Spring into Action: Combatting the Effects of DXM Misuse

About one in four teens know someone who ingests DXM, are you aware of the risks of DXM misuse?

By Neethu Mathew, Clinical Pharmacy Specialist and Ashley Guidry, Communications Associate

The winter months have ended and spring is finally here! Unfortunately, this means common cold cases are on the rise. The pandemic interrupted the typical flu pattern for the past few years, but researchers are predicting most pre-Covid colds will be making their way back into our lives.

One of the many cold remedies is over-the-counter (OTC) medications sold directly at local pharmacies. OTC medications are available for purchase without a prescription and can treat a variety of illnesses. However, OTC medications may contain the ingredient Dextromethorphan (DM or DXM) and are often misused.

DXM is an opioid and cough suppressant found in cough syrups, tablets and gel capsules. This medication is used in ‘robotripping’ or ‘skittling’, a form of substance abuse where users drink DXM straight, mix it with soda or inject it.

According to Legacy Pharmacist, Neethu Mathew, “Use of DXM in combination with other drugs or alcohol is particularly dangerous and deaths have been reported. Side effects are rarely observed when taken as directed per the drug facts label for a medical need. Typical adult dosage of DXM is between 10 – 20mg every four hours or 20 – 30mg every six to eight hours.”

Some teens and adults partake in DXM to experience psychological and physical effects.

What are these effects?

“Robotripping” can be highly addictive depending on the dosage consumed.

1. A dosage of 100 – 200 milligrams (mg) of DXM produces effects similar to ecstasy.
2. A second dosage between 200 – 400 mg can be compared to alcoholic intoxication.
3. A third dosage of DXM between creates an effect like ketamine that can leave the consumer incapacitated with intense hallucinations.
4. The highest dosage is between 500 to 1,500 mg providing a hallucinogenic effect like PCP. This level of consumption makes it harder to withdraw from and can last up to two weeks. It can also lead to violent behavior or leave an individual in a ‘trance-like’ state.

“Around 33% to 50% of individuals who experiment with DXM will continue with drug abuse regularly,” adds Mathew. “Patients between 12 to 20 years of age accounts for 51% of emergency department visits for nonmedical DXM use.”

Keep in mind that certain DMX containing cough syrups are mixed with other ingredients that can lead to further damage. DXM products containing acetaminophen can be improperly ingested and  cause liver damage.

If an individual suddenly stops the consumption of  DXM, withdrawal symptoms can consist of muscle and bone pain, sleep problems, diarrhea and vomiting, cold flashes and severe cravings. DXM can be found in over 125 OTC medications  and about one in 30 teens say they use it to get high.

House Bill 1518 was passed and signed into law by Governor Greg Abbot in May 2019 preventing minors from purchasing DXM products. Stores violating this law will receive a warning, then a $150 fine for a second violation, and $250 fines for every violation after that. After the law took effect on September 1^st, 2019, Texas joined 18 other states that have passed similar laws preventing minors 18 and under from purchasing OTC medications containing DXM.

How do I protect my teen?

Be aware of what your teen is ingesting and make sure to read labels before taking any medications. Ensure they are taking the proper amount of medication and keep track of what leaves and enters your medicine cabinet. It can be difficult for a parent to monitor every action of their teen but be sure to sit down and talk with them about the dangers of abusing medication, it’s all about open communication.

“Some warning signs of potential DXM misuse include changes in behavior, being withdrawn from friends/family, changing in appetite or sleeping patterns, high blood pressure or heart rate, engaging in risky behavior, etc.” says Mathew. “In case of an emergency, call 911 or go to the nearest emergency room for immediate medical attention.”

Take charge of your teen’s health this spring!