What are the side effects of cough and cold medicine abuse. How does dextromethorphan (DXM) affect the body when misused. Why is cold medicine abuse becoming more prevalent among teenagers. What are the potential dangers of overdosing on DXM-containing products.

The Rise of Cough and Cold Medicine Abuse

Cough and cold medicine abuse, particularly involving products containing dextromethorphan (DXM), has become an alarming trend, especially among adolescents. This practice, sometimes referred to as “pharming,” involves the intentional misuse of over-the-counter (OTC) medicines to achieve a high. The accessibility, affordability, and perceived safety of these products contribute to their appeal as substances of abuse.

DXM is a common ingredient in many OTC cough suppressants and cold remedies. When used as directed, it effectively alleviates coughing by acting on the brain’s cough center. However, when consumed in large quantities, DXM can produce euphoric and hallucinogenic effects similar to those of illicit drugs like ecstasy and LSD.

Why are teenagers turning to cold medicine abuse?

• Easy accessibility in stores
• Low cost compared to illicit drugs
• Legal status
• Lack of suspicion from parents
• Perception of safety due to OTC status

Understanding Dextromethorphan (DXM): The Key Player in Cold Medicine Abuse

Dextromethorphan, commonly abbreviated as DXM, is a cough suppressant found in numerous over-the-counter cold and flu medications. It belongs to a class of drugs known as opioids, although it does not have the same pain-relieving properties as other opioids like morphine or codeine.

How can you identify DXM-containing products?

Products containing DXM are often labeled with “DM,” “cough suppressant,” or “Tuss” (or include “tuss” in the title). These medications come in various forms, including:

• Syrups
• Capsules
• Pills
• Throat lozenges

Some individuals go to extreme lengths to abuse DXM, extracting it from cough syrup to create a powder or capsule of “pure” DXM for more potent effects.

The Effects of DXM Abuse on the Body and Mind

When consumed in excessive amounts, DXM can produce a range of effects on the body and mind, some of which can be extremely dangerous or even life-threatening.

What are the short-term effects of DXM abuse?

• Hallucinations and “out-of-body” sensations
• Impaired motor function and coordination
• Blurred vision
• Slurred speech
• Dizziness
• Impaired judgment
• Paranoia and confusion
• Excessive sweating
• Nausea and vomiting
• Abdominal pain
• Irregular heartbeat and high blood pressure
• Restlessness
• Dry, itchy skin and facial redness

These effects can persist for up to 6 hours, creating a prolonged period of impairment and potential danger for the user.

The Dangers of DXM Overdose and Long-Term Abuse

While DXM may seem relatively safe due to its OTC status, consuming large quantities can lead to severe and potentially fatal consequences. The risk of overdose is particularly high when using pure DXM powder or extremely concentrated forms of the drug.

What are the risks of DXM overdose?

• Loss of consciousness
• Seizures
• Brain damage
• Death

One of the most dangerous side effects of DXM abuse is hyperthermia, or extremely high body temperature. This condition is especially problematic in hot environments or when users engage in physical activities like dancing at clubs. Hyperthermia can rapidly lead to brain damage or coma if left untreated.

Polysubstance Abuse: The Hidden Danger of Cold Medicine Misuse

Many individuals who abuse cold medicines may not realize they are ingesting multiple drugs simultaneously, not just DXM. This polysubstance abuse significantly increases the risk of adverse effects and life-threatening conditions.

How does combining DXM with other substances increase risks?

Mixing DXM with other drugs or alcohol amplifies the likelihood of dangerous outcomes. For example, combining DXM with MDMA (ecstasy) heightens the risk of hyperthermia, potentially leading to severe consequences such as:

• Brain damage
• Seizures
• Coma
• Death

The interaction between DXM and other substances can create unpredictable and potentially lethal effects on the body, making polysubstance abuse particularly dangerous.

Recognizing the Signs of Cold Medicine Abuse

Parents, educators, and healthcare professionals should be aware of the signs that may indicate cold medicine abuse, especially among adolescents and young adults.

What are the warning signs of DXM abuse?

• Frequent purchase or possession of cough and cold medicines
• Empty cough syrup bottles or packaging in trash
• Sudden changes in behavior or mood
• Decreased academic or work performance
• Social withdrawal
• Unusual sleep patterns
• Slurred speech or impaired coordination
• Unexplained absences from school or work

If you suspect someone is abusing cold medicines, it’s crucial to approach the situation with care and seek professional help if necessary.

