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RIA Expert Summary

DXM (Cough Suppressant) Abuse

DMX doses

Published April 18, 2013

A dangerous chemical kick may be no farther away than your medicine cabinet.

About one in 20 teens have gotten high on dextromethorphan (DXM) – the active ingredient in more than 100 over-the-counter (OTC) cold remedies like Robitussin, Coricidin, Vicks 44 and NyQuil, to name just a few.

Therapeutic use of DXM at recommended dosages (typically 15- 30mg, 3-4 times a day) has few if any side effects. Recreational "megadoses" (250-1500 mg), however, produce a euphoria-like and dissociative "out-of-body" experience.

In 1958, DXM was approved for use as a safe, nonaddictive cough suppressant. The drug's deliberately unpleasant taste, combined with other cough/cold remedy ingredients (e.g., expectorants) that induce vomiting when consumed in large quantities, effectively discouraged widespread recreational abuse…until the 1990s. The invention of the gelcaps and the online availability of practical tips for "safe" megadosing may have contributed to the growth of DXM abuse over the past 15 years.

  • In 2006, about 3.1 million Americans aged 12 to 25 (5.3 percent) had used cough and cold remedies nonmedically at least once in their lifetime; nearly 1 million (1.7 percent) had done so in the past year.
  • After peaking in 2006, DXM abuse has since leveled off and declined slightly, perhaps due to increased public awareness and risk perception.
  • 33 to 50 percent of individuals who experiment with DXM go on to abuse it regularly.
  • Patients aged 12-20 account for 51 percent of emergency department visits for nonmedical DXM use.
  • Between 2000 and 2010, there were 44,206 DXM abuse calls to U.S. poison control centers, including 17 fatalities.

Prevalence of Past Year Drug Use Among 12th Graders

Prevalence of Past Year Drug Use Among 12th Graders

Complications

Dextromethorphan

The long-term effects of DXM abuse are not clear. Although dependence on DXM is rare, habitual abusers do develop an escalating tolerance and craving for the drug and may experience withdrawal symptoms when discontinuing use. Although the immediate effects of DXM abuse are rarely fatal, the accompanying loss of sensory and motor control also increases the risk of victimization or accidental injury. Serious adverse reactions are most likely to occur when DXM is combined with alcohol, opioids or other drugs of abuse. DXM-based cold remedies also tend to contain other active ingredients that may be dangerous if misused; for example, excessively large doses of acetaminophen may cause severe liver damage.

Robo-what?!?

The technical name for DXM (d-3-methoxy-N-methyl-morphine) is a mouthful. Common slang terms derive from the drug's most popular brand names (Coricidin Cough and Cold = Triple C, Robitussin = robo) or appearance in typical gelcap form (skittles, red devils, red hots, rojo, candy). DXM abuse is also known as robo-tripping, skittling, or dexing.

What parents can do…

Close-up DXM dose
  • Monitor OTC medications in the household – even those that seem "harmless."
  • Be alert to physiological symptoms and/or behavioral changes that could indicate abuse.
  • Talk to children about potential consequences of DXM abuse and interactions.

What physicians can do…

  • Screen for DXM abuse in routine medical visits.
  • Be alert to physiological symptoms and/or behavioral changes that could indicate abuse.
  • Provide education on potential consequences of DXM abuse and interactions.

What pharmacists can do…

  • Put cough/cold remedies at risk for abuse behind the counter to discourage shoplifting.
  • Track sales and monitor inventory of DXM-containing products.
  • Provide education on potential consequences of DXM abuse and interactions.

The SAFE DOSES Act targets drug theft at every point of the supply chain, increasing sentences for robbing pharmacies, creating a new category of crime dealing with theft of medical products and increasing sentences for individuals in the medical field who are convicted of prescription drug theft.

For more information

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