Dextromethorphan: Still a Drug of Abuse, Still Readily Available, Still Dangerous
Parents, legislators and law enforcement offices go to great or even extreme lengths to keep hazardous substances out of children’s hands. Laws are passed, drug dealers are arrested, schools have drug prevention lectures, parents sit down with kids at home to educate them.
But one drug is still within easy reach of many children, that good old standby whenever a child in the household has a cold: cough medicine.
Now, not all cough medicine is created equal. Some cough medicines just contain herbal ingredients. Some contain acetaminophen and antihistamines. And some contain dextromethorphan (DM), an abusable drug that can definitely get a person high.
How can you tell a cough medicine contains dextromethorphan? In most cases, the packaging will be printed with a fairly noticeable “DM” on the packaging. You can also read the list of ingredients on the package.
Even children’s cough medicines can contain this ingredient. According to the Drug Enforcement Administration, there are more than 120 formulas that contain dextromethorphan. Most of the popular cough medicines you are familiar with either contain this drug or there is a version of the product that contains it.
Is Dextromethorphan Bad?
It’s an antitussive which means it suppresses coughing. That can be helpful for a person who can’t sleep because of their constant nighttime coughing.
But all a young person has to do to misuse this drug to get high is to consume more of it than recommended. How much? Let’s take a look.
The recommended dosage of typical cough medicine in syrup form is as follows:
- Adults: 30 mg every six to eight hours.
- Children ages 6 to 12: 15 mg every six to eight hours.
- Children ages 4 to 6: 7.5 mg every six to eight hours.
- Children under 4: Not recommended.
If we look at the packaging of a typical brand of DM cough medicine, 20 ml of the liquid (4 teaspoons) contain 20 mg of dextromethorphan.
Cough medicine typically comes in four-ounce, eight-ounce and 12-ounce bottles. With one 12-ounce bottle in the house, that equals 355 ml of cough syrup. That’s enough for almost 18 doses of cough medicine at 20 mg per dose. If a person were to drink the whole bottle, they would consume 360 mg of pure dextromethorphan.
An Example of DM Abuse
To get an idea of what would happen if a person abused cough medicine, let’s assume we have a 12-year-old boy investigating the high they can get off a bottle of cough medicine he finds in the family medicine cabinet. At this age, a boy would be likely to weigh around 90 pounds or 41 kilograms.
If he drank an entire 12-ounce bottle, he would consume nearly nine ml of pure dextromethorphan per kilogram of his body weight.
How High Would He Get?
We have to compare this dosage to his weight.
The Canadian Medical Association Journal published a scale of dosages with the effects resulting at each level.
- Stage 1 (1.5-2.5 mg/kg): Restlessness, euphoria
- Stage 2 (2.5-7.5 mg/kg): Closed-eye hallucinations, enhanced sensations, imbalance
- Stage 3 (7.5-15 mg/kg): Partial dissociation, anxiety, altered consciousness
- Stage 4 (more than15 mg/kg): Complete dissociation, hallucinations, delusions
We can see that this young man would be in Stage 3 and manifest quite an altered condition. He would have passed the level of experiencing hallucinations.
Just to experience euphoria, he would only need to drink about six ounces of cough medicine that contains dextromethorphan.
If he had a second bottle available to him and drank most of that in addition, he could suffer truly severe and even life-threatening effects, including hypertension, seizures, tachycardia (rapid heartbeat), and rhabdomyolysis (muscle destruction leading to kidney damage).
At very high dosages, a person may go into a coma, suffer seizures, or experience a psychotic episode. It is also possible to die from large dosages of dextromethorphan. One report noted the deaths of teens in Washington, Florida and Virginia who had purchased cough medicine over the internet.
There are also reports of violence and assaults after high dosages of dextromethorphan were consumed.
