How Dextromethorphan (DXM) Abuse Happens with OTC Cough Syrups

It starts with a cold. A stuffy nose, a scratchy throat, maybe a lingering cough. You grab a bottle of cough syrup from the cabinet-something you’ve used before, something labeled OTC, something your mom kept around the house. You read the label: Take 10 mL every 4 to 6 hours as needed. Simple. Safe. But for some, that label doesn’t mean safety. It means a shortcut. A cheap, easy way out. And that’s how dextromethorphan, or DXM, turns from a cough suppressant into a street drug.

What DXM Actually Does (When Used Right)

Dextromethorphan is a synthetic compound, first approved by the FDA in 1958. It’s not a narcotic. It doesn’t relieve pain. It doesn’t make you feel euphoric-at least, not at the right dose. When taken as directed, DXM works by quieting the cough reflex in your brainstem. It’s in over 70 OTC products, from Robitussin DM to NyQuil, DayQuil, Coricidin, and Tylenol Cold. You’ll see “DM” on the label. Or “Tuss.” Or “Cough Suppressant.” That’s DXM.

The recommended dose? 15 to 30 milligrams every 4 to 8 hours. That’s about one or two teaspoons. At that level, it does its job: stops the cough. No high. No hallucinations. Just relief.

How Abuse Starts: The Jump from Medicine to High

The problem isn’t DXM itself. It’s the dose. When someone takes 240 mg-or 500 mg, or even 1,500 mg-they’re not treating a cough. They’re chasing a trip.

Teens and young adults are the most common abusers. Why? Because it’s cheap. Because it’s legal. Because it’s sitting right there in the medicine cabinet. According to the National Institute on Drug Abuse, about 3% of teens admit to abusing OTC cough medicines to get high. That’s one in 30. And it’s not just teens. Adults too. Especially those who’ve tried other drugs and are looking for something easier to get.

The high doesn’t come from the sugar or the flavoring. It comes from DXM itself-when it floods the brain. At high doses, DXM acts like a dissociative, similar to ketamine or PCP. That’s why users call it “the poor man’s PCP.”

The Four Plateaus: What Happens When You Take Too Much

DXM abuse isn’t random. There are predictable stages-called plateaus-that users aim for, based on how much they take.

• First plateau (100-200 mg): Mild euphoria, slight dizziness, warmth, mild visual changes. Feels like a buzz.
• Second plateau (200-400 mg): More intense. Distorted time, blurred vision, numbness, feeling detached from your body. Some call this “the float.”
• Third plateau (400-600 mg): Strong dissociation. Out-of-body experiences. Hallucinations. Confusion. Loss of motor control. Users often can’t walk straight.
• Fourth plateau (600+ mg): Near-complete detachment from reality. Delirium. Amnesia. Risk of seizures, coma, or death. This is where people end up in the ER.

These aren’t myths. They’re documented effects from hospital reports and poison control data. And the higher you go, the more dangerous it gets.

How People Take It: Robo Tripping, Robo Shake, and Extraction

You won’t find someone just drinking one bottle. They go big.

• Robo tripping: The most common method. Drink multiple bottles of cough syrup at once. Some users consume 8, 10, even 15 bottles in a single session. That’s 1,500 mg or more of DXM.
• Robo shake: A more advanced trick. Drink a huge amount of syrup, then force yourself to vomit. The idea? Keep the DXM absorbed through the stomach lining while getting rid of the sugar, alcohol, and other ingredients that cause nausea. It’s brutal on the body.
• Chemical extraction: Some users don’t even drink the syrup. They find online guides that show how to extract pure DXM powder from the liquid. They then swallow it in capsules, or even snort it. This is far more dangerous. Pure DXM has no buffer. No warning. One wrong measurement and you overdose.

There are street names too: “C-C-C,” “dexing,” “robo,” “drank.” Products like Coricidin HBP (the red and blue pills) are called “Red Devils.” Robitussin is “Orange Crush.”

The Real Danger: What Happens When You Combine It

DXM alone is risky. But when mixed with other substances? That’s when people die.

• Alcohol: Combining DXM with alcohol increases the risk of respiratory depression. Your breathing slows. Stops. You pass out. You don’t wake up.
• SSRIs or antidepressants: This can trigger serotonin syndrome-a life-threatening spike in body temperature, heart rate, and blood pressure. Seizures. Organ failure.
• MDMA (ecstasy): The combination can cause hyperthermia. Your body overheats. Muscles break down. Kidneys fail. Death can happen within hours.
• Decongestants like pseudoephedrine: Found in many cold syrups, this raises blood pressure dangerously when combined with DXM. Heart attacks. Strokes.

Mount Sinai Health System warns that combining DXM with other drugs can lead to brain damage, seizures, coma, or death. And it’s not rare. Poison control centers in the U.S. get hundreds of calls every year about DXM overdoses.

Long-Term Effects: Addiction, Brain Changes, and Withdrawal

Some people think DXM isn’t addictive because it’s OTC. That’s a myth.

The New Mexico Department of Health says DXM isn’t addictive. But treatment centers like Greenhouse Treatment report increasing cases of dependence. Why the difference? Because science is catching up.

Chronic users develop tolerance. They need more to get the same effect. They start planning their day around their next dose. They lie to friends. Skip school. Lose jobs.

Withdrawal symptoms include anxiety, insomnia, irritability, cravings, and depression. Some users report lasting memory problems and cognitive fog-even after quitting.

And here’s the scary part: the brain changes from repeated high-dose use. Studies suggest DXM abuse can affect the prefrontal cortex-the part of your brain that controls decision-making and impulse control. That means even after stopping, users may struggle with poor judgment or risky behavior.

What’s Being Done? And Why It’s Not Enough

The pharmaceutical industry knows. The CHPA (Consumer Healthcare Products Association) has worked with manufacturers to reduce DXM concentrations in some products and add bittering agents to make it taste worse. Some states have passed laws restricting sales to minors. But it’s not enough.

DXM is still sold in every pharmacy, gas station, and dollar store. Online retailers sell pure DXM powder in bulk. A 100-gram container costs less than $20. That’s enough for 200 doses.

The DEA has monitored DXM abuse since 2004. They’ve even considered putting it under the Controlled Substances Act. But because it’s still used legitimately for coughs, they haven’t. So the loophole stays open.

What You Should Do

If you’re using DXM as directed-15-30 mg every few hours for a cough-you’re fine. It’s safe. Effective. No problem.

But if you’re taking more than that? If you’re doing it to feel something? If you’re hiding bottles or lying about how much you’ve taken? You’re not just experimenting. You’re playing with fire.

Parents: Check your medicine cabinet. Look for bottles labeled “DM.” Watch for empty containers. Notice if your teen is unusually drowsy, confused, or has slurred speech. These aren’t just signs of being tired. They’re signs of overdose.

If you or someone you know is struggling with DXM abuse, get help. Talk to a doctor. Call a treatment center. This isn’t a phase. It’s a medical issue.

DXM doesn’t care if you’re 16 or 26. It doesn’t care if you think you’re in control. At high doses, it breaks your brain. And sometimes, it doesn’t let you back.