How Dextromethorphan (DXM) Abuse Happens with OTC Cough Syrups

It’s easy to overlook a bottle of cough syrup on the bathroom shelf. You’ve got a cold, you take the right dose, you feel better. But what happens when someone takes dextromethorphan-not to stop a cough, but to get high? This isn’t rare. It’s happening in bedrooms, school bathrooms, and basements across the country. And it’s not just teens. Adults, too. The drug is legal. The bottle is on the shelf. The danger? It’s hidden in plain sight.

What Is Dextromethorphan, Really?

Dextromethorphan, or DXM, is a cough suppressant. It’s been around since the 1950s. It’s not a narcotic. It doesn’t relieve pain. It doesn’t make you sleepy like codeine. At normal doses-15 to 30 mg every 4 to 8 hours-it simply tells your brain to stop triggering a cough. That’s it. You take it, you feel better, you go about your day.

But DXM has a second life. At doses 5 to 10 times higher, it starts acting like a dissociative drug. Think of it like a switch flipping. Instead of calming your cough, it starts messing with your perception. Colors get brighter. Sounds stretch out. You feel detached from your body. Some people call it ‘robo tripping’ or ‘dexing.’ Others say they’re ‘drankin’-a slang term from Southern U.S. street culture. It’s not magic. It’s chemistry. DXM hits the same brain receptors as PCP and ketamine. That’s why it’s called ‘the poor man’s PCP.’

How Do People Abuse It?

Abuse starts with a bottle you can buy without a prescription. Over 70 OTC cough and cold products contain DXM. You’ll see ‘DM’ on the label-Robitussin DM, Benylin DM, Coricidin HBP, NyQuil, DayQuil, TheraFlu, Dimetapp. Some even have ‘Tuss’ in the name. It’s everywhere.

Most abusers don’t just sip. They gulp. A single bottle of cough syrup can contain 300 mg of DXM. To get high, users drink two, three, even six bottles at once. That’s 900 to 1,800 mg-way past the safe limit. Some call this ‘candy’ or ‘C-C-C.’ Others mix it with soda or juice to mask the awful taste.

Then there’s the ‘robo shake.’ Users drink a whole bottle, then make themselves throw up. Why? To get rid of the sugar, alcohol, and other ingredients that cause nausea-while letting the DXM get absorbed through the stomach lining. It’s dangerous. You’re forcing your body to handle a toxic load.

And it’s getting worse. You can now buy pure DXM powder online. No syrup. No labels. Just white crystals. People snort it. They swallow capsules. They mix it with other drugs. One study found users combining DXM with MDMA or alcohol. That’s a recipe for overheating, seizures, heart failure, or death.

The Plateaus: What Happens When You Take Too Much

DXM abuse isn’t random. It follows patterns called ‘plateaus.’ Each dose level produces different effects:

• First plateau (100-200 mg): Mild euphoria, slight dizziness, warmth. Feels like a buzz.
• Second plateau (200-400 mg): Distorted vision, altered sense of time, numbness. You might feel like you’re floating.
• Third plateau (400-600 mg): Hallucinations, out-of-body experiences, confusion. People report feeling like they’re in another world.
• Fourth plateau (600+ mg): Complete dissociation. Loss of motor control. Slurred speech. Inability to move or speak. Risk of coma or death.

At the highest levels, users lose touch with reality. They can’t walk. They don’t recognize their own name. Some end up in emergency rooms because they passed out, stopped breathing, or had a seizure. And if they’re alone? No one finds them until it’s too late.

Why Teens Are Especially at Risk

In 2016, nearly 3% of U.S. teens admitted to abusing OTC cough medicine to get high. That’s about 1 in 30. Why? Because it’s cheap. Easy. Legal. A bottle of Robitussin costs less than $10. You don’t need to know a dealer. You don’t need to sneak into a party. You just grab it from the pharmacy shelf.

And social media makes it worse. Videos show people chugging cough syrup. Memes joke about ‘drank.’ Influencers downplay the risks. Teens think it’s harmless. But the truth? DXM isn’t a party trick. It’s a brain-altering drug. And the brain doesn’t stop developing until age 25. Every time someone abuses DXM during adolescence, they risk damaging areas responsible for memory, decision-making, and emotional control.

What Happens When You Combine It With Other Drugs

DXM alone is dangerous. DXM with alcohol? Deadly.

Alcohol and DXM both depress the central nervous system. Together, they slow your breathing, lower your blood pressure, and shut down your reflexes. There are documented cases of teens dying after mixing NyQuil with beer.

Combine DXM with antidepressants like SSRIs? Risk of serotonin syndrome-a life-threatening surge of brain chemicals that causes fever, muscle rigidity, and seizures.

Pair it with stimulants like Adderall or MDMA? Your body overheats. You can’t sweat. Your core temperature spikes. Organs fail. Brain damage can happen in minutes.

There’s no safe combo. Ever.

Signs Someone Is Abusing DXM

If you’re worried about a teen-or even an adult-you’re not overreacting. Watch for:

• Empty cough syrup bottles hidden in rooms or backpacks
• Slurred speech, poor coordination, or staggering
• Blurred vision, dilated pupils, or unusual eye movements
• Unexplained mood swings-sudden laughter, then silence
• Secretive behavior, especially around medicine cabinets
• Wearing long sleeves in hot weather (to hide red, itchy skin-a common side effect)
• Using the term ‘dex,’ ‘robo,’ or ‘drank’ casually

And don’t ignore the smell. Cough syrup has a strong, sweet, chemical odor. If you notice that smell on someone’s breath or clothes, it’s a red flag.

Can You Get Addicted to DXM?

Some experts say DXM isn’t addictive. Others say it absolutely can be. The truth? It’s complicated.

Unlike opioids, DXM doesn’t cause physical withdrawal symptoms like shaking or vomiting. But people who use it regularly report cravings. They feel anxious without it. They build tolerance-needing more and more to get the same effect. That’s the definition of psychological dependence.

Treatment centers are seeing more cases. People who abused DXM for months or years now need counseling to break the habit. Some have been hospitalized after overdosing. Others lost jobs, friends, or their sense of self.

It’s not just about the high. It’s about what happens when the high stops.

What to Do If Someone Is Abusing DXM

If you suspect someone is using DXM to get high, don’t wait. Don’t assume they’ll grow out of it. Don’t blame them. Talk to them. Calmly. Without judgment.

Check the medicine cabinet. Remove all DXM-containing products. Don’t just hide them-throw them away. Keep track of how many bottles are missing.

Call a doctor. Or a counselor. Or a poison control center. If someone has taken a huge dose and is confused, vomiting, or unresponsive-call 911. Immediate medical help saves lives.

And if you’re the one using it? You’re not alone. But you’re not safe. This isn’t just ‘experimenting.’ It’s risking your brain, your heart, your future. Reach out. Talk to someone. You don’t have to do this alone.

It’s Not Just a ‘Bad Trip’

DXM abuse isn’t a phase. It’s not a joke. It’s not something you can ‘just stop.’

People die from this. Brain damage happens. Relationships break. Careers end. And it all starts with a bottle you can buy at the corner store.

The truth? OTC doesn’t mean harmless. Just because it’s legal doesn’t mean it’s safe. And just because it’s cheap doesn’t mean it’s worth the risk.