Dextromethorphan Addiction

Dextromethorphan Addiction

Dextromethorphan Addiction

Some years ago, experts in drug addiction were predicting that cough syrup abuse was “unlikely to catch on.” It just seemed too bizarre that people would chug down two or three bottles of cough medicine at one time in order to enter a mind-altering state. These experts were proven wrong after a study completed in 2004 found that cough syrup abuse had increased ten times over in the past six years. Probably three million or more young people are “robotripping” — i.e, getting high on over-the-counter drugs like Robitussin and Nyquil.

The 2012 Monitoring the Future Study, an annual survey of over 50,000 high school students, recently found that about five percent have tried or are now abusing cough medications. Similar researcher has found that “sizzup” and “skittles” are often “starter drugs” for children as young as nine years old. What is worrisome about all this is that there is increasing evidence that dextromethorphan, the substance in cold medications that causes the mind-altering state, may have addictive qualities. Just as troubling is the fact that most cough medicines contain not only dextromethorphan but also antihistamines, decongestants, pain relievers, and expectorants that can be extremely damaging to the body when ingested in very high amounts.

What Is Dextromethorphan?

Dextromethorphan is an active ingredient in over 120 cough and flu medications sold in the United States without doctors’ prescriptions. It is classified as a non-narcotic cough suppressant or antitussive.  Dextromethorphan or DXM is a man-made analog of codeine, commonly used in cough medicines until DXM started to replace it in the 1950s. Although DXM is chemically similar to morphine and codeine, and although it can function as a mild central nervous system depressant, the United States government does not classify it as a Controlled Substance. Throughout its history, however, the United States Food and Drug Administration has periodically issued warnings and restrictions about DXM because it is so widely abused as a mind-altering drug. Nevertheless, it is still sold over-the-counter with few restrictions in many jurisdictions, although certain city and state legislatures have passed ordinances restricting its sale to minors.

DXM suppresses coughs by reducing the sensitivity of the brain’s cough control center. It does not cure the cause of the cough, but only the symptom. It affects certain nerve signals in the brain that trigger coughing, and increases levels of a nerve transmitter called dopamine, which is associated with pleasure. Dextromethorphan comes as a white powder.  Its chemical formula is (+)-3-methoxy-17-methyl-(9α,13α,14α)-morphinan

Dextromethorphan Addiction

What Are the Medical Uses of Dextromethorphan?

The FDA has approved DXM as a cough suppressant, but it is not supposed to be used for coughs associated with smoking, asthma or emphysema. Because DXM may inhibit glutamate, a chemical involved in nerve transmission, it is sometimes prescribed for people with Lou Gehrig’s disease or those who suffer from involuntary laughing and crying spells.

DXM is an active ingredient in trademark products such as Alka-Seltzer Cold Medicine, Actifed DM, Bayer Cold Medicine, Benylin, Bromarest, Calmylin, Cardec, Comtrex, Contac, Coricidin, Day Quil, Delsym, Dimetane, Dristan, Mediflu, Nyquil, Ornex, Pediacare, Pertussin, Robitussin DM, Sudafed, Theraflu, Triaminic DM, Tussafed, Tylenol Cold and Flu Medicine, Vicks, Viravon, Dimetap DM, Tylenol Cold Medicine, St. Joseph Cold Medicine and many more. Most of these products contain antihistamines, expectorants, decongestants, and/or pain relievers, and they are sold as liquid filled capsules, dissolving strips, extended release liquids, lozenges, syrups, elixirs, and solutions.

In 2011, the FDA announced that it was removing certain drugs containing DXM from the market. However, many of them are still being sold, so you need to check with your doctor or the FDA website you want to use only FDA-approved drugs. In 2007, the FDA declared DXM as potentially harmful and proposed a ban on over-the-counter cough medicines containing DXM for children under six years old. That same year the American College of Chest Physicians recommended that no one under the age of 14 years old should take DXM products.

DXM may not even be effective as a drug that controls coughs. In a 2010 double-blind study of 105 children and teenagers with colds, one-third of them took honey for their coughs, one-third took DXM products, and one-third took nothing. The group taking honey had the most relief, according to the study published in the Archives of Pediatric and Adolescent Medicine. Six years earlier, other research compared children with coughs who took DXM, antihistamines, or flavored water, and found that the group taking flavored water did the best. Studies comparing remedies containing DXM and guaifensin (a cough expectorant) found that neither drug works very well because people taking placebos found equal relief compared to those taking the real drugs.

