How Dextromethorphan (DXM) Abuse Happens with OTC Cough Syrups

Every year, thousands of teens and young adults swallow bottles of cough syrup-not because they’re sick, but because they’re trying to get high. The drug they’re chasing is dextromethorphan, or DXM, a common ingredient in over-the-counter cold and flu remedies. It’s legal. It’s cheap. And it’s sitting right there on the pharmacy shelf next to pain relievers and throat lozenges. But when taken in massive doses, DXM doesn’t just stop a cough-it rewires your brain, distorts reality, and can land you in the emergency room.

What Is Dextromethorphan, Really?

Dextromethorphan is a synthetic cough suppressant first approved by the FDA in 1958. Unlike codeine, it doesn’t relieve pain or cause physical dependence when taken as directed. That’s why drugmakers added it to more than 100 OTC products-from Robitussin DM and NyQuil to DayQuil, Coricidin, and Dimetapp. You’ll find it labeled as “DM,” “Tuss,” or “Cough Suppressant” on the bottle. The normal dose? 15 to 30 milligrams every 4 to 8 hours. That’s it. Enough to quiet a stubborn cough. Nothing more.

But here’s the problem: at doses 5 to 50 times higher, DXM starts acting like a dissociative drug-similar to ketamine or PCP. People who abuse it call it “robo tripping,” “dexing,” or “candy.” At 240 mg or more, users report out-of-body experiences, blurred vision, slurred speech, and hallucinations. Some say they feel like they’re floating. Others describe being trapped inside their own heads. It’s not a party trick. It’s a neurological overload.

How Do People Abuse It?

Abuse doesn’t start with a lab or a dealer. It starts with a bottle of cough syrup bought with cash at the corner store. Teens and young adults often drink entire bottles-or multiple bottles-in one sitting. Some mix it with soda or alcohol to mask the bitter taste. Others use a method called the “robo shake”: drink a huge amount of syrup, then force yourself to throw up to get rid of the sugar and other ingredients while letting the DXM absorb through the stomach lining.

More advanced abusers skip the syrup entirely. They buy DXM powder online or extract it from pills using simple chemical methods. YouTube videos and underground forums have detailed guides on how to do it. Once purified, DXM can be snorted, swallowed in capsules, or even injected. Pure DXM powder is far more dangerous than syrup. One wrong scoop-and you’ve overdosed.

The Plateaus: What Happens When You Take Too Much

DXM abuse isn’t random. Users follow a pattern called “plateaus,” each one triggered by a specific dosage range:

1. First plateau (100-200 mg): Mild euphoria, slight dizziness, warmth, and altered perception. Like a heavy buzz.
2. Second plateau (200-400 mg): Distorted sounds and colors, blurred vision, nausea, and loss of coordination. People start feeling detached from their bodies.
3. Third plateau (400-600 mg): Intense dissociation. Users feel like they’re floating, watching themselves from outside. Hallucinations begin. Some can’t speak or move.
4. Fourth plateau (600+ mg): Complete loss of touch with reality. Out-of-body experiences, delusions, paranoia, and sometimes psychosis. This is where brain damage, seizures, and death become real risks.

These aren’t myths. They’re documented effects from emergency room reports and medical journals. The National Institute on Drug Abuse found that 3% of teens admit to abusing DXM-containing cough syrup at least once. That’s 1 in 30. And many do it repeatedly.

The Hidden Dangers: When DXM Turns Deadly

DXM alone can cause vomiting, rapid heartbeat, high blood pressure, and seizures. But the real danger comes when it’s mixed with other substances. Many cough syrups already contain acetaminophen, antihistamines, or decongestants. Taking extra doses means overdosing on those too. Acetaminophen overdose can destroy your liver. Antihistamines can cause coma.

Combine DXM with alcohol? That’s a death sentence. Both depress the central nervous system. Together, they can shut down breathing. The Mount Sinai Health Library has documented multiple teen deaths from this combo.

And then there’s MDMA, cocaine, or antidepressants. Mixing DXM with these can trigger serotonin syndrome-a life-threatening surge of brain chemicals that causes fever, muscle rigidity, and organ failure. One case study from 2022 involved a 17-year-old who died after taking DXM and ecstasy together. He had no history of drug use. Just a bottle of Robitussin and a friend’s advice: “Take four.”

Why Is It So Easy to Abuse?

Because no one thinks it’s a drug. Parents don’t lock up cough syrup. Pharmacies don’t require ID. Teens don’t see it as “drugs” like cocaine or heroin. They see it as medicine. And that’s the trap.

It’s cheap. A bottle of Coricidin HBP Cough & Cold costs less than $5. A single bottle can contain enough DXM for a full trip. Compare that to a gram of marijuana or a pill of Adderall. DXM is the poor man’s hallucinogen. It’s accessible, legal, and unregulated-at least for now.

The Drug Enforcement Administration (DEA) has watched this trend for years. In 2004, they warned that DXM abuse was rising and that it might soon be classified as a controlled substance. That hasn’t happened yet. But some states have moved. New Mexico, for example, passed laws restricting sales to minors. Other states require pharmacies to keep DXM products behind the counter. But enforcement is patchy. And online sales of pure DXM powder are growing fast.

What Does Recovery Look Like?

Not everyone who abuses DXM becomes addicted. Many try it once, have a terrifying experience, and never touch it again. But for others, it becomes a pattern. The National Institute on Drug Abuse says DXM can lead to psychological dependence. Users report cravings, anxiety when they can’t get it, and withdrawal symptoms like irritability and insomnia.

Treatment isn’t always medical. Many cases resolve on their own once the person stops using. But for those who’ve been abusing it for months or years, therapy is essential. Cognitive behavioral therapy helps them understand why they turned to DXM in the first place-whether it was boredom, trauma, peer pressure, or mental health struggles.

And here’s the hard truth: hospitals don’t have a “DXM antidote.” Treatment is supportive-monitoring heart rate, controlling seizures, managing vomiting, and waiting for the drug to leave the system. Survival depends on how fast someone gets help. If you or someone you know takes too much, call 911. Don’t wait. Don’t assume they’ll “sleep it off.”

What Parents and Educators Should Know

If you’re a parent, check your medicine cabinet. Look for bottles with “DM” on the label. Ask your kids what they’ve heard about “robo.” Don’t assume they’re too smart to try it. The teens who abuse DXM aren’t the ones skipping school or wearing all black. They’re the honor students, the athletes, the quiet ones.

Teachers and school counselors need to talk about it too. DXM abuse isn’t just a “drug problem.” It’s a public health blind spot. Most school drug programs don’t even mention OTC medications. That needs to change.

And if you’re a teen reading this? If you’ve ever taken more than the label says, you’re not alone. But you’re also not invincible. One bad trip can change your life-or end it.

DXM is safe when used correctly. But when it’s used to escape, to feel something, to get high-it becomes a weapon. And like any weapon, it’s only as dangerous as the person holding it.