Cough syrup provides temporary cough relief. When used as directed, these over-the-counter medications are generally safe. However, some individuals consume large, non-therapeutic doses for intoxicating effects. This misuse leads to psychoactive experiences unintended by the medication.
The Primary Psychoactive Ingredient
The main psychoactive component in many cough syrups is Dextromethorphan (DXM). DXM is a synthetic codeine analog that functions as a cough suppressant by inhibiting the cough reflex. It is available in various forms, including liquids, capsules, pills, and throat lozenges. DXM is a common ingredient in over 100 over-the-counter cough and cold medicines. While safe at recommended doses, its properties change considerably at much higher concentrations, leading to misuse.
How It Induces a High
In abusive doses, DXM acts on the brain through multiple mechanisms. It blocks N-methyl-D-aspartate (NMDA) receptors, producing dissociative effects similar to ketamine and phencyclidine (PCP). DXM also functions as a nonselective serotonin reuptake inhibitor, influencing mood and perception, and acts as an agonist at sigma-1 receptors. These combined actions lead to dose-dependent “plateau” effects, from mild stimulation and euphoria at lower doses to profound dissociative states, altered sensory perceptions, and hallucinations at higher levels.
Identifying Abusable Cough Syrups
Consumers should read product labels to identify cough syrups with psychoactive potential. The active ingredient list is crucial; products containing “Dextromethorphan” or “DXM” (including HBr or Polistirex forms) are associated with misuse. Many cough and cold medications combine DXM with other substances like acetaminophen, antihistamines, or decongestants. While these combinations address multiple symptoms, their abuse significantly increases health risks due to other ingredients. Misusers often seek single-ingredient DXM products.
Severe Health Repercussions
Abusing DXM-containing cough syrup carries significant immediate and long-term health risks. Physical effects include nausea, vomiting, stomach pain, increased heart rate, and elevated blood pressure. More severe consequences are seizures, respiratory depression, extreme hyperthermia (dangerously high fever), and coma. Hyperthermia is hazardous, especially in hot environments or during physical activity, and can lead to brain damage.
Psychological effects include paranoia, confusion, and panic attacks. Higher doses can induce psychosis, with delusions and hallucinations similar to PCP. Chronic misuse may lead to psychological dependence, cognitive decline, and increased psychosis risk. Danger escalates when DXM is combined with alcohol, other cold medications, or antidepressants, potentially causing life-threatening conditions like serotonin syndrome or severe organ damage, including liver damage if acetaminophen is present.
Legal Status and Control Measures
DXM is an over-the-counter (OTC) medication, readily available without a prescription. This accessibility contributes to its misuse, as it is often perceived as safer than illicit drugs. However, many U.S. jurisdictions have implemented control measures. These include age restrictions, prohibiting sales to individuals under 18. Some states may require identification, and some retailers ask for ID from anyone appearing under 25. Stores may also move DXM products behind the counter or impose quantity limits to prevent bulk buying for misuse.