Prevention and Education: Combating Cold Medicine Abuse

Addressing the issue of cold medicine abuse requires a multifaceted approach involving education, prevention, and intervention strategies.

How can we prevent cold medicine abuse?

• Educate young people about the dangers of OTC medicine abuse
• Implement stricter regulations on the sale of DXM-containing products
• Encourage parents to monitor and secure medications at home
• Promote awareness among healthcare providers and pharmacists
• Develop and promote drug abuse prevention programs in schools and communities
• Provide accessible resources for addiction treatment and support

By raising awareness and implementing preventive measures, we can work towards reducing the prevalence of cold medicine abuse and its associated risks.

Seeking Help: Treatment Options for Cold Medicine Addiction

For individuals struggling with cold medicine abuse or addiction, various treatment options are available to support recovery and promote long-term health.

What treatment approaches are effective for cold medicine addiction?

• Medical detoxification to manage withdrawal symptoms
• Cognitive-behavioral therapy (CBT) to address underlying issues and develop coping strategies
• Group therapy and support groups
• Family therapy to improve communication and support systems
• Dual diagnosis treatment for co-occurring mental health disorders
• Holistic approaches such as mindfulness and stress management techniques

Recovery from cold medicine addiction is possible with the right support and treatment. Seeking help early can prevent long-term health consequences and improve overall quality of life.

As we continue to grapple with the issue of cold medicine abuse, it’s crucial to remain vigilant and proactive in our efforts to educate, prevent, and treat this form of substance misuse. By working together, we can help protect individuals, especially young people, from the dangers of DXM abuse and promote healthier communities.

Cough and Cold Medicine Abuse (for Parents)

en español: Abuso de los medicamentos para la tos y el resfriado

Reviewed by: KidsHealth Medical Experts

Primary Care Pediatrics at Nemours Children’s Health

What It Is:

Dextromethorphan (DXM) is an ingredient in many over-the-counter (OTC) cough and cold medicines.

Sometimes Called:

candy, drank, robo, C-C-C, dex, DM, drex, red devils, rojo, skittles, tussin, velvet, and vitamin d

How It’s Used:

Medicines that have DXM in them come as syrups, capsules, pills, or throat lozenges. But some people extract DXM from cough syrup and make it into a powder or capsule of “pure” DXM.

Dextromethorphan-containing products — tablets, capsules, gel caps, lozenges, and syrups — are labeled DM, cough suppressant, or Tuss (or contain “tuss” in the title).

What It Does:

When people take too much DXM, they might have hallucinations and “out-of-body” sensations. DXM also depresses brain function, particularly the parts of the brain that control breathing and heart function.

Taking a lot of DXM causes hallucinations and out-of-body sensations similar to the ones caused by drugs like ketamine and PCP. These effects can last as long as 6 hours.

DXM also can make users have trouble controlling their limbs and cause blurred vision, slurred speech, dizziness, and impaired judgment.

Other short-term effects include:

• paranoia and confusion
• excessive sweating
• nausea and vomiting (large quantities of cough syrup almost always cause people to throw up)
• belly pain
• irregular heartbeat and high blood pressure
• restlessness
• dry, itchy skin and facial redness

DXM might seem safe because it’s sold over the counter. But large quantities can cause dangerous side effects, including loss of consciousness, seizures, brain damage, and death.

One particularly dangerous side effect of DXM is hyperthermia — extremely high fever. This is a big problem in hot environments or when DXM users physically exert themselves, like while dancing at a club. High body temperatures can quickly lead to brain damage or a coma.

It’s possible to overdose on too much DXM, especially if it’s in pure powder form. Someone who overdoses may have brain damage or seizures, and might even die.

People using cold medicines to get high may not realize they are taking high doses of many drugs, not just DXM. Mixing DXM with other drugs or alcohol increases the likelihood of life-threatening conditions. For instance, combining it with drugs like MDMA increases the risk of hyperthermia and can lead to brain damage, seizures, a coma, and death.