The typical dosage for DXM is 5mg to 15mg for people over 12 years old taken every two to four hours; 5mg to 15mg for those ages six to 12 years old taken every four to six hours, and 5mg for those ages four to six years old every four hours. DXM takes 15 to 30 minutes to work and lasts about four hours.

What Are the Side Effects of Dextromethorphan?

When taken at medically recommended levels, DXM causes dizziness, drowsiness, nausea, and sometimes cramps. Because it causes patients to be drowsy, doctors recommend that they do not drive, climb ladders or do work that requires coordination. When taken at very high levels, DXM causes euphoria and a dissociative state similar to PCP.

What Drugs Interact with Dextromethorphan?

You should never take DXM with a MAO inhibitor such as Marplan, Nardil, Emsam, Eldepryl, Zelapar or Parnate. DXM should not be taken with Selective Serotonin Re-uptake Inhibitors such as Prozac or Zoloft, and it should never be used with central nervous system depressants such as alcohol, opiates, sleeping pills, or sedatives.

What People Should Not Take Dextromethorphan?

DXM is not for children under four years old because just a small quantity can kill a small child.

DXM should not be taken by people with asthma, diabetes, liver diseases, bronchitis, emphysema, or people who breathe slowly.

Does Dextromethorphan Show up in Urine Tests?

DXM can produce a false positive for PCP. Some anecdotal evidence indicates that at high levels DXM produces false positives for certain opiates such as codeine and morphine, but so far no one has this scientifically.

What Are the Dangers of Dextromethorphan?

DXM is not harmful or addictive if you use it as medically recommended. The problem is this drug is widely abused, especially by teenagers, as a mind-altering substance similar to PCP.  In order to achieve euphoric, dissociative states that can last up to six hours, people will ingest ten to 75 times the therapeutic amount, or the equivalent of 20 to 30 tablets or three to four bottles of cough syrup. They have to “chug” down the syrups very rapidly to avoid vomiting.

At 100 to 200mg, DXM is just a mild stimulant, but at 200mg to 400mg, people will experience euphoria and hallucinations. At 300 to 600mg, the user will have a distorted vision and loss of motor control. At 500mg to 1500mg, the person will be sedated and enter a dissociative state.

These cough syrups and cold medications were never meant to be taken in such large amounts. High levels of DXM can cause hypoxic brain damage due to lack of oxygen to the brain. Nearly all of these over-the-counter medications contain pain relievers, antihistamines, and/or decongestants. If you take too much acetaminophen (Tylenol) or aspirin even just once, you run the risk of severe of liver and stomach damage. If you take into much ibuprofen (Advil) at once, you can develop stomach bleeding and ulcers. Anti-histamines in large amounts can damage nerve cells, and cause high blood pressure and cardiovascular toxicity. Phenylpropanolamine (Sudafed PE®) is a decongestant that can cause hallucinations, dizziness, faintness, changes in heartbeat, seizures and slow breathing at high doses.

Between five and ten percent of all Caucasians are poor metabolizers of dextromethorphan, which means they are more susceptible to its side effects and to overdoses.

Abusing DXM products can lead to dependency on them.

What Is a Dextromethorphan Overdose?

Dextromethorphan overdoses are actually fairly common. According to the Drug Abuse Warning Network Report, about 1% of all emergency room drug-related visits or over 16,000 a year involve DXM. Over half of these patients are ages 12 to 20 years old. Alcohol is involved in 41% of the cases of patients ages 18 to 20 years old, and 13% of the time for those ages 12 to 17 years. About 16% are accidental overdoses and 17% are suicide attempts.

Symptoms of a DXM overdose can be euphoria, over-activity, intoxication, visual and auditory hallucinations, lack of coordination, stagger, stupor and shallow breathing. Some people are unable to talk or move their arms and legs. Without emergency room treatment, the person can have a stroke, cerebral hemorrhages, or brain damage. Since many people abuse DXM at parties or dance clubs, and since the drug causes sweating, some patients are taken to emergency rooms overheated and dangerously dehydrated.  DXM overdoses are particularly life-threatening if the person has mixed the drug with central nervous system depressants, such as alcohol or opiates. DXM is frequently abused with heroin.

