Substance guides
DXM abuse and addiction: The cough medicine crisis
Dextromethorphan (DXM), the active ingredient in over-the-counter cough medications like Robitussin and NyQuil, is one of the most accessible drugs of abuse — available without prescription at any pharmacy. At therapeutic doses, it suppresses coughs. At high doses, it produces dissociative, euphoric, and hallucinogenic effects that have led to widespread misuse, particularly among adolescents.
How DXM is abused
Abusers consume large quantities of cough syrup ("robotripping"), take DXM-only pills in high doses, or purchase pure DXM powder online. Effects vary by dose and are categorized into four "plateaus" of increasing intensity, from mild stimulation to full dissociation and hallucination. The dangers include overdose from co-ingredients (acetaminophen in combination products can cause fatal liver failure, antihistamines can cause cardiac arrhythmias), serotonin syndrome when combined with SSRIs or other serotonergic drugs, impaired judgment and motor function, and with chronic use, cognitive impairment and psychological dependence.
Signs of DXM abuse
Empty cough medicine bottles or packaging, purchasing large quantities of OTC cough products, appearing intoxicated without alcohol smell, slurred speech and impaired coordination, rapid eye movement, sweating and elevated body temperature, and withdrawal from normal activities.
Treatment
DXM dependence is treated similarly to other dissociative drug dependencies. Medical monitoring during acute intoxication is important due to serotonin syndrome and co-ingredient overdose risks. CBT addresses the psychological components. Adolescent-specific programs are often most appropriate given the demographics of DXM abuse.