What Are the Risks of Abusing Dextromethorphan (DXM)?

Dextromethorphan is a cough suppressant commonly found in over-the-counter allergy, cold, and flu medications. At present, this medication can be found in over 120 OTC drugs.

The medication mildly suppresses areas of the brain that control coughing. The drug can also act as an expectorant, helping to break up congestion and provide temporary relief for runny nose, watering eyes, and sinus congestion. Many medications with DXM also have acetaminophen, which is a common pain reliever.

Because DXM is legal and not as tightly controlled as prescription medications or illegal drugs, many people misuse cough medications at very large doses in order to get high. At large doses, DXM can have hallucinatory and euphoric effects, but it can also be very dangerous.

Effects and Risks of DXM Misuse

Misuse of DXM can lead to many negative health effects and risks, including:

• Hallucinations and delusions: People suffering hallucinations, paranoia, and delusions may harm themselves.
• Memory loss: Someone on high doses of DXM may experience blackouts or lose memories of what occurred while they were high.
• Impairment and self-injury: Intoxication on DXM can lead to a loss of coordination, which can lead to further accidental self-injury.
• Vomiting: This is a very common occurrence with DXM intoxication. A typical method of use involves quickly ingesting as much of a DXM drug (cough syrup, or cold and flu gel capsules) for the body to absorb the DXM before vomiting the medication. Other illicit methods of ingesting the drug, such as powder that is purchased online, prevent vomiting but lead to worse physical damage, including overdose.
• Liver damage: Chronic use of medications containing DXM can lead to liver damage, as most drugs are filtered through the liver if ingested orally. Over-the-counter cough medications often contain acetaminophen, and ingesting more than 350 mg of acetaminophen per day, for several days, can lead to liver toxicity.
• Tachycardia or cardiovascular harm: Rapid heartbeat, high blood pressure, and changes to breathing rates are common during DXM intoxication. Heart attack can occur at high levels of DXM intoxication or due to an increased fight-or-flight response because of a paranoid delusion.
• Overdose: At large doses, DXM acts like a CNS (central nervous system) depressant. This means that the brain can shut down in the same way as with benzodiazepine or opioid overdoses. Symptoms of overdose are dissociation from reality, stupor or unconsciousness with no response, reduced or stopped breathing, changes to heart rate and blood pressure, changes to body temperature, sweating and flushing, vomiting more than once, seizures, heart attack, and coma.

• Seizures: This is a specific complication of DXM overdose. Seizures can impair consciousness, coordination, and other brain activity. At their most dangerous, a drug-induced seizure can lead to permanent brain damage due to dangerous changes in neuron activity that destroy brain tissue.

Treatment for DXM Abuse

Dextromethorphan continues to be an over-the-counter medication, although it has shown some potential for addiction and a high potential for misuse. It is important to get help as soon as possible for DXM addition or misuse problems. Medically monitored detox, individual and group therapy, and social support are extremely important elements of any rehab program.

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