Cold Medicine Abuse

Dextromethorphan Abuse

Dextromethorphan (sometimes referred to as DXM) is a semisynthetic derivative of morphine that's used to treat cough. The drug is an ingredient in more than 125 over-the-counter cough and cold products sold in the U.S. When used as directed, products containing dextromethorphan are considered to be safe and non-addicting. However, some people are taking dextromethorphan for non-medical purposes.

In high doses, the drug reportedly produces a "high" similar to that from LSD. Users may have vivid hallucinations and/or an "out of body experience." But high doses of dextromethorphan can also be dangerous, leading to a rapid heart beat, increase in blood pressure, changes in mental alertness, altered time perception, sleepiness, blurred vision, slurring of speech, muscle spasms, confusion, paranoia, seizures, loss of consciousness, or death. Withdrawal can cause insomnia and depression. Although dextromethorphan is not considered to be addictive, some users report intense craving during withdrawal, suggesting a psychological, rather than a physical dependence.

A Growing Trend?

Use of dextromethorphan as a recreational drug is not a new phenomenon. For years, some people have been abusing large amounts of Robitussin DM® and similar cold medicines. A more recent trend is the abuse of Coricidin®, a cold tablet containing the drug. The pill is sometimes referred to as "Triple C." Health care specialists theorize the pill form is becoming popular because users find it easier to swallow many tablets (often ten or more at a time) than several bottles of cough syrup. In addition, large doses of liquid cough syrup can cause nausea and vomiting.

Several local Poison Control Centers are reporting an increase in the number of reported cases of Coricidin abuse among teens. In Texas, the number of reported cases increased by 60 percent between 1998 and 1999. Patients average around 13 to 17, with males involved slightly more often than females. Of more concern is the use of dextromethorphan with other drugs.

Some forms of Coricidin contain other ingredients, such as chlorpheniramine maleate (an antihistamine) and/or acetaminophen (a pain reliever). At high doses, chlorpheniramine maleate interacts with dextromethorphan, amplifying the effect of both drugs and leading to potentially dangerous problems. High doses of acetaminophen can cause serious liver damage. Large doses of another cold medicine ingredient, phenylpropanolamine (a decongestant) can damage the heart and central nervous system. Drug abuse professionals worry teens don't understand the dangers of dextromethorphan abuse. Unlike illicit drugs, DXM is readily available in over-the-counter products. Because it's considered safe at recommended doses, teens may believe larger doses are also safe.

To combat the problem in areas with high rates of abuse, some stores are placing products containing dextromethorphan behind counters, limiting amounts of purchase, or restricting their sale to adults. Parents should be alert for signs of potential abuse, such as the disappearance of cold products from home or large quantities of empty packages in the trash.

For information on dextromethorphan abuse:

Consumer Healthcare Products Association, 1150 Connecticut Ave., NW., Washington, DC 20036,


National Clearinghouse for Alcohol and Drug Information, , (800) 729-6686

National Institute on Drug Abuse, , or

U.S. Department of Justice, Drug Enforcement Administration,