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The Dangers of Abusing Cough Medicine

A substance doesn’t have to be illegal to be a harmful, mind-altering drug. Cough medicine sits on the shelves of every pharmacy, but certain varieties are prone to abuse for their depressive effects. The same compounds that stop the body from coughing can slow the nervous system and alter a person’s mental state. In high doses, cough medicine can cause brain damage, coma and death. Some prescription cough medicine contains codeine, an opiate. Even though cough medicine is readily available, abusing it is just as dangerous as abusing any illegal drug.

Cough Medicine Abuse

