If you’re raising a teenager and you don’t know much about DXM or cough medicine abuse, you’re hardly alone. DXM, or dextromethorphan, is a common ingredient in cough and combination cold medicines. Teens, however, have found another use for cough medicine -- getting high. Taking huge doses of cough medicine to get high may sound revolting. In fact, you might assume it’s just an obscure fringe thing.
But it’s not. A 2008 study found that one in 10 American teenagers has abused products with DXM to get high, making it more popular in that age group than cocaine, ecstasy, LSD, and meth. Although DXM products are quite safe when taken as recommended, high doses can cause hallucinogenic trips -- and pose serious risks.
DXM is in almost half of all of the OTC drugs sold in the U.S. For teens experimenting with drugs, DXM is cheap, easy to get, and legal.
“A lot of parents just have no idea,” says Deborah Levine MD, clinical assistant professor of pediatrics and emergency medicine at NYU Langone Medical Center. “Alarms would sound if they ever found an empty beer can in a teenager’s car, but they wouldn’t think twice about an empty bottle of cough syrup or used-up package of tablets.”
As a conscientious parent, you may occasionally check the bottles in the liquor cabinet, or sniff for the scent of pot. It’s time to also pay attention to what’s in your medicine cabinet. Here’s what parents need to know about DXM abuse.
DXM - or dextromethorphan - was introduced in the U.S. in the 1950s, and is the most commonly used cough suppressant in the U.S. DXM is now in more than 125 drugs for cough, cold, and flu, including many household names such as Dimetapp DM, Nyquil, Robitussin, Coricidin, Delsym, Theraflu, and Vick’s Formula 44. It’s also used in store brands of cough and cold medicines, such as Wal-Tussin or Wal-Flu sold at Walgreen’s. It’s used in cough syrups, capsules, lozenges, tablets, and gelcaps.
At normal doses, DXM is quite safe. Dextromethorphan affects the brain, specifically the region that controls coughing. However, at high doses - as much as 10 to 50 times the suggested amount - DXM can cause hallucinatory and dissociative effects similar to those of PCP or ketamine (special K.) Some people assume that teens who abuse cough medicine are after the alcohol content, but they’re really after DXM.
Although DXM abuse is not new, the scope has been changing. In California, rates of DXM cases reported to poison control centers jumped by 10 times between 1999-2004. Among children aged 9-17, it increased by 15 times. More recent national surveys have shown DXM abuse holding steady or dropping slightly, but it remains a serious problem.
DXM is easy to get. The sheer number of products that contain DXM makes it tempting. If you don’t have at least one in your medicine cabinet right now, your neighbor does. Some of the most commonly abused drugs are not cough syrups - which are hard to keep down - but higher-dose tablets, such as Coricidin and store brands such as Walgreen’s Flu BP. “It’s much easier to take in high doses than cough syrup,” Levine tells WebMD.
DXM is cheap. Compared to buying illicit drugs from a dealer, getting a bottle of cough syrup or a packet of tablets is a bargain. DXM is a habit that’s easy to support with babysitting money. And for kids sneaking their DXM from home -- or shoplifting -- it’s free.
Cough medicine seems safer. Many teens try DXM because they assume -- incorrectly -- that even at high doses it still must be safer than illicit drugs. Although they might be uneasy about what they’d get from a shady dealer on a street corner, they’re comfortable trying a legal, brand name medicine they got in a brightly-lit drugstore. And because the medicine is legal, they can carry it with them, or use it on the street. “It’s a kind of sick consumer savvy,” says Hallie Deaktor, director of public affairs at the Partnership for a Drug-Free America in New York City. Unfortunately, Deaktor often sees that misconception about DXM abuse reflected in parents too. “I talk to some parents, and they tell me how relieved they are that their kids are abusing cough syrup instead of illegal drugs,” says Deaktor. “They have no idea how serious the risks are.”
DXM is popular. A whole subculture has risen up around DXM abuse. There’s a specialized jargon for its use, like robo-tripping, sheeting, dexing, and skittling. There are many more terms for the drug itself: CCCs, dex, red devils, robo, skittles, tussin, syrup, and velvet. On the Internet, there are lengthy guides outlining DXM abuse, with detailed tips about the pros and cons of different brands and formulations.
Their parents don’t know. According to surveys, even among parents who diligently have the “drug talk” with their kids, fewer than one in five think to mention DXM abuse. “I talk to a lot of parents who just don’t get it,” says Deaktor. “Many just can’t get their brains around the idea that anyone would want to drink a whole bottle of cough syrup. It just seems too disgusting.” (After all, this is the same medicine that parents had to beg their kids to take when they were sick.)
