Dextromethorphan (DXM) is a common ingredient in many over-the-counter cough and cold medications. While generally safe when used as directed, its potential for abuse and addiction is a concern. This article explores DXM’s potential for addiction, its effects, and the implications of misuse.
What is DXM and How is it Abused?
Dextromethorphan is a synthetic opioid derivative that functions as a cough suppressant by acting on the brain’s cough center. At therapeutic doses, it influences receptors in the brain to reduce the frequency and strength of coughing. DXM is found in various forms, including syrups, pills, and capsules, and is readily available in many cold and flu preparations.
When taken in much higher quantities than recommended, DXM produces psychoactive effects, leading to its abuse. This recreational use is sometimes called “robo-tripping” or “dexing.” At these elevated doses, DXM acts as a dissociative anesthetic, creating feelings of detachment, euphoria, and hallucinations, similar to substances like ketamine or PCP.
The Development of DXM Addiction
Addiction to DXM is possible with chronic, high-dose abuse. Continued misuse can lead to neurobiological changes in the brain’s reward pathways, affecting pleasure perception. This contributes to compulsive drug-seeking behavior.
Tolerance often develops, requiring larger amounts of DXM for the same effects. This escalating use can lead to physical dependence, where the body adapts to the drug, causing withdrawal symptoms if use stops. Psychological dependence can also form, marked by intense craving and preoccupation with obtaining and using the substance. While physical dependence is the body’s adaptation, addiction involves a broader, compulsive pattern of drug use despite negative consequences.
Recognizing DXM Abuse and Addiction
DXM abuse or addiction can be recognized by behavioral, physical, and psychological indicators. Behavioral changes might include secretive behavior, neglecting responsibilities, or a sudden disinterest in previously enjoyed activities. Preoccupation with obtaining and using DXM, including “doctor shopping” for cough medicine, may also be present.
Physical signs can manifest as dilated pupils, slurred speech, poor muscle control, and nausea. Other physical effects include sweating, increased blood pressure, or a racing heart. Psychological indicators often involve mood swings, confusion, paranoia, or heightened anxiety.
Health Risks and Withdrawal
Chronic DXM abuse carries several health risks. Products combining DXM with other ingredients, such as acetaminophen, can lead to severe liver damage at high doses. Recreational use can also cause cognitive impairment and changes in brain structure in adolescents who abuse DXM. Other potential consequences include seizures, respiratory depression, and mental health issues like psychosis, depression, or anxiety.
Stopping chronic DXM use can lead to withdrawal symptoms. These symptoms can include intense cravings, restlessness, insomnia, fatigue, and gastrointestinal distress such as nausea, vomiting, or diarrhea. Psychological symptoms like depression, anxiety, and mood swings are also common during withdrawal. Acute withdrawal symptoms typically appear within 24 to 48 hours and can last up to 14 days, though psychological effects may persist longer.
Pathways to Recovery
Recovery from DXM addiction is achievable with professional support. Medical detoxification may be a first step, especially for those with significant dependence, to manage withdrawal symptoms. Behavioral therapies, such as cognitive-behavioral therapy (CBT), help individuals understand their substance use and develop healthier coping mechanisms.
Individual and group counseling provide structured environments for addressing psychological aspects of addiction. Support groups, like Narcotics Anonymous, offer peer support and a network for long-term recovery. Both inpatient and outpatient programs are available, providing varying levels of care to suit individual needs.