DXM (dextromethorphan) is a cough suppressant found in many over-the-counter cough and cold medicines. When taken as directed, DXM is considered safe and effective for temporary relief of cough caused by minor throat and bronchial irritation. However, DXM cough syrup has also become popular as a recreational drug, especially among teenagers, leading to concern over its easy availability.
Quick Answers
– DXM cough syrup is available over-the-counter without a prescription in the United States.
– DXM is approved by the FDA for use as a cough suppressant when taken in normal doses.
– In large doses, DXM can have psychoactive effects and is used recreationally, especially by teenagers.
– Concerns over recreational DXM abuse have prompted some retailers to restrict access and require ID for purchase.
– DXM remains legal and widely available over-the-counter despite some calls to make it prescription-only.
Is a prescription required for DXM?
In the United States, DXM cough syrup and other medications containing DXM do not require a prescription and can be purchased over-the-counter at pharmacies, grocery stores, convenience stores, and other retailers. The most common sources of DXM are “extra-strength” cough syrups, capsules, and liquid gels. Popular brand name cough and cold medicines containing DXM include NyQuil, Robitussin, Vicks, Coricidin, and others.
DXM cough products are available without a prescription because DXM is considered safe and effective when used for its intended purpose as a cough suppressant. The typical adult dose of DXM for cough is 15-30 mg taken every 4 to 6 hours as needed. Children ages 6 to 12 can take 7.5-15 mg every 4 to 6 hours.
In these therapeutic dosages, DXM works as an antitussive, meaning it suppresses the cough reflex. It is especially helpful for dry, unproductive coughs. DXM achieves its cough-relieving action in the brain by blocking signals that trigger coughing.
Recreational use of DXM
When taken in very large quantities, DXM has psychoactive effects due to its activity on various receptors in the brain. Doses of 300 mg or more cause dissociation, detachment from reality similar to the effects of the anesthetic ketamine or hallucinogen PCP. Users report euphoria, visual and auditory hallucinations, and out of body sensations.
Because of these mind-altering properties, DXM has become popular as a recreational drug, especially among teenagers. Surveys indicate that about 2-6% of adolescents in the U.S. have abused DXM by taking large doses to get high. DXM is sometimes referred to on the street as “Triple C” when Coricidin cough medicine is used, or “robo tripping” derived from Robitussin.
Recreational use of DXM is very risky because the margin between a “high” dose and potentially fatal overdose is small. High doses of DXM are unsafe and can lead to confusion, panic, psychosis, respiratory depression, heart arrhythmias, loss of consciousness, seizures, coma, and death.
What are the dangers of recreational DXM use?
Some of the dangers associated with using DXM in supratherapeutic recreational doses include:
- Nausea, vomiting, abdominal pain
- Dizziness, double vision, loss of coordination
- Numbness, sweating, overheating
- Impaired judgment, memory and concentration
- Disorientation, confusion
- Distorted vision and hearing
- Paranoia, agitation
- Dangerously high blood pressure, heart rate
- Seizures
- Respiratory depression
- Coma, death from overdose
DXM also interacts with many medications and substances. Combining DXM with alcohol or other drugs intensifies the effects and increases the risks.
Preventing DXM abuse
To discourage recreational DXM abuse, especially among youth, some retailers have imposed sales restrictions limiting purchase quantity, requiring identification, or keeping products locked up. For example:
- Walmart limits purchase of DXM-containing products to 3 packages per customer.
- CVS requires identification for purchase and limits to 2 bottles.
- Rite Aid keeps DXM cough medicines behind pharmacy counters.
Some states have also passed laws restricting access to DXM. For example, California prohibits sale to minors under 18 years old. A few other states have proposed legislation to make DXM a prescription-only drug but this has not gained much momentum.
Calls to regulate DXM further
Due to concerns over abuse, there have been calls to impose greater restrictions on DXM:
- Prescription-only: This would prohibit OTC sale of DXM, requiring a doctor’s prescription. However, it would severely limit access for legitimate medical use.
