How Dextromethorphan (DXM) Abuse Happens with OTC Cough Syrups

It’s easy to overlook a bottle of cough syrup sitting on the bathroom shelf. It’s not a pill, not a prescription, and it’s sold right next to toothpaste and hand sanitizer. But when taken in large amounts, dextromethorphan - or DXM - can turn a simple cold remedy into a dangerous hallucinogen. This isn’t science fiction. It’s happening in bedrooms, basements, and high school bathrooms across the country, often with teens who think they’re just drinking something harmless.

What Is DXM, Really?

Dextromethorphan is a synthetic drug approved by the FDA in 1958 to stop coughs. Unlike codeine, it doesn’t relieve pain or cause physical dependence when taken as directed. A standard dose? 15 to 30 milligrams every four to eight hours. That’s it. But the label doesn’t tell you what happens when you take 10 times that amount - or 50 times.

When abused, DXM acts on the brain’s NMDA receptors, the same ones targeted by drugs like PCP and ketamine. This triggers dissociation - a feeling of being detached from your body, your thoughts, even reality. People call it “robo tripping,” “dexing,” or “candy.” Some call it “drank,” especially when mixed with soda and hard candy to mask the bitter taste. It’s cheap. It’s legal. And for many, it’s the first time they’ve ever gotten high.

How Do People Abuse It?

It starts with a bottle. Robitussin DM, Benylin DM, Coricidin, NyQuil, DayQuil - if it says “DM” on the label, it contains DXM. Some products have as much as 30 mg per 10 mL. To get high, abusers drink entire bottles - sometimes multiple - in one sitting. That’s 240 mg to over 1,500 mg of DXM. The recommended daily maximum? 120 mg.

Some users don’t just drink it. They’ve figured out ways to bypass the nausea and vomiting that come with swallowing so much syrup. One method, called “robo shake,” involves drinking a large amount of cough syrup and then vomiting on purpose. The idea? Let the DXM absorb through the stomach lining while getting rid of the other ingredients that make you sick. It doesn’t always work. People still end up in emergency rooms with seizures or dangerously high blood pressure.

Others go further. They extract pure DXM powder from the syrup using simple household chemicals - vinegar, water, filters. Online forums and videos show how. Once it’s isolated, users swallow capsules, snort the powder, or even inject it. Pure DXM is far more dangerous. One gram can be lethal. There’s no margin for error.

The Four Plateaus of a DXM High

DXM doesn’t just make you feel “off.” It takes you through distinct stages - called plateaus - each more intense than the last. These aren’t myths. They’re documented by users and medical professionals alike.

• First plateau (100-200 mg): Mild euphoria, slight dizziness, tingling. Like a buzz from alcohol, but clearer.
• Second plateau (200-400 mg): Distorted vision, altered sense of time, mild hallucinations. Colors seem brighter. Sounds echo.
• Third plateau (400-600 mg): Strong dissociation. Users report feeling like they’re floating outside their body. Confusion, slurred speech, loss of coordination. This is where people fall, hit their heads, or wander into traffic.
• Fourth plateau (600+ mg): Complete detachment from reality. Vivid hallucinations, delusions, paranoia. Some describe it as near-death. Others never come back.

Most people don’t plan to reach the fourth plateau. But when you’re mixing syrups, chasing a high, and not knowing how much DXM is in each bottle, it’s easy to cross the line.

What Happens When You Mix It?

DXM is rarely taken alone. Teens mix it with soda, alcohol, energy drinks, or even antidepressants. That’s when things turn deadly.

Combining DXM with alcohol? A recipe for respiratory failure. Both depress the central nervous system. Together, they can stop your breathing. The Mount Sinai Health Library says this combo has caused multiple deaths.

Mixing it with MDMA (ecstasy) or SSRIs like Prozac? That’s a fast track to serotonin syndrome - a life-threatening spike in body temperature, heart rate, and blood pressure. Seizures. Brain damage. Death. The NIH reports cases where teens collapsed after mixing DXM with over-the-counter cold pills that already contained antihistamines or decongestants.

And it’s not just the drugs. Many cough syrups contain acetaminophen (Tylenol). Take too much of that with DXM? Liver failure. No warning. No second chance.

Why Teens Are Turning to DXM

It’s not about rebellion. It’s about access.

Unlike marijuana, alcohol, or even vaping devices, DXM is legal, cheap, and easy to buy. A bottle of Robitussin costs less than $5. No ID needed. No questions asked. For kids who can’t afford street drugs or don’t know how to get them, DXM is the only option.

It’s also invisible. Parents don’t check the medicine cabinet for cough syrup abuse. Schools don’t test for it. And because it’s not a controlled substance, there’s no stigma - until someone ends up in the hospital.

The National Institute on Drug Abuse found that nearly 5% of high school seniors admitted to abusing OTC cough medicine in 2015. That number hasn’t dropped. In fact, with the rise of online extraction tutorials, it’s likely growing.

The Hidden Risks Nobody Talks About

Most people think DXM abuse is a one-time thing. That you take a few bottles, have a wild night, and move on. But that’s not always true.

Some users develop tolerance. They need more and more to get the same effect. Others report cravings, anxiety, and depression when they stop. Treatment centers like Greenhouse Treatment say they’re seeing more cases of DXM dependence - not because it’s physically addictive like opioids, but because the psychological pull is strong. The dissociation feels like an escape. And for kids dealing with trauma, anxiety, or loneliness, that escape is hard to give up.

Even after one use, some people report lasting mental effects: memory loss, difficulty concentrating, emotional numbness. The brain doesn’t bounce back easily after being flooded with dissociative chemicals.

And then there’s the legal gray area. While DXM isn’t federally controlled, some states have passed laws restricting sales to minors. Others require pharmacies to keep DXM products behind the counter. But enforcement is patchy. A 15-year-old can still walk into a corner store and buy three bottles without blinking.

What Can Be Done?

Parents, teachers, and even pharmacists need to pay attention. Look for empty bottles. Notice changes in behavior - poor grades, withdrawal, strange speech patterns. Ask questions. Don’t assume it’s just “kids being kids.”

Some pharmacies now limit how many bottles you can buy at once. Some schools run prevention programs. But the real solution? Education. Not scare tactics. Real talk about what DXM does to your brain, your body, your future.

And if someone you know has taken too much? Don’t wait. Call 911. Don’t try to “sleep it off.” DXM overdoses can kill silently. Survival depends on how fast help arrives.

DXM isn’t evil. Used correctly, it helps millions of people sleep through a bad cough. But when you take it for the wrong reason - when you chase a high instead of relief - it becomes something else entirely. Something dangerous. Something deadly.