Reviewed by: KidsHealth Medical Experts

Date reviewed: March 2023

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Cold Medicine Abuse | Connecticut Poison Control Center

During the fall and winter months, it is not uncommon to see people carrying around bottles of cough medicine or taking cold pills on their break. It’s the time of year for cold and flu, and many people choose to self-medicate to alleviate their symptoms. This includes adolescents, who can easily purchase these products at local stores.

However, an increasing trend among young people is the abuse of over-the-counter (OTC) cold medications. Of particular concern is dextromethorphan or DXM, which is used in a variety of over-the-counter cough and cold medications, particularly those whose name includes “DM” or “Tuss.”

DXM is a narcotic related to opium and is a cough suppressant that suppresses an area in your brain that causes you to cough. When used according to directions, the drug will alleviate cough, and is particularly helpful with night-time coughing that keeps you awake.

However, when abused in higher doses, it creates a euphoric and hallucinogenic effect, similar to ecstasy and LSD. It alters perception of reality. People report having creative dream-like and dissociative experiences while using the drug. Increased media coverage of “pharming” or intentional misuse of over-the-counter medicines, reveal that this practice is becoming more popular and potentially more deadly. It is cheap, legal, and readily available, and most parents won’t question their children for having cold medicine in their bags or rooms. That is why teens turn to dextromethorphan (DXM), to get high. But misuse of DXM is potentially deadly.

Experts believe abuse of DXM is rising among adolescents, particularly on the rave and club scene. However, reported cases are sporadic often because parents are unaware of DXM abuse, or it is being mixed with other substances that mask the drug’s effects. In 2002, the Regional Center for Poison Control and Prevention serving Massachusetts and Rhode Island recorded 1048 calls for misuse of DXM, up from 870 the year before.

Symptoms of DXM misuse include loss of balance, increased pulse, hypothermia, severe high blood pressure, loss of consciousness, mania, loss of muscle control, permanent brain damage, coma, seizures, cerebral hemorrhages and stroke. Decreased ability to regulate body temperature, because of reduced sweating can cause increased body temperatures. When taken in a dance-club setting, accompanied by vigorous physical activity (dancing, etc.) and poor air circulation, the result can be heat stroke. This phenomenon is sometimes called “rave-related heat stroke.”

In addition, to the problems from dextromethorphan itself, many DXM containing products also contain acetaminophen or antihistamines. DXM also interacts with many prescription medicines. These co-ingestions or interactions can result in life threatening symptoms.

These drugs are deadly when abused and can create permanent damage. If parents and teachers notice young people frequently carrying cough and cold medicines, particularly when they do not have cold symptoms, it is very important to respond. If you suspect an overdose, call your local Poison Control Center at 1-800-222-1222.

Street names for DXM include:

• Dex
• DM
• Drex
• Robo
• Rojo
• Skittles
• Triple C
• Velvet

Be careful with medicines!

Many parents are accustomed to the numerous colds of the child and no longer go to the doctor when a runny nose or cough appears. However, it is important to remember that using drugs on your own can be dangerous, especially for children’s health. Very often, parents “automatically” give a cold baby prepared preparations for a runny nose and cough, without understanding all the symptoms of the disease. While many dangerous diseases in the initial stages manifest themselves as a common cold or SARS. At the same time, out of habit, the mother forces her baby to drink expectorants without seeing a dry whooping cough. Accordingly, the treatment turns out to be not only useless, but also harmful, since the baby remains for some time without proper medical care.

Parents forget that the symptoms of true illness can be distorted by drugs. Uncontrolled intake of antipyretics and painkillers often hides a much more serious course of the disease, creating the appearance of an improvement in the child’s condition.

There are a lot of drugs that fight the symptoms of a cold, and only a doctor can make the right choice for each specific case.
Moreover, there are mutually exclusive medications that should not be taken at the same time. They can weaken or enhance each other’s action, which can lead to complications.

Uncalculated dosage

The pediatrician prescribes the dosage of the drug in accordance with the age and weight of the small patient. It is very easy for parents to make a mistake in choosing a dose of medicine, acting according to the usual instructions. The most common mistake is too much cough syrup or vasoconstrictor drops for a child with a runny nose. In addition, the doctor clearly stipulates how many days you need to take the prescribed remedy. Relatives may not think about this moment, using the drug more or less than the prescribed period.