For the most part, cough medicine abuse seems to be popular among teens and sometimes younger kids, Levine says. After they graduate high school, illicit drugs are more easily available, especially on college campuses. “By the time they’re young adults, they tend to look at using cough medicine as beneath them,” says Levine.
Another type of danger is posed by the sale of so-called “pure DXM,” the raw ingredient used by pharmaceutical companies to manufacture drugs. Pure DXM is sometimes sold in bulk over the Internet -- often from outside the U.S. -- and then resold in smaller doses by dealers. For teens who are used to low doses of DXM in OTC products, raw DXM can pose a much higher risk of overdose.
In 2004, the most recent data available, abuse of DXM sent more than 5,500 people to the emergency room, including children as young as 12. Although uncommon, DXM has also played a role -- directly or indirectly -- in a number of deaths. High amounts of DXM have the potential to be very dangerous, or even fatal when taken alongside other medicines or illicit drugs.
Overdoses. There have been several fatal overdoses associated with pure DXM powder, which is sometimes sold on the Internet. High amounts can shut down the central nervous system. There’s another sort of overdose risk, too. Combination cold and flu drugs often contain a number of other active ingredients - other cough suppressants, decongestants, antihistamines, and painkillers. When taken at high doses, these other drugs - like the pain killer acetaminophen - can be quite toxic. They can cause liver damage, heart attack, stroke, and death.
Impairment. One serious risk of DXM abuse is that people will injure themselves while high, says Levine. The altered consciousness, impaired vision, and hallucinations can lead to irrational and dangerous behavior. For example, in 2003, a 14-year-old Colorado boy who was high on DXM was killed while trying to cross a highway.
Combined effects with other substances. According to studies, abusing OTC medicines is associated with a higher risk of abusing alcohol or illicit drugs. DXM is often a gateway drug, says James E. Lessenger, MD, who has studied OTC medicine abuse in California. Once kids get comfortable with it, they move on to illegal drugs, he says. Unsurprisingly, in all of the emergency room visits related to non-medical DXM use, more than a third of the people had also been drinking. Compounding the effects of DXM with other substances increases the risks. For instance, when DXM is taken with ecstasy, the risk of potentially fatal overheating is possible.
What should you do if you find your child high on DXM? Levine says that it will typically pass on its own, and you can usually wait it out. But you need to get emergency medical attention if your child:
If other symptoms are worrying you, err on the side of caution and get medical help right away, Levine says.
Although the subject of teen DXM abuse is grim, there is some good news. Recent surveys have shown that the number of teens abusing DXM seems to have stopped growing and leveled off. In a 2008 survey, the percentage of teens who said they saw cough medicine abuse as risky increased by over 6% in just one year. Some experts think that the message about DXM’s dangers is getting through.
The issue of DXM abuse has also been getting some political attention. A bill currently before Congress would outlaw the sale of raw DXM to individuals. Of course, this wouldn’t have any impact on kids who are getting their DXM in drugstores. Some advocacy groups have proposed further restrictions to tackle that problem, like age limits on the sale of products with DXM. Meanwhile, some stores have decided on their own to impose age restrictions or to keep DXM products behind the counter to discourage abuse and shoplifting.
As a parent, you can’t expect outside forces to resolve this problem. You have to take action. So what should you do?
Start by cleaning out your medicine cabinet and keeping an eye on how much medicine is in each bottle or package. Keep prescription and OTC medicines such as cough medicine away from your children’s reach and sight. Some parents decide to lock up their medicine cabinets like they do their liquor cabinets. But the most important thing is to talk with your kids.
“The best thing is education,” says Levine. “It’s so much better for kids to learn about the risks of drug abuse from a parent than from a peer. So look your kids in the eye and tell them that abusing drugs like DXM can have terrible risks, no matter what their friends are doing.” Stress that although OTC medications can have real benefits, they can have serious risks when not used as recommended.
Although it’s disturbing to know that 10% of teens have abused DXM, but keep in mind that 90% of teens haven’t. By talking about the risks of DXM abuse with your teens, you can help them stay in that healthy majority.
General Arthur T. Dean, chairman and CEO, Community Anti-Drug Coalitions of America (CADCA), Alexandria, Va.
Deborah Levine, MD, clinical assistant professor of pediatrics and emergency medicine, NYU Langone Medical Center; Bellvue Hospital, New York City.
Substance Abuse and Mental Health Services Administration (SAMHSA) web site, “The New DAWN Report: Emergency Department Visits Involving Dextromethorphan, 2006.”