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Cough Medicine Abuse by Teens

Close up image of a bottle of cough medicine.

Dextromethorphan (DXM) is a common ingredient found in many cough and cold remedies. It helps stop a cough. Used as directed, DXM products are safe and effective. But DXM has become popular among teens who want a cheap, easy high. DXM was approved by the FDA in 1958. You can find it in at least 70 over-the-counter (OTC) products. These include:

  • Alka-Seltzer Plus Cold & Cough Medicine

  • Coricidin Cough and Cold Tablets

  • Dimetapp DM

  • Robitussin cough products

  • Triaminic cough syrups

  • Tylenol Cold products

  • Vicks NyQuil LiquiCaps

DXM has no serious side effects when used in small doses. When taken in larger amounts, it can distort awareness and alter time perception. It can also cause hallucinations.

Cold medicines with DXM also contain other ingredients that can be harmful in large amounts. These include acetaminophen or decongestants. Combining high doses of DXM with alcohol is very unsafe, too. It can lead to death.

Less common is abuse of prescription cough medicines containing codeine and promethazine. This has become glamorized by some hip hop artists. The medicine is usually mixed with soda and candy to decrease the bitter taste. This form is usually referred to as "syrup" or "sizzurp." Several hip hop artists have reportedly been hospitalized after abusing this drink.

Abuse on the rise

Cough syrup abuse has been a problem for decades. But the concern in the past had been about the alcohol and codeine in cough and cold products. Because of that, the alcohol has been removed from most OTC cough and cold remedies. State laws also restrict the sale of products that contain codeine.

DXM seemed a good substitute to codeine and alcohol. It had few, if any, side effects, when used as directed. And a larger amount of DXM—drinking several bottles of cough syrup at one time, for instance—would cause vomiting.

Today, teens have alternatives to drinking the syrup, though. DXM is available in powder, capsule, and pill forms. You can find it on the Internet. These forms can be swallowed or snorted. Some websites even tell users how to extract DXM from cough syrup. They also advise users how much DXM to take to get high. Illicit users may take 240 mg to 1,500 mg of DXM at a time.

Slang terms for DXM include the following:

  • Black Beauties

  • Brownies

  • Dexies

  • Dextro

  • Drix

  • Gel

  • Groove

  • Mega-perls

  • Poor Man's Ecstasy

  • Red Devils

  • Robo/Robotripping

  • Rojo

  • Rome

  • Skittles/Skittling

  • Sizzurp/Syrup

  • Sky

  • Triple C (Coricidin Cough and Cold)

  • Tussin

  • Velvet

bottle of cough syrup

Effects of abuse

The effects of DXM have been compared to PCP and the anesthetic ketamine. All 3 are called dissociative substances. At high doses, they give the abuser a feeling of not being in one's own body. DXM also causes hallucinations. The effects can last up to 6 hours. But that can vary. It depends on how much DXM is taken and what other drugs or chemicals are taken along with it.

Other effects of DXM include:

  • Hot flashes

  • Nausea, vomiting, and dizziness

  • Lack of coordination

  • Panic attack or seizures

  • Impaired judgment

  • Sweating

  • Lethargy or drowsiness—or hyperactivity

  • Slurred speech

  • High blood pressure

  • Rapid eye movement

  • Rash

  • Racing or pounding heartbeat

  • Paranoia and hallucinations

  • Feeling of floating

Regular abuse of DXM at high doses can lead to a chemical psychosis. That’s when a person loses contact with reality. He or she may need to be hospitalized. The person may also need to take medicine.

What you can do

As a parent, you should warn your children about the dangers of abusing OTC drugs. Some teens believe that OTC drugs are safer to abuse because they are legal.

Here are other suggestions:

  • Monitor the OTC drugs in your home. Keep track of how much medicine is in each bottle.

  • Don't buy extra OTC drugs to "stock up."

  • Don't allow your children to keep OTC drugs in their bedroom, backpack, or school locker.

  • Monitor your children's Internet use, keeping an eye out for websites visited that discuss OTC or other drug abuse.

  • Use OTC and prescription medicines responsibly yourself.

Online Medical Reviewer: Brown, Kim, APRN
Online Medical Reviewer: Perez, Eric, MD
Date Last Reviewed: 2/1/2017
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