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Dextromethorphan, also known as DXM, is a substance commonly found in many over-the-counter medications. Its primary uses are as an antitussive (a cough suppressant) and as an expectorant (decongestant).
DXM was developed in the 1950s and formally approved by the Food and Drug Administration in 1958 as a cough suppressant.
It was almost immediately introduced as an over-the-counter medication for cough suppression under the brand name Romilar; however, the drug was abused by some and removed from the market in the 1970s.
DXM was not included in the Controlled Substances Act of 1970, and it was reintroduced in more refined versions of a number of cough medications that attempted to make it very unpleasant tasting if it was consumed in large amounts. This, of course, made it very unpopular, and manufacturers began developing more taste-friendly versions of the cough syrups, again opening up the potential for the drug to be abused. Today, DXM is contained in over 100 different products, including commonly known over-the-counter medications like Robitussin and Vicks Formula 44.
DXM is a synthetic drug produced from a derivative of morphine; however, it does not mimic the same action as opiate derivatives mimic. Instead, DXM acts on a neurotransmitter known as NDMA (N-methyl-d-aspartate). In high doses, its effects are similar to drugs like ketamine (special K) and phencyclidine (PCP). At recommended dosages, the drug is considered to be safe and produces therapeutic effects, whereas at high doses, it acts as a dissociative hallucinogenic drug that produces feelings of detachment, euphoria, and visual hallucinations.
It is safe to assume that any drug or medication can be abused if taken for purposes other than its intended medicinal usage. Therefore, the answer to the question regarding DXM’s potential for abuse is obviously “yes.”
There is a concern regarding DXM abuse in the United States, particularly by young people taking the drug to experience the euphoria, hallucinations, and dissociative effects that occur in conjunction with the consumption of larger-than-recommended quantities of the drug.
The prevalence of DXM abuse has been difficult to estimate by concerned organizations, such as the Drug Enforcement Administration (DEA); however, it is noted that the drug is available online. This availability makes it particularly attractive to individuals seeking to abuse it. Other street names for DXM include:
Medicinal Use vs. Abuse
When individuals take the recommended dosage, there are few side effects associated with DXM usage. Typically, the recommended dose is 15-30 mg taken 3-4 times a day. The medicinal effects usually last 5-6 hours after administration orally. Very few side effects occur at this dosage level but some can occur, including constipation, mild dizziness or drowsiness, mild headache, and mild to moderate nausea and vomiting in some cases.
The DEA reports four plateaus of dosage levels of DXM abuse and the effects that occur based on these plateaus:
The DEA also reports that at high doses, deaths due to DXM abuse have been reported.
Signs of DXM Abuse and Overdose
The DEA reports that adolescents and young adults are the most likely group of individuals to abuse DXM. Indicators that someone is abusing DXM include:
Some of the signs of an DXM overdose include:
If individuals use other substances in conjunction with DXM, the potential effects of all substances are exacerbated and can produce extremely toxic results. There is some evidence that naloxone, a drug used to reverse the effects of overdose on opioid drugs may also be useful in reversing DXM overdose.
DXM abuse, like the abuse of other substances, may co-occur with other substance use disorders or other mental health disorders. It is extremely important to engage any individual who abuses DXM in a full psychosocial and medical evaluation to determine the presence of any coexisting issues that will need to be addressed as the person attempts to recover from abuse of DXM.
There does not appear to be sufficient evidence to indicate that abuse of DXM, even over long periods of time, results in any significant risk of physical dependence; however, psychological dependence to any substance can occur. Thus, individuals who have chronically abused DXM may experience significant cravings, depression, anxiety, jitteriness, and so forth after initially stopping use of the drug. As a result, medical detox may be needed to manage psychological withdrawal symptoms, depending on the individual’s particular situation.
Individuals who abuse DXM can benefit from formal substance abuse and addiction treatment programs that consist of both individual and group therapies. Since many individuals who abuse DXM are young, it can be beneficial to find an age-appropriate treatment program. Oftentimes, people benefit from residential treatment programs that surround them with peers in similar situations, and this may include those in a similar age demographic.
Typically, therapy will consist of cognitive behavioral principles or other formalized methods that address the individual’s assumptions and beliefs that led to substance abuse and attempt to change these beliefs along with changing behaviors. Clients can also benefit from social support groups such as 12-Step groups (Narcotics Anonymous and others).
As with any substance abuse, continued DXM abuse can result in serious consequences on various levels. With comprehensive care that addresses the issues that led to substance abuse, complete recovery is possible. Since DXM is often abused with other substances, treatment must address all substances of abuse.