How Dextromethorphan (DXM) Abuse Happens with OTC Cough Syrups

It’s easy to overlook a bottle of cough syrup sitting on your medicine cabinet. After all, it’s OTC-over the counter. No prescription. No doctor visit. Just grab it when you’ve got a bad cold. But for some, especially teens and young adults, that bottle isn’t for coughs anymore. It’s a shortcut to a high. And the ingredient behind it? Dextromethorphan, or DXM.

What DXM Is-And What It’s Not

Dextromethorphan is a synthetic cough suppressant. It’s been in OTC cold medicines since the 1950s. Unlike codeine, it doesn’t relieve pain or cause physical dependence when taken as directed. That’s why it was originally marketed as a safer alternative. The label says: take 15-30 mg every 4 to 8 hours. That’s it. That’s the safe range.

But DXM has a hidden side. At doses far beyond what’s recommended-240 mg, 500 mg, even 1,500 mg-it starts acting like a dissociative drug. Think hallucinations, out-of-body feelings, distorted time and sound. That’s not a side effect. That’s the point for people abusing it. They call it "robo tripping," "dexing," or "candy." Some even refer to it as "the poor man’s PCP," because the effects mimic the illegal drug phencyclidine, but without the cost or legal risk.

How People Abuse It

Abuse doesn’t happen by accident. It’s intentional. And it’s often done in ways that make it easy to hide.

The most common method? Drinking multiple bottles of cough syrup at once. Products like Robitussin DM, NyQuil, Coricidin, and Dimetapp DM all contain DXM. Many are labeled with "DM" on the front. Some people drink entire 8-ounce bottles in one sitting. That’s 300 mg of DXM-ten times the recommended dose.

There’s also the "robo shake." Users chug a large amount of syrup, then make themselves throw up. Why? To get rid of the other ingredients-like acetaminophen or antihistamines-that cause nausea, drowsiness, or liver damage. But DXM absorbs quickly through the stomach lining. So they keep the high, ditch the side effects.

Even more dangerous? Extracting pure DXM. Some users follow online guides to chemically strip the active ingredient from syrup, turning it into powder or capsules. They then swallow it, snort it, or even inject it. This removes all safety buffers. One wrong measurement and you’re looking at an overdose.

The Plateaus: What Happens When You Take Too Much

DXM doesn’t just make you feel "buzzed." It hits in stages, called plateaus. Each one is more intense-and more dangerous.

• First plateau (100-200 mg): Mild euphoria, slight dizziness, altered perception. Feels like a strong cold medicine buzz.
• Second plateau (200-400 mg): More intense. Visual distortions, numbness, loss of coordination. Users report feeling "detached" from their body.
• Third plateau (400-600 mg): Hallucinations, time distortion, out-of-body experiences. Some users describe it as a near-death or spiritual trip.
• Fourth plateau (600+ mg): Complete dissociation. Loss of motor control, delirium, coma risk. This is where overdoses happen.

At these levels, the body can’t handle it. Heart rate spikes. Blood pressure goes wild. Breathing slows. Seizures can start. And if DXM is mixed with alcohol, MDMA, or antidepressants? The risk of death jumps dramatically. There’s no "safe" recreational dose.

Why Teens Are Turning to It

It’s cheap. It’s legal. It’s everywhere.

A bottle of Robitussin costs less than $10. It’s sold in pharmacies, gas stations, grocery stores. No ID check. No questions asked. For teens who can’t afford marijuana, LSD, or even alcohol, DXM is the only option that gives them a strong, mind-altering experience.

According to the National Institute on Drug Abuse, about 3% of teens admit to abusing OTC cough medicine to get high. That’s 1 in 30. And in 2015, nearly 5% of high school seniors had tried it in the past year. Those numbers haven’t dropped. In fact, with pure DXM powder now available online, access is easier than ever.

Some kids don’t even realize they’re abusing a drug. They think they’re just "taking extra cough syrup" because they "really needed it." But when the goal shifts from treating a cough to chasing a hallucination, it’s no longer medical use.

The Hidden Dangers

Most people think: "It’s just cough medicine. How bad can it be?"

Here’s the reality:

• Liver damage: Many cough syrups contain acetaminophen. Too much of it-especially when combined with alcohol-can cause fatal liver failure.
• Cardiac arrest: DXM can cause dangerously high blood pressure and irregular heart rhythms.
• Brain damage: High doses, especially with other stimulants like MDMA, can trigger hyperthermia-body temperature so high it cooks brain tissue.
• Addiction: Even though some sources say DXM isn’t addictive, treatment centers like Greenhouse Treatment report increasing cases of dependence. Users report cravings, withdrawal symptoms, and compulsive use.
• Psychological trauma: Dissociative states can trigger lasting anxiety, paranoia, and psychosis-even in people with no prior mental health issues.

And here’s the scariest part: survival often depends on how fast someone gets to a hospital. If you’re found unconscious after a DXM binge, every minute counts.

What’s Being Done?

Some states have passed laws restricting sales of DXM products to minors. Others require pharmacies to keep cough syrups behind the counter. The CHPA (Consumer Healthcare Products Association) has partnered with abuse prevention groups to educate parents and retailers.

But enforcement is patchy. A teenager in Sydney, Australia, can still walk into a pharmacy and buy a bottle of Benylin DM without showing ID. Online retailers sell pure DXM powder with no questions asked.

And here’s the irony: the very thing that made DXM popular-its accessibility-is what makes it so dangerous. There’s no control. No oversight. No warning label that says: "This can break your brain."

What You Can Do

If you’re a parent: Check your medicine cabinet. Look for bottles labeled "DM," "Tuss," or "Cough Suppressant." Count them. Notice if any are missing. Talk to your kids-not with fear, but with facts. Ask what they’ve heard about "robo tripping." Most don’t realize how deadly it is.

If you’re a teen: Don’t experiment. What you think is a harmless party trick could end your life-or ruin your brain. The effects don’t always go away.

If you’re a friend of someone who’s abusing DXM: Don’t wait for them to hit rock bottom. Talk to them. Get them help. There are treatment centers that specialize in OTC drug addiction.

DXM isn’t a gateway drug. It’s a trapdoor. One bottle. One bad decision. And then you’re down a path you can’t come back from.

Frequently Asked Questions