suicidal thoughts.

In studies, users have been shown to develop a tolerance to DXM, making addiction and abuse of the drug more likely.

Chronic use of high-dose DXM can result in a condition called toxic psychosis, in which the user loses touch with reality and experiences a continuous state of confusion. This can result in more severe psychological and behavioral problems. 

Long-term use of DXM can cause dangerous and long-lasting health problems, including liver problems and digestion issues. The liver may be damaged from having to work so hard to detoxify DXM from the system.

Because of its effects on the central nervous system (CNS), long-term DXM use can cause memory loss, depression, anxiety, and sleeping problems.

Treatment for DXM Abuse

The treatment for DXM abuse will vary depending on the user’s relationship with and dependence on DXM.

An individual who has been using high doses of DXM continually over a long period of time is likely very psychologically dependent on the drug. They may require withdrawal support to ensure they can safely and effectively overcome the physical effects of withdrawal. A residential program may be the best option for an individual with a severe DXM addiction.

Many users of dissociative drugs seek out the feeling of dissociation because they are looking to escape something. This may be trauma, an underlying mental illness, or an inability to cope with stressful events in life. Treatment and counseling can help individuals get to the root of these issues and deal with them, so they can embrace life rather than looking to become numb or escape.

Effective counseling methods, like one-on-one therapy, group therapy, or cognitive behavioral therapy (CBT), can encourage a sense of accountability and provide clients with life skills that can help them on their path to recovery and beyond.

Just as Dangerous as Any Illicit Drug

Many people, especially adolescents, may be drawn to DXM use because the drug is so easy to get. Robo-tripping may seem less dangerous because DXM-containing cough syrup is found in every drug store in the U.S. This doesn’t make it safe.

When taken in high doses, DXM can be dangerous and even fatal. It’s just not worth the risk.

Sources

Dextromethorphan (DXM). Center for Substance Abuse Research (CESAR). from http://www.cesar.umd.edu/cesar/drugs/dxm.asp

(February 2008) Dextromethorphan Abuse in Adolescence. The Archives of Pediatrics & Adolescent Medicine. National Institutes of Health. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2257867/

(May 2018) ‘Robo-Tripping’: What Residents Need to Know. MDEdge Psychiatry Presented by Clinical Psychiatry News. from https://www.mdedge.com/psychiatry/article/164195/addiction-medicine/robotripping-what-residents-need-know

(August 2016) A Guide to Robitussin DM. University of Illinois-Chicago, Drug Information Group. Healthline. from https://www.healthline.com/health/cold-and-flu/robitussin-dm

(September 2018) The Types of Dissociative Drugs. Verywell Mind. from https://www.verywellmind.com/what-are-dissociative-drugs-63387

(December 2017) Over-the-Counter Medicines. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines

(February 2015) What are the Effects of Common Dissociative Drugs on the Brain and Body? National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/research-reports/hallucinogens-dissociative-drugs/what-are-effects-common-dissociative-drugs-brain-body

(February 2019) Hallucinogens. Psychology Today. from https://www.psychologytoday.com/us/conditions/hallucinogens

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