Sometimes symptoms can reflect the fact that the patients ingested not only too much DXM, but also too many pain killers, expectorants, antihistamines or decongestants that are other ingredients in these medications. Taking too much antihistamines can lead to convulsions.  Overdosing on acetaminophen can cause sweating, diarrhea, and cramps. Taking too much ibuprofen causes convulsions, chest pain, psychosis, and fainting.  People who ingest too much of an expectorant called guaifenesin have difficulty breathing and vomit. Allergic reactions can include closed throat, swollen lips, hives and rashes. People who mixed DXM with alcohol or other central nervous system depressants can have their breathing and heart rate slowed down to the point of death.

Emergency room personnel typically administer charcoal, intravenous fluids, and/or laxatives for DXM overdoses. Sometimes they will “pump and stomach.” Survival can depend on how quickly the person got emergency medical treatment.

What Is Dextromethorphan Withdrawal?

For a long time most scientists believed there was no such thing as experiencing withdrawal symptoms when you stop using DXM.  However, Dr. David Shurtleff, deputy director of the National Institute of Drug Abuse, has identified a DXM withdrawal syndrome that includes symptoms of sleepiness, nausea, sweating, muscle aches, diarrhea, restlessness, and anxiety. Other symptoms indentified in a pamphlet for teens from the U.S. federal government are insomnia, dysphoria and depression. Dr. Shurtleff said in an interview with Parade Magazine that many DXM abusers undergo detoxification in psychiatric wards or residential treatment centers.

What Is Dextromethorphan Abuse?

Although DXM is classified by the government as a non-addictive drug, Dr. Shurtleff and other experts have said that people who abuse the drug in large amounts develop a tolerance for its effect within one or two weeks. This means they will have to keep using more of the drug to achieve the mind-altering states they desire.  These experts have also said that DXM abusers do develop cravings and drug seeking habits, and that heavy users will go through a withdrawal syndrome. Tolerance, drug cravings, drug-seeking behaviors, and withdrawal are all characteristics of addiction.

DXM users chat with one another on the Internet, and share stories about what they call “the drug of God” or “the drug that can make you fly.” As they become more dependent on it, they describe how the drug consumes their lives, taking away all their ambition beyond buying and using the drug.  One teen said that she thought she had achieved enlightenment, only to realize once she stopped using DXM that her lifestyle had been completely self-centered and hurtful to her parents and friends. DXM is sold illegally as bulk powder over the Internet, a form more easily abused.

Slang names for dextromethorphan are DXM, DM, CCC, Triple C, Skittles, Candy, Velvet, Rojo, Robo, and Poor Man’s PCP.  Using DXM is called robotripping.

What Treatments Are Available for Dextromethorphan Abuse?

Abusing DXM is usually a symptom of other drug abuse. Some people use cough syrups when marijuana is not available; others typically abuse DXM with heroin. Heavy DXM abusers get caught up in a lifestyle and friendships with other drug abusers, and often require treatment at residential centers for drug and alcohol rehabilitation.  Sometimes a person abusing DXM and other drugs needs to get away physically from these friendships and their drug environment, and that is why residential treatment is ideal for them.

Many people seek mind-altering drugs as an escape from reality because they are clinically depressed or experiencing constant failures at work or school. While in a treatment center, the person can work one-on-one with a counselor who can help him or her with these underlying psychological problems that addiction specialists call comorbidities. The vast majority of people in drug and alcohol rehabilitation have untreated and undiagnosed comorbidities such as depression, childhood trauma, sexual abuse, learning disabilities, attention deficit disorder, and so forth that contribute to drug abuse but do not cause it. These comorbidities are treated in protocols with specific and appropriate interventions and medications.

Many DXM abusers have lost any sense of purpose or ability to set goals for themselves beyond drug use. Their therapists at residential treatment centers can also help them plan for new careers or further education. Since drug use has a way of debilitating the human body, a big part of any residential treatment program will be physical fitness and good nutrition.

The person abusing DXM faces one of the difficulties of alcoholism in that his drug of choice is legally available in every grocery or drugstore. This means every time he passes a store, he will think about going inside and buying cough syrup. At a residential treatment program he or she will learn how to deal with such “triggers” that cause relapse into drug abuse. Usually, once the person returns home, he or she has to remain in counseling and attend support meetings in the community.