Our Young Drug Abuser Probably Didn’t Know the Risks
If he decided to abuse cough medicine, it’s very likely that he doesn’t know what these different stages are or what the dangers are. He’s probably only heard from his friends that it’s a lot of fun. Therefore, there has been an increasing number of measures taken in the last few years to keep this drug out of the hands of our youth.
Many states have taken steps to prevent the sale of a product containing dextromethorphan to anyone under 18 years of age. Of course, it’s still possible for an underage person to acquire this medication by searching the medicine cabinet, asking an older friend to buy it or shoplifting it.
How Many Kids are Doing it?
In 2020, the annual Monitoring the Future survey of school-aged youth found that 3.7% of teens admitted to abusing a cough medicine containing dextromethorphan. This was an increase from 2019 in which only 2.8% of youth said they had.
Ironically, the highest level of use was found in eighth-grade students. Among this group, 4.6% reported misusing cough medicines.
A similar survey in Ontario found that 9.7% of students in grades 7 to 12 reported misuse of this medication.
Opioids are Also Cough Suppressants
Before we leave this topic, it might be useful to know that opioids have long been used around the world as cough suppressants. The use of opioids as cough suppressants has largely dropped out of style except for certain prescription-only formulas that contain codeine, a derivative of opium.
As of 2018, the Food and Drug Administration changed the age range for which this drug was recommended. They required labeling for prescription products containing codeine, advising that use be limited to patients 18 and older. But this does not keep this drug out of the hands of younger members of the household if it’s stored in the medicine cabinet.
Because codeine is an opioid, it has a similar effect to heroin or oxycodone. That means that it has the potential to create fatal respiratory depression if a high quantity is consumed.
Preventing Abuse of These Drugs
Parents should know and watch for the signs that one of their kids is abusing cough medication. They should even be vigilant when their children go away to college because this newfound freedom is not well-managed by every young adult.
Here are the signs to watch for:
- Empty cough medicine bottles in a child’s room, backpack or car
- Medication in the home goes missing
- Internet history shows investigation into how to buy or use the drug
- Odd charges on credit or debit cards
- Unusual packages arriving for the child
- Youth’s attitude becomes hostile, secretive, uncooperative
- Health declines
- Becomes more inactive, gives up hobbies
- Changes groups of friends
- Household money is missing
- Complains of stomach ache or nausea
- Appears dizzy or confused
- Fingers and toes are numb
It is possible to become addicted to dextromethorphan. Therefore a person who has been abusing this drug regularly may need special support while withdrawing from the drug and recovering his or her sobriety.
It’s vital to not be too trusting or complacent about having these medications around the house. It costs very little to purchase a locking box in which to store medications that might be misused. It costs just a little more to install a locking medicine cabinet. Parents become accustomed to trusting their kids and maybe their kids are totally trustworthy. But other kids that visit the home might not be. Prevention is far easier and cheaper than getting a loved one through recovery.
Sources:
- https://www.dea.gov/sites/default/files/2020-06/DXM-2020.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131504/
- https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-requires-labeling-changes-prescription-opioid-cough-and-cold
- https://www.mayoclinic.org/drugs-supplements/dextromethorphan-oral-route/proper-use/drg-20068661
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216279/
- https://www.ncbi.nlm.nih.gov/books/NBK538502/
- https://www.chpa.org/about-consumer-healthcare/activities-initiatives/preventing-dextromethorphan-abuse
- https://stopmedicineabuse.org/blog/details/2020-monitoring-the-future-survey-results-rates-of-teen-otc-cough-medicine-abuse-slightly-rise/
- https://www.drugabuse.gov/drug-topics/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-
- https://pubmed.ncbi.nlm.nih.gov/19239735/
- https://pubmed.ncbi.nlm.nih.gov/22537430/
- https://www.healthline.com/health/acetaminophen-and-codeine-overdose#treatment
- https://stopmedicineabuse.org/what-does-abuse-look-like
Reviewed by Claire Pinelli, ICAADC, CCS, RAS, MCA, LADC, LCDC-I
®