- Age restrictions: Many support restricting OTC sales only to those over 18 years old given DXM abuse is predominantly among youth.
- Product limitations: Limiting package sizes and recommended doses would make it more difficult to obtain large abusable quantities of DXM.
However, DXM has remained available OTC without a prescription due to a lack of political momentum for greater regulation. Arguments against making DXM prescription-only include:
- DXM has a long history of safe and effective medical use for cough.
- Restricting legitimate access would unfairly penalize millions of law-abiding adults who benefit from DXM cough medicines.
- Prescription requirements would impose burdens on the healthcare system just to prevent illicit recreational abuse.
- Teen abuse might simply shift to other medications like opioid cough syrups that would be more dangerous.
Law enforcement efforts against DXM abuse
Although DXM remains legal to purchase and possess, law enforcement agencies have cracked down on illegal distribution and sales related to recreational DXM use:
- Arrests have been made for DXM possession with intent to distribute or sale to minors.
- Some convenience stores have been sanctioned for selling large quantities of DXM cough medicine to abusers.
- Illicit DXM powder has been seized that was likely synthesized in clandestine labs for the black market.
- Some arrests involve “DXM trafficking” across state lines from areas with looser sales restrictions.
Overall though, law enforcement does not treat personal DXM abuse as high priority compared to more dangerous and deadly illegal drugs.
Prevalence of DXM abuse
Government and medical surveys provide estimates on the prevalence of recreational DXM use:
Youth DXM Abuse Rates
| Age Group | Percentage Reporting DXM Abuse |
|---|---|
| 8th graders | 1.3% |
| 10th graders | 2.7% |
| 12th graders | 4.4% |
Sources: National Institute on Drug Abuse (NIDA), Monitoring the Future Survey
Emergency Room Visits Related to DXM Abuse
| Year | DXM-related ER Visits |
|---|---|
| 2005 | 4,060 |
| 2006 | 5,549 |
| 2007 | 5,866 |
| 2008 | 6,072 |
| 2009 | 5,385 |
Source: Drug Abuse Warning Network (DAWN), Substance Abuse and Mental Health Services Administration (SAMHSA)
These statistics indicate that around 5-10% of teenagers report having recreationally using DXM cough syrup to get high, and several thousand ER visits each year are linked to DXM abuse. However, DXM abuse rates remain relatively low compared to other illicit drugs.
Addiction treatment for DXM abuse
Because DXM is legal and easily obtained, addiction often starts casually out of curiosity. With increasing use over time, psychological and physical dependence can develop. Warning signs of addiction may include:
- Taking DXM more frequently and at higher doses
- Strong cravings and inability to control use
- Using DXM despite negative consequences
- Spending significant time and money obtaining DXM
- Giving up social, work, or school activities to use DXM
- Experiencing withdrawal when stopping DXM
Teenagers and young adults with problematic DXM abuse can benefit from substance abuse treatment programs. Options may include:
- Detox and withdrawal management – Since DXM withdrawal can involve depression, anxiety, cravings and fatigue, medical support can ease the process.
- Inpatient rehab – For severe addictions, 24/7 structured care removes DXM access and focuses fully on recovery.
- Outpatient counseling – Less intensive ongoing therapy helps develop coping skills and change addictive behaviors.
- Support groups – 12-step programs provide social support from others in recovery from addiction.
Treatment should also address any co-occurring mental health issues like depression that may be contributing to abuse. The earlier treatment interventions begin, the greater the likelihood of overcoming DXM addiction.
Conclusion
DXM cough syrup continues to be widely available without a prescription in the United States despite concerns over recreational abuse. While DXM has psychoactive effects at high doses, legitimate medical use as a cough suppressant enables it to remain OTC in most states without age restrictions. However, some retailers have imposed sales limits to deter abuse. Rates of DXM addiction remain relatively low but can be hazardous, highlighting the importance of education and access to treatment for abusers.
