If you were asked to come up with common drugs of abuse, how many could you name? Most of you would be able to come up with a few examples, such as alcohol, nicotine (the addictive agent found in cigarettes), and even a few highly dangerous and illegal ones like marijuana, cocaine, heroine, or phencyclidines (a.k.a “angel dust”).

But how many of you would list cough syrup amongst this list of abused drugs? Turns out that cough syrup (along with other cough and cold medications) can be just as dangerous as these other drugs if taken in large quantities. This is due in large part to one of the main ingredients found in over 100 different over-the-counter cough and cold medications: Dextromethorphan or DXM.

Did You Know?
Coughing is a natural reaction designed to help in clearing the respiratory tract of foreign particles, or even of excess secretions like mucous or phlegm. Sometimes a cough can arise for no reason, and scientists don’t always know why it happens.

The main reason for including DXM in cough and cold medicine is because of its strong antitussive abilities, meaning that it suppresses those annoying coughs when you get sick. The exact way by which DXM does this isn’t totally known, but it’s thought to act on the nervous system, perhaps by blocking certain chemical receptors in your brain.

Why DXM is Abused

At low levels, such as those found in cough syrup or tablets (up to 30 mg), DXM is perfectly safe with no side effects. But, it’s when large quantities (150-300 mg) of this drug are ingested that severe side effects can occur, one of which abusers of this drug are actually hoping to get: a “euphoric high”.

This type of “high” can resemble the types of “highs” people normally feel from alcohol, opiates, or marijuana, and because of this effect, incidents of its abuse among adolescents have been growing in Canada. In fact, one study estimated that the abuse of DXM has increased 10-fold in adolescents between 1999 and 2004!

Did You Know?
Street names for DXM include “CCC,” “Robo” (based on it being included in Robitussin), “Skittles,” “Red Devils,” “DXM,” “dex,” and many others. It may be found either as an ingredient in cold or cough medication, or in a pure, concentrated powder or pill form on the street.

The Dangers of DXM Abuse

As with other drugs of abuse, however, while some people may take DXM for this perceived “euphoric high,” there are other side effects which can lead to serious problems and can even land you a stay in the hospital. These include slurred speech, confusion, hallucinations, headache, nausea, abdominal pain, vomiting, irregular heartbeat, numbness in the extremities, loss of consciousness or even death.

The risks don’t end there. Once ingested, DXM stays in your system for 5 or 6 hours before being broken down by enzymes in the liver. But this doesn’t fully eliminate the drug’s effects. This is because during the break down process of DXM in the liver, it is converted into a similar molecule called dextrorphan. High levels of this breakdown product, or metabolite, are responsible for many of the psychotropic (mind-altering) feelings associated with DXM abuse.

Ingesting high levels of cold and cough medicine for their DXM content can also put you in further danger, because you may also be ingesting dangerously high levels of other drugs found in the cold medication such as acetaminophen (also known as Tylenol®) or anti-histamines, which can lead to additional complications like liver failure or potentially fatal arrhythmia (irregular heartbeat).

Did You Know?
DXM was first approved by the U.S. Food and Drug Administration in 1958 as a less addictive, equally therapeutic alternative to codeine - a drug still used today in some medications for its pain relief (though usually requiring a prescription).

So I’m not trying to scare you away from taking DXM-containing medications when you have a bad cough, but rather reveal some of the dangers that abusing over-the-counter drugs carry, even ones that are a common find among many medicine cabinets.

The best thing you can do for yourself is to only take DXM when you have a cough or cold, and always follow the instructions on the packaging. And of course, if someone offers you a quick DXM hit on the street, just say no!

Article first published November 10, 2007

Learn More!

DXM Stories

http://www.dxmstories.com/

Greater Dallas Council on Alcohol and Drug Abuse: DXM

http://www.gdcada.org/statistics/dxm.htm

Bryner JK, Wang UK, Hui JW, Bedodo M, MacDougall C, Anderson IL. 2006. DXM abuse in adolescence. Arch Pediatr. Adolesc. Med. 160: 1217-1222.

Boyer EW. 2004. DXM Abuse. Ped. Emer. Care. 20(12): 858-863.

Schwartz RH. 2005. Adolescent abuse of DXM. Clin. Ped. 44: 565-568.

The Antidrug: DXM

http://www.theantidrug.com/drug_info/drug_info_dxm.asp

Drug Free

http://www.drugfree.org/Parent/Resources/Cough_Medicine_Abuse

Wikipedia on DXM

http://en.widipedia.org/w/index.php?title=DXM

Andrew is a native of Vancouver, with a B.Sc. in pharmacology from the University of British Columbia (UBC), and is currently doing his Ph.D in cardiovascular physiology at UBC. He is an avid photographer and hiker, having hiked the 77 km West Coast Trail on Vancouver Island twice, among other conquests. In addition, he is an frequent player of video games, owning several different systems. His favorite games, while numbering too many to mention, include God of War, Metroid Prime, and Super Mario Galaxy.

Andrew H

I am a native of Vancouver, with a B.Sc. in pharmacology from the University of British Columbia (UBC), and am currently doing my Ph.D in cardiovascular physiology at UBC. I am an avid photographer, hockey fan (Go Canucks!) and hiker, having hiked the 77 km West Coast Trail on Vancouver Island twice, among other conquests. In addition, I am a frequent player of video games, owning several different systems. My favorite games, while numbering too many to mention, include God of War, Metroid Prime, and Super Mario Galaxy.


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