Signs Your Teenager Is Abusing Dextromethorphan

If your son or daughter is showing any of the following signs of drug abuse, you should schedule a talk with a local mental health professional or an addiction specialist at a residential treatment center. See if you can answer yes to any of the following questions:

  • Has your child recently lost any interest in hobbies, sports or other activities that used to give him pleasure?
  • Has your child recently taken up with a new set of friends that seem less wholesome to you? Has your child dropped his old set of friends?
  • Has your child’s grades fallen at school?
  • Have you caught your child stealing money from you?
  • Are there medications — prescription or over-the-counter– missing from your house?
  • Does your child spend long amounts of time in a locked room? Is your child hostile to you when you try to ask questions about his personal life?
  • Is your child excessively secretive about phone conversations or computer contacts?
  • Does your child ever seem “drunk” to you but without an alcoholic breath?
  • Does your child act paranoid, hostile or confused?
  • Have you found drug paraphernalia in your child’s room?
  • Does your child carry boxes of “breath mints” that look more like pills to you?
  • Does your child wear clothing with drug references?
  • Does your child seem depressed and hopeless to you?
  • Does your child have severe, unpredictable mood swings and inappropriate anger?

Signs You May Have a Problem with Dextromethorphan

If you can answer yes to any of the following questions, it may be time for you to talk to a mental health professional about your problems with drugs.

  • Are you using DXM in amounts not medically recommended?
  • Are you using DXM to get high and not because you have a cough?
  • Have you tried to quit using drugs but failed?
  • Is it hard for you just to cut back on your drug use?
  • Do you get anxious or worried when drugs are not available to you?
  • Do you experience withdrawal symptoms when you stop using drugs?
  • Do your friends or family members criticize you for your drug use?
  • Are your hallucinogenic experiences more important to you than everyday life?
  • Have you ever risked your life or the lives of others by driving under the influence of drugs?
  • Does your drug use interfere with your functioning at work, school, or in your relationships?
  • Do you feel guilty or ashamed about your drug use?
  • Do you keep putting off getting help for your drug problems?
  • If money were no object, which you enter a treatment center for drug abuse?

References:

 

