How Dextromethorphan (DXM) Abuse Happens with OTC Cough Syrups

Every year, thousands of teens in the U.S. start experimenting with something they can buy at the corner store: a bottle of cough syrup. It’s not because they’re sick. They’re chasing a high. The active ingredient? Dextromethorphan, or DXM. It’s in over 70 over-the-counter products like Robitussin DM, NyQuil, and Coricidin. Taken as directed, it’s a safe, effective cough suppressant. Taken in massive doses? It turns into a powerful hallucinogen that can wreck your body, your mind, and even your life.

How DXM Works - When Used Right

Dextromethorphan was approved by the FDA in 1958 as a non-addictive alternative to codeine for cough suppression. It works by calming the part of your brain that triggers coughing. No pain relief. No euphoria. Just relief from a nagging cough. At the right dose - 15 to 30 mg every 4 to 8 hours - it’s harmless. That’s why it’s been in medicine cabinets for decades. But here’s the problem: the line between medicine and misuse is dangerously thin.

How Abuse Starts - The Easy Access Problem

Unlike street drugs, DXM doesn’t require a dealer. You don’t need cash under the table. You just walk into a pharmacy, pick up a bottle labeled "DM" or "Cough Suppressant," and pay with cash. No ID needed. No prescription. In Pittsburgh, where I live, you can buy three bottles of Robitussin DM in 10 minutes. That’s 450 mg of DXM - enough to hit the second plateau of abuse. Teens call it "candy," "drank," or "robo." The slang is everywhere on social media. And it’s cheap. A bottle costs less than $5. A full-blown hallucinogenic trip? That’s less than the price of a movie ticket.

The "Plateaus" - What Happens When You Take Too Much

DXM doesn’t just make you dizzy. It breaks you down in stages. Experts call these "plateaus," and each one is more intense - and more dangerous - than the last.

• First plateau (100-200 mg): Mild euphoria, slight dizziness, altered perception of colors and sounds. Feels like being buzzed.
• Second plateau (200-400 mg): Strong dissociation. You feel detached from your body. Sounds echo. Time slows. This is where most first-timers get hooked.
• Third plateau (400-600 mg): Hallucinations. Out-of-body experiences. You might think you’re floating or seeing things that aren’t there. Motor control fades. Walking becomes impossible.
• Fourth plateau (600-1,500 mg): Complete loss of reality. You’re not just tripping - you’re in a coma-like state. Risk of seizures, brain damage, and death spikes here.

Some users take 1,500 mg at once. That’s 50 times the recommended dose. And it’s not rare. The National Institute on Drug Abuse found nearly 5% of high school seniors admitted to abusing DXM in the past year.

The Tricks - How Abusers Get More DXM, Faster

It’s not just about drinking more. Abusers have gotten creative.

• "Robo shake": Drink a whole bottle, then vomit on purpose. The goal? Keep the DXM in your stomach while flushing out the sugar, antihistamines, and other junk that makes you sick. This method is common among repeat users.
• Chemical extraction: Some users follow online guides to strip DXM out of syrup using simple household chemicals. They end up with a white powder - pure DXM. This is far more dangerous. Powder is easier to overdose on. Snorting it burns nasal tissue. Swallowing it can cause fatal respiratory depression.
• Combining with other drugs: Mixing DXM with alcohol, MDMA, or antidepressants is a death sentence. The risk of hyperthermia (dangerously high body temperature), seizures, and cardiac arrest skyrockets. Mount Sinai Health System has documented multiple teen deaths from DXM-alcohol combos.

What It Does to Your Body - The Real Costs

Short-term effects include blurred vision, slurred speech, nausea, vomiting, rapid heartbeat, high blood pressure, and extreme sweating. But long-term? It’s worse.

Repeated abuse damages your liver. Many cough syrups contain acetaminophen (Tylenol). Taking too much of that can cause liver failure - silently, painfully, and sometimes fatally. One study showed teens who abused cough syrup for months developed chronic liver inflammation, even if they didn’t drink alcohol.

Psychologically, DXM can trigger paranoia, anxiety, and depression. Some users report lasting memory loss and difficulty concentrating. The NIH calls it "the poor man’s PCP" because its dissociative effects mimic the illegal drug phencyclidine - but without the same medical oversight or safety controls.

And yes - it can be addictive. The New Mexico Department of Health says DXM isn’t addictive. But treatment centers like Greenhouse Treatment report rising cases of dependence. Users report cravings, withdrawal symptoms like insomnia and irritability, and an inability to stop even after hospital visits.

What You Might Not Know - The Hidden Dangers

Many parents assume if it’s sold over the counter, it’s safe. That’s a deadly myth.

Products like Coricidin HBP and Drixoral contain DXM without decongestants - making them ideal for abuse. Teens know to look for "DM" on the label. Some even buy multiple brands to stack doses. One bottle of NyQuil has 30 mg. To reach the third plateau, you’d need 15 to 20 bottles. That’s not just risky - it’s a medical emergency waiting to happen.

And it’s getting worse. DXM is now sold as powder, capsules, and pills online. No syrup. No label. No warning. Just a dark web link and a credit card. The DEA has flagged this trend. They’re watching.

What to Do - Prevention and Recognition

If you’re a parent, check your medicine cabinet. Look for bottles with "DM," "Tuss," or "Cough Suppressant" on the label. Keep track of how many you have. If bottles disappear faster than they should, ask questions. Don’t assume it’s just a cold.

If you’re a teen and you’ve tried this - stop. You’re not invincible. One bad trip can end your life. Or leave you with brain damage you can’t fix.

Doctors say most people who abuse DXM once won’t need treatment. But if you’re doing it regularly - if you’re chasing the high, hiding bottles, or lying about your use - you’re not just experimenting. You’re addicted. And help exists. Treatment centers now specialize in DXM recovery. It’s not easy. But it’s possible.

The truth? DXM abuse isn’t about rebellion. It’s about access. It’s about ignorance. And it’s about the dangerous idea that "if it’s legal, it’s safe." That’s not true. And too many kids are learning that the hard way.