Variety of dosage forms

The same drug can be produced in several forms at once – powders, syrups, tablets or suppositories. In this case, the same drug may have different names. You may not harm the child if you make a mistake with the choice of the form of the medicine, but it is likely that a similar remedy in the form of candles will be more effective than in the form of tablets. Of course, only the attending physician should take into account such nuances.

Side effects

Perhaps the most dangerous consequence of self-medication is the manifestation of side effects from drugs chosen by parents. Most often, they occur from the gastrointestinal tract, when the child starts bloating, nausea, or loose stools. As a result, an imbalance in the intestinal flora develops, which requires additional treatment and special nutrition for a long time.

Common side effects include an allergic reaction. It happens that parents do not take into account the herbal composition of the remedy, and the baby develops an allergy to one of the natural components of the drug. In such a situation, you should immediately consult a doctor.

Unnoticed complications

Fully controlling the course of the disease, parents may mistakenly think that the baby is already healthy, because all the unpleasant symptoms have disappeared. However, if the child is not really cured yet, and he returns to kindergarten or school, there is a high probability of not only a new wave of illness, but also the occurrence of serious complications, such as otitis media or pneumonia. Only a doctor should conclude that the child has recovered and is ready to return to normal school life.

Pediatrician OKDC Anna Pogorelova

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Colds and medicines

Taking medication for an acute respiratory viral infection (ARVI) can be indicated only if the disease interferes with sleep, drink, or greatly worsens general well-being. The risks associated with the use of drugs for cold symptoms often outweigh the possible benefits: in studies, many drugs showed little more efficacy than placebo, but could lead to the development of noticeable adverse reactions. Therefore, it is better to start treatment not with drugs, but with harmless non-drug ways to make you feel better. They don’t necessarily help everyone, but they are safer.

To reduce irritation with a sore throat and dry cough, to make the secret more liquid (due to which it will be easier to come out), a warm drink is recommended – apple juice, tea, chicken broth. Children older than a year can be given ½-1 teaspoon of honey. In addition, you can use saline solutions or nasal sprays and humidify the air in the room using special devices. It is worth choosing a cold humidifier, especially if there are children in the house, they can burn themselves (more tips can be found here).

At the same time, there are unsafe methods and means that, moreover, do not help with ARVI. These include steam inhalation, the use of humidifiers that heat the air. Inhalation of warm air and steam does not reduce the symptoms of a cold, but it can dry out mucous membranes and even lead to burns. An attempt to bring down the temperature by rubbing with vodka, vinegar or water will also lead to undesirable consequences, never do this. There is no point in putting cups and steaming your legs, since there is no evidence of the effectiveness of these methods, and a burn can be quite real. The advice to take vitamin C is useless, even regular intake of which has almost no effect on the course of a cold. And you should not seriously rely on garlic, echinacea and zinc.

It is also important to remember that antiviral drugs, as well as antiseptics, antibiotics, and “immune” drugs, do not work with the common cold.

Drugs that are used for colds can be divided into three groups:

+ effective, completely safe drugs;

+/- drugs that can help, but at the same time sometimes cause side reactions;

– practically ineffective or unsafe drugs, as well as drugs whose safety and efficacy are poorly understood.

Medicines to reduce fever and pain (if you have a sore throat, ears, head, muscles or joints)

+ Acetaminophen (paracetamol) and non-steroidal anti-inflammatory drugs by mouth or suppositories can be used for several days without exceeding doses when feeling unwell associated with fever or pain. These drugs do not reduce cough and nasal discharge and do not affect the duration of the illness. Remember that only paracetamol and ibuprofen are suitable for children, in no case should you give acetylsalicylic acid, aspirin.

+/- Sprays and lozenges with anesthetics (with benzocaine, menthol, etc.) can help with sore throats. Lollipops can choke, so they are not recommended for children under 6 years old.

Nasal relievers

+/- Drops and sprays with decongestants (vasoconstrictor drugs – oxymetazoline, xylometazoline, phenylephrine) reduce swelling of the nasal mucosa. The absorption of oxymetazoline and xylometazoline rarely leads to systemic side effects, but they should not be used for longer than 2-3 days due to the risk of developing drug-induced rhinitis (a feeling of nasal congestion after stopping the use of the drug). The effectiveness of these drugs has not been proven in children under 2 years of age.