Sink, Mindy. “At Your Drugstore: A Cheap and Dangerous High,” The New York Times, June 15, 2004.
“Dextromethorphan,” U.S. Drug Enforcement Agency, Office of Diversion Control, posted at http://www.deadiversion.usdoj.gov/drugs_concern/dextro_m/dextro_m.htm
“National Survey Finds Less Than 5 Percent of Teens Abuse OTC Cough Medicine,” Monitoring the Future Study, December 2012, see http://www.businesswire.com/news/home/20121219006614/en/National-Survey-Finds-5-Percent-Teens-Abuse
Kasanuki, Mari. “Adolescent Cough Medicine Abuse: What Adults Need to Know,” Parade Magazine, October 22, 2012.
“Facts about Dextromethorphan,” The Consumer Healthcare Products Organization, see http://www.chpa-info.org/issues/FAQs_Dex.aspx
Parker-Pope, Tara. “Rethinking Remedies for Colds and Coughs,” TheNew York Times, October 1, 2007.
Nizza, Mike. “Cough Syrup Abuse Worries,” The New York Times, February 8, 2008.
“Dextromethorphan,” Medline, the United States Library of Medicine, The National Institute of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682492.html
“Fact Sheet on Dextromethorphan,” The National Institute of Drug Abuse, see http://teens.drugabuse.gov/drug-facts/dextromethorphan-dxm-and-cold-medicine-fact
“Promethazine HCl and Dextromethorphan Hydrobromide Syrup,” The RX List, http://www.rxlist.com/promethazine-hcl-and-dextromethorphan-hydrobromide-syrup-drug.htm
“Dextromethorphan (Oral Route),” The Staff of the Mayo Clinic, see http://www.nhtsa.gov/people/injury/research/job185drugs/dextromethorphan.htm
Pollack, Andrew. “New Use for Two Older Drugs,” The New York Times, May 9, 2005.
Pollack, Andrew. “Pill to Control Laughter and Weeping,” The New York Times, October 30, 2010.
Griffith, H. Winter (Editor). The Complete Guide to Prescription and Nonprescription Drugs. New York: Penguin Group, 2011.
“Dextromethorphan,” Medline, the United States Library of Medicine, The National Institute of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682492.html
Ibid.
“Dextromethorphan (Oral Route),” The Staff of the Mayo Clinic, see http://www.nhtsa.gov/people/injury/research/job185drugs/dextromethorphan.htm
Ibid.
Parker-Pope, Tara. “Rethinking Remedies for Colds and Coughs,” theNew York Times, October 1, 2007.
O’Connor, Anahad. “Honey for Coughs,” the New York Times, December 16, 2010.
Parker-Pope, Tara. “Rethinking Remedies for Colds and Coughs,” TheNew York Times, October 1, 2007.
“Dextromethorphan (Oral Route),” The Staff of the Mayo Clinic, see http://www.nhtsa.gov/people/injury/research/job185drugs/dextromethorphan.htm
Griffith, H. Winter (Editor). The Complete Guide to Prescription and Nonprescription Drugs. New York: Penguin Group, 2011.
“Dextromethorphan (Oral Route),” The Staff of the Mayo Clinic, see http://www.nhtsa.gov/people/injury/research/job185drugs/dextromethorphan.htm
“Fact Sheet on Dextromethorphan,” The National Institute of Drug Abuse, see http://teens.drugabuse.gov/drug-facts/dextromethorphan-dxm-and-cold-medicine-fact
“Dextromethorphan,” Medline, the United States Library of Medicine, The National Institute of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682492.html
“Fact Sheet on Dextromethorphan,” The National Institute of Drug Abuse, see http://teens.drugabuse.gov/drug-facts/dextromethorphan-dxm-and-cold-medicine-fact
“Dextromethorphan,” Medline, the United States Library of Medicine, The National Institute of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682492.html
“Dextromethorphan (Oral Route),” The Staff of the Mayo Clinic, see http://www.nhtsa.gov/people/injury/research/job185drugs/dextromethorphan.htm
Neerman, Michael (PhD). “Is Dextromethorphan Causing a False Positive during Urine Drug Screening?” Laboratory Medicine2010, 41(8), pg. 458-460.
“DXM Abuse,” Greater Dallas Council on Drug and Alcohol Abuse, posted at http://www.gdcada.org/statistics/dxm.htm
“Dextromethorphan,” U.S. Drug Enforcement Agency, Office of Diversion Control, posted at http://www.deadiversion.usdoj.gov/drugs_concern/dextro_m/dextro_m.htm
“Fact Sheet on Dextromethorphan,” The National Institute of Drug Abuse, see http://teens.drugabuse.gov/drug-facts/dextromethorphan-dxm-and-cold-medicine-fact
“Phenylpropanolamine HCl Oral, Uses and Effects”, at Web.MD.com, http://www.webmd.com/drugs/drug-21821-Phenylephrine+HCl+Oral.aspx?drugid=21821&drugname=Phenylephrine+HCl+Oral
“Dextromethorphan,” U.S. Drug Enforcement Agency, Office of Diversion Control, posted at http://www.deadiversion.usdoj.gov/drugs_concern/dextro_m/dextro_m.htm
“Emergency Room Visits Involving Dextromethorphan,” The DAWN Report from the Substance Abuse and Mental Health Services Administration, the United States Department of Health and Human Resources,
see http://www.samhsa.gov/data/2k6/TNDR32DXM/TNDR32DXM.htm
Griffith, H. Winter (Editor). The Complete Guide to Prescription and Nonprescription Drugs. New York: Penguin Group, 2011.
“DXM Abuse,” Greater Dallas Council on Drug and Alcohol Abuse, posted at http://www.gdcada.org/statistics/dxm.htm
“Guaifenesin”at Drugs.com, see www.drugs.com/guaifenesin.html
“Dextromethorphan Overdose,” Medline, the United States Library of Medicine, The National Institute of Health, see http://www.nlm.nih.gov/medlineplus/ency/article/002628.htm
“Fact Sheet on Dextromethorphan,” The National Institute of Drug Abuse, see http://teens.drugabuse.gov/drug-facts/dextromethorphan-dxm-and-cold-medicine-fact
Kasanuki, Mari. “Adolescent Cough Medicine Abuse: What Adults Need to Know,” Parade Magazine, October 22, 2012.
Ibid. See definition of physical dependency and addiction in the Diagnostic and Statistical Manual of Mental Disorders, as defined by the American Psychiatric Association.
What Every Parent Needs to Know about Dextromethorphan,” The Partnership for a Drug-Free America, Parent Resources, posted at http://www.drugfree.org/Parent/Resources/Cough_Medicine_Abuse#.
“Dextromethorphan,” U.S. Drug Enforcement Agency, Office of Diversion Control, posted at http://www.deadiversion.usdoj.gov/drugs_concern/dextro_m/dextro_m.htm

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