Cough and cold medications addiction
Cough and cold medication addiction, particularly involving dextromethorphan (DXM), is a growing concern, especially among adolescents. DXM, a common ingredient in over-the-counter cough suppressants like Robitussin and NyQuil, is legal and easily accessible, leading some individuals to misuse it for its hallucinogenic effects. When taken in high doses, DXM can produce profound alterations in perception and consciousness, resulting in experiences that resemble those induced by other dissociative substances.
Historically, DXM was developed in the 1950s as a non-addictive alternative to codeine, but its abuse began to rise notably in the 1990s among teens. This trend has raised alarms, with increasing numbers of emergency room visits attributed to DXM misuse. While some states have since implemented age restrictions on the sale of these medications to mitigate the issue, the problem persists, albeit with a reported decline in teenage abuse in recent years.
Users often combine DXM with other ingredients found in cough medications, which heightens the risk of overdose and severe health complications, particularly liver damage. The effects of DXM can vary widely, leading to dangerous behaviors and impaired judgment. Understanding the risks associated with DXM misuse is essential for prevention and education efforts, particularly directed at younger populations.
Subject Terms
Cough and cold medications addiction
ALSO KNOWN AS: Dextromethorphan; DXM; poor man’s PCP; red devils; robo; skittles; triple C; tuss
DEFINITION: Dextromethorphan hydrobromide (DXM HBr) is an active ingredient (cough suppressant) in a variety of over-the-counter (OTC) cough and cold medications sold under such trade names as Robitussin, NyQuil, Dimetapp, and Coricidin. DXM can also be purchased on the Internet in pure powder form. In high doses, DXM is a dissociative hallucinogen that produces effects similar to those of ketamine and phencyclidine, or PCP.
STATUS: OTC medications containing DXM are legal worldwide; some US states require proof of age to purchase and limit the amount that can be purchased
CLASSIFICATION: Noncontrolled substance
SOURCE: Synthetic compound
TRANSMISSION ROUTE: Oral
History of Use
The United States (US) Navy developed Dextromethorphan (DXM) in the early 1950s as a nonaddictive substitute for codeine. It was patented in 1954 and approved by the US Food and Drug Administration for over-the-counter (OTC) sale as an antitussive (cough suppressant) in 1958.
DXM has been widely used since as an active ingredient in cough and cold medications. More than 125 OTC medications containing DXM are sold in the US. DXM in powder form can be purchased online in 1-gram multiples.
DXM abuse was first noted in the 1960s with the use of Romilar, an OTC tablet form of DXM. Romilar was taken off the market in the US in 1973. Abuse of DXM in liquid and capsule forms of cough and cold medications was first observed among teenagers in the 1990s. These preparations are appealing to adolescents because they are inexpensive (compared with other drugs of abuse) and are easy to purchase (or shoplift). In addition, many teenagers and their parents think DXM-containing products are safe because they can be obtained without a prescription; websites promote its abuse and offer recipes for extracting the substance from cold tablets.
Between 1999 and 2004, the number of reported cases of DXM abuse among adolescents increased tenfold; some experts considered it the most commonly abused dissociative drug in North America. According to Substance Abuse and Mental Health Services Administration estimates, the number of people taken to emergency rooms each year in the US because of antitussives rose from 2,420 (including 1,627 teens) in 2004 to some 4,449 (including 2,682 teens) in 2011. To address the growing problem of DXM abuse among teens, between 2012 and 2017, fourteen states passed laws banning anyone under the age of eighteen from purchasing such OTC medications, prompting a few major retail drugstore chains to institute the policy nationally themselves. By 2022, twenty states had adopted the policy. As of the 2021 National Survey on Drug Use and Health, about 2.7 percent of teens in the US reported ever having abused cough and cold medications. This number was higher in the eighteen to twenty-five-year-old demographic. However, most young people stop using DXM in their mid-to-late twenties because harder drugs are readily available to young adults. However, the problem remains. In 2022, over 6,000 people reported visiting the emergency room for issues related to DXM abuse, although abuse by teens appears to be declining.
Effects and Potential Risks
DXM in therapeutic doses (15–30 milligrams) suppresses coughing by acting on the area in the brain that controls coughing, rather than directly on the respiratory tract. At the therapeutic level, it can cause drowsiness or dizziness.
Because it affects the brain, it can cause hallucinations, blurred vision, feelings of unreality, out-of-body sensations, loss of sense of time, excitement, euphoria, and distortions of perception when taken in high doses (between thirteen and seventy-five times the normal therapeutic dose). DXM can also cause paranoia, high blood pressure, rapid pulse, unsteadiness, drowsiness, vision changes, heavy sweating, nausea, fever, vomiting, headache, skin rash or itching, seizures, loss of consciousness, and death.
DXM is unusual among dissociative drugs of abuse in that users experience its effects in a series of distinct stages, or plateaus, rather than in a gradual fashion. Users at the first plateau typically experience DXM as a stimulant, while those at the second plateau are more likely to feel a dreamlike state and be detached from reality. Abusers at the third plateau may report serious disruptions of cognitive function (such as inability to perform simple arithmetic) and other frightening experiences.
Several specific risks are associated with DXM abuse. First, teenagers who use it in the form of OTC preparations are taking it in combination with antihistamines, pain relievers (usually acetaminophen), and fever reducers. These other ingredients considerably increase the risk of overdose or damage to the liver from the acetaminophen. DXM is also dangerous when taken in combination with ecstasy because of the risk of overheating and dehydration, particularly when taken at raves or in hot weather.
Second, about 5 percent of Caucasians are genetically unable to metabolize the drug normally, which leads to the rapid development of toxic levels of DXM in the bloodstream. Third, because DXM affects an abuser’s sense of reality and awareness of their surroundings, it can lead to impaired driving, risk-taking, and fatal accidents.
DXM in OTC medications is safe for most persons when the products are taken as directed. It should not, however, be taken by persons using monoamine oxidase inhibitors or selective serotonin reuptake inhibitors because it has potentially dangerous interactions with these drugs.
Bibliography
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