Last Updated: March 21, 2023

DXM (dextromethorphan) is a common, over-the-counter cough suppressant found in many cold, flu and allergy medications. However, it is also a popular drug of abuse, and its use can lead to a number of dangerous side effects and long-term effects. 

DXM Abuse

DXM is a drug found in many over-the-counter cold medications, and has become a popular drug of abuse, particularly among teens. This is often referred to as “robotripping”, and involves taking large doses of DXM for its dissociative and hallucinogenic effects. DXM is used as an alternative to harder drugs, as it is cheap and easily accessible. It is also used in combination with other drugs, such as alcohol and marijuana.

According to the National Institute on Drug Abuse, approximately 3.7% of teens reported using DXM for recreational purposes – up 32% from the previous year. DXM abuse isn’t just a growing problem among teens. In fact, DXM abuse is most common for adults, with an estimated 1.2 million adults aged 26 and older abusing cough medicines containing DXM in the past year.

Popular OTC drugs that may or may not contain DXM include:

• Robitussin
• Coricidin
• Vicks
• NyQuil
• Delsym
• Alka-Seltzer Plus
• TheraFlu
• PediaCare
• Sudafed
• Actifed

The Effects of Abusing DXM

Prescribed doses of DXM, or dextromethorphan, can cause mild euphoric effects. This is because it is an antitussive, or cough suppressant, that affects the central nervous system. DXM works by acting on certain receptors in the brain, providing a sedative effect and relieving symptoms of a cough. Side effects are rare when taken at recommended doses. However, when taken at higher-than-recommended  doses, it can cause a mild euphoric feeling, such as a sense of relaxation, mood enhancement, and a heightened sense of wellbeing. It is important to note that prescription doses of DXM can be dangerous if taken in large amounts, as it can produce more intense psychoactive effects, especially when taken in combination with other medications like certain antidepressants. It is for this reason that it is important to consult with a doctor before taking any medication containing DXM.

Common short-term effects of higher-than-recommended doses of DXM include:

• Confusion
• Inappropriate laughter 
• Agitation
• Paranoia
• Euphoria
• Hallucinations 
• Over-excitability 
• Lethargy
• Loss of coordination 
• Slurred speech
• Sweating
• Hypertension
• Nausea 
• Vomiting
• Involuntary eye movement 

At higher doses, users may experience more intense effects such as disorientation, auditory and visual hallucinations, and out of body experiences.

The consequences of long-term DXM abuse are unknown, however physical dependence is possible¹. In addition, cognitive decline has been reported.

DXM abuse can also lead to the abuse of other drugs and alcohol because it can cause a person to become tolerant to the effects of the drug, leading them to seek out stronger drugs in order to achieve the same effects. It can also lead to a psychological dependence, as people may become addicted to the euphoria and other effects associated with the drug. Additionally, DXM abuse can lead to an increased risk of engaging in potentially dangerous activities and behaviors, such as driving under the influence of drugs or alcohol, or participating in risky sexual behaviors. Furthermore, DXM abuse can lead to an increased risk of developing a polysubstance use disorder, where the person combines substances to enhance the effects of the drugs.

Robotripping Plateaus

Robotripping is typically divided into four distinct plateaus

• Plateau 1: This plateau is the lowest level of intoxication, resulting in mild stimulation and mild visual and auditory hallucinations. This plateau usually lasts around 2–3 hours with a dose of between 50–100 mg of DXM. 
• Plateau 2: At this plateau, the user may experience mild to moderate dissociation, mild visual and auditory hallucinations, and mild euphoria. This plateau usually lasts around 4–6 hours with a dose of between 150–300 mg of DXM. 
• Plateau 3: This plateau is characterized by a more intense dissociative effect, moderate visual and auditory hallucinations, and moderate euphoria. This plateau usually lasts around 6–8 hours with a dose of between 300–500 mg of DXM.
• Plateau 4: At this plateau, the user experiences a strong dissociative effect, strong visual and auditory hallucinations, and strong euphoria. This plateau usually lasts between 8–12 hours with a dose of between 500–750 mg of DXM.

DXM Abuse and Dangerous Behavior

• Overdosing on cough medicine
• Driving under the influence of DXM
• Taking higher doses than recommended
• Combining DXM with other drugs or alcohol
• Engaging in dangerous activities while under the influence
• Taking DXM in a non-medical context
• Developing a tolerance to the drug
• Experiencing hallucinations or delusions
• Engaging in risky sexual behavior while under the influence
• Suffering long-term health problems due to DXM abuse

DXM Overdose

It is difficult to say exactly how much DXM it takes to overdose as it can vary greatly from person to person. Certain factors such as weight, height, and medical conditions can all play a role in how much it takes to overdose. It is important to be aware of the risks associated with DXM use and to always take medications as prescribed.

Symptoms of DXM overdose can include:

• Confusion
• Blurred vision
• Slurred speech
• Increased heart rate
• Difficulty breathing
• Nausea 
• Vomiting
• Convulsions
• Death

Additionally, DXM can cause serious cognitive effects such as memory loss, psychosis, and paranoia. It is important to remember that DXM is a powerful drug, and it can be very dangerous when taken in large doses. 

Is DXM Addictive?

Experts disagree on whether DXM is addictive. Although it is possible to become physically dependent on the drug with long-term high doses, addiction appears to be very rare. Physical dependence means that your brain and body have become used to the presence of the drug and begin to rely on its presence to feel normal. In contrast, symptoms of addiction include:

• Craving for DXM
• Unable to control DXM use
• Tolerance to DXM
• Withdrawal symptoms when not using DXM
• Social, occupational or financial problems due to DXM use
• Continued use of DXM despite negative consequences

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If you or a loved one is struggling with drug or alcohol abuse, it’s time to reach out and get help. At The Recovery Village Columbus, our team of dedicated professionals are committed to helping you or your loved one take the first steps towards recovery. Don’t wait any longer. Take the first step towards a healthier, happier life by speaking with our Recovery Advocates.