+/- Decongestants for oral administration (phenylephrine, pseudoephedrine) act in the same way as drops and sprays, but are less effective and more often lead to systemic adverse reactions (stimulation of the nervous system, increased blood pressure and increased heart rate). The most commonly used dose of phenylephrine, 10 mg, is no more effective than placebo. Given their unproven efficacy and possible serious side effects, oral decongestants are not recommended for children under 6 years of age and are not recommended for children 6-12 years of age.

+/- Topical aromatics with menthol, camphor and eucalyptus oil produce a subjective sensation of improved nasal breathing, but are not able to objectively increase airflow through the nose. Also, these drugs can somewhat reduce nocturnal cough and improve sleep (although it cannot be ruled out that this effect is associated with a placebo effect). Side effects are possible with accidental ingestion.

– Sprays with hormonal drugs – glucocorticosteroids (beclomethasone, fluticasone) have been proven effective in allergic rhinitis and can help with acute and chronic rhinosinusitis, but are ineffective in relation to the symptoms of acute respiratory viral infections and do not affect the duration of the common cold.

Medications that reduce nasal discharge

+/- Nasal drops and sprays with anticholinergics (ipratropium bromide) can reduce the amount of mucus and reduce sneezing, but do not affect nasal congestion. Common side effects include nasal dryness and crusting. In children under 5 years of age, these funds are not used.

+/- 1st generation antihistamines (chlorpyramine, diphenhydramine, hydroxyzine, brompheniramine, clemastine) for oral administration may slightly reduce the amount of discharge due to anticholinergic side effects. At the same time, the drug has a sedative effect, due to possible side effects, they are not recommended for children under 6 years old and are not advised for children 6-12 years old.

– Non-sedating antihistamines (2nd and 3rd generations – cetirizine, loratadine, etc.) do not have the anticholinergic effect that 1st generation antihistamines have, therefore they cannot affect any manifestations of the common cold.

Cough relievers

+/- Topical aromatics with menthol, camphor and eucalyptus oil, and 1st generation antihistamines (see above).

+/- Non-narcotic antitussives (dextromethorphan) inhibit the cough center in the brain and are somewhat more effective than placebo. Due to possible side effects, they are allowed to be used only in case of severe prolonged cough that interferes with sleep and food intake (in such a situation, other causes of cough, such as whooping cough, asthma, must first be excluded). Not recommended for children under 6 years old and not recommended for children 6-12 years old.

+/- Mucolytics (sputum thinners – acetylcysteine, bromhexine, etc.) make the secret more liquid, and probably their effect is slightly higher than that of placebo. Due to possible side effects, they are not recommended for children under 6 years of age and are not recommended for children 6-12 years of age.

– Homeopathic remedies, like herbal medicine, have no evidence of effectiveness, while herbal preparations can have serious side effects.

– Narcotic antitussive drugs (codeine, hydrocodone) affect the cough center in the brain. Their effect is not very high, but there is a risk of developing serious undesirable effects. Therefore, these drugs are not recommended for children and are not recommended for adults.

– Expectorants (guaifenesin) increase the production of mucus (so that the thinner secretion is more easily removed with a cough), but they alleviate the cough slightly more than placebo. By itself, guaifenesin is practically safe, but it is usually included in combined preparations, where there are other substances that may have side effects.

– Bronchodilators (bronchodilators used for asthma, COPD – salbutamol, salmeterol, etc.) are ineffective for acute cough in people without bronchospasm.

Combinations

It is not for nothing that combination drugs for oral administration are not recommended for children under 12 years of age and are not advised for adults. Their composition often includes both the necessary and the useless. Moreover, the doses may not correspond to each other: for example, a small dose of paracetamol, which will not be enough to reduce fever or reduce pain, and the maximum safe dose of phenylephrine or vitamin C that is useless for colds. In addition, people sometimes inattentively monitor what is included in the composition such drugs, and the risk of overdose increases. A person can take the same medicine twice, for example, an antipyretic: first separately, and then as part of a combined remedy. If the treatment is prescribed by a doctor, he can choose a combined preparation containing only those components that are necessary for a particular person, and in the correct dosage. But there is no universal recommendation: only paracetamol and non-steroidal anti-inflammatory drugs are proven effective and safe, sometimes antihistamines, vasoconstrictors and cough medicines may be required. And therefore, if the decision to purchase medicines is made independently at the pharmacy, it is better to buy several single-component medicines.