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Dextromethorphan (DXM), the Most Abused & Dangerous OTC Drug: The Six Signs of Abuse

When it comes to drug abuse, what often comes to mind are the illegal kind, sold on the street or passed around nightclubs or parties.

But a dangerous new trend has emerged, making it possible for people -- especially kids -- to get high anywhere and anytime, and to do so legally. It's done by using over-the-counter (OTC) drugs, the kind available at any convenience or grocery store, and it's prevalence has become so high that the U.S. Food and Drug Administration (FDA) administered a warning just last month.

The most widely abused OTC drugs? By far, cough and cold remedies, in particular those that contain dextromethorphan (DXM).


The new (and LEGAL) drug of choice for teens? DXM, a main ingredient in over-the-counter cough and cold remedies.

Here's what the FDA had to say:

The [FDA] is concerned about the abuse of dextromethorphan (DXM), a synthetically produced ingredient found in many over-the-counter cough and cold remedies. The agency is working with other health and law enforcement authorities to address this serious issue and warn the public of potential harm, after five recently reported deaths of teenagers that may be associated with the consumption of powdered DXM sold in capsules.

In a 2004 study of teens in grades 7-12, conducted by the Partnership for a Drug-Free America, some 9 percent of teens reported having abused cough medicine.

Where Is DXM Found?

DXM is widely available and has replaced codeine as the most widely used cough suppressant in the United States.

According to the National Youth Anti-Drug media campaign, over half of the OTC drugs on the market--more than 125 products--contain DXM. Most commonly, though, the source used for DXM abuse is "extra-strength" cough syrup, says the National Institute on Drug Abuse (NIDA), though capsules, liquid gel capsules, lozenges and tablet forms may also be used. (Capsules are becoming increasingly popular with teens, as they're easier to ingest in large quantities than the liquid form.)

Another "disturbing new trend, which involves the sale of pure DXM in powdered form ... often encapsulated by the 'dealer' and offered for street use," has also surfaced, according to the FDA. DXM is also sold, often in bulk "pure" powder form, over the Internet.

"Parents need to remember that ruthless and dangerous individuals try to entice our children with risky products on the Internet. We need to continually communicate and inform our kids of the dangers that lurk on something as innocent as the home computer," said Michael A. Braun, Special Agent in Charge of the Drug Enforcement Administration Detroit Field Division.

Health Effects of Abusing OTC Cough and Cold Remedies

According to the FDA, "Although DXM, when formulated properly and used in small amounts, can be safely used in cough suppressant medicines, abuse of the drug can cause death as well as other serious adverse events such as brain damage, seizure, loss of consciousness, and irregular heart beat."

Six Signs Your Child May be Abusing OTC Drugs

Over The Counter Drugs

  • Taking large quantities of cold and cough remedies, even when not ill.

  • Stashing OTC drugs in a backpack or bedroom.

  • OTC drugs disappear from the family medicine cabinet.

  • Mood swings.

  • Problems at school (grades, attendance).

  • Changes in normal behaviors or eating habits.]


Teens take the drug, sometimes downing two boxes of cough pills at a time, for the mild euphoric and hallucinogenic effects. "The effects vary with dose, and dextromethorphan users describe a set of distinct dose-dependent "plateaus" ranging from a mild stimulant effect with distorted visual perceptions at low doses to a sense of complete dissociation from one's body at [high] doses," says the NIDA.

Furthermore, when DXM is taken in medications that also contain antihistamines or decongestant ingredients, such as Coricidin Cough & Cold (known by DXM users as "Triple C"), the effects become increasingly dangerous.

Aside from the risks of the drug itself, everyday activities like driving, swimming or biking can become deadly when performed under a DXM high.

What Can You, the Parent, Do?

Even though OTC drugs are readily available to teens, parents can play a large role in whether or not a child chooses to abuse such drugs. Here are some tips from the Anti-Drug media campaign and the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to help keep your child safe:

  • Talk with your child about the dangers of abusing OTC medications and other drugs. Teach them the importance of only using OTC drugs when necessary, and as instructed on the label.

  • Keep track of OTC medications in your home (including pill/liquid levels in bottles) and don't allow your child to keep medications in his or her room, backpack or school locker.

  • Don't keep large quantities of OTC medications in your home.

  • Monitor your child's Internet use, and watch out for signs he or she may be visiting DXM-related Web sites.

FDA Warns Against Abuse of Dextromethorphan (DXM) May 20, 2005

The Partnership for a Drug-Free America 2004 Partnership Attitude Tracking Study (PDF)

National Institute on Drug Abuse: Hallucinogens and Dissociative Drugs

SAMHSA: Legal but Lethal: The Danger of Abusing Over-the-Counter Drugs

Parents: The Anti-Drug

U.S. Drug Enforcement Administration (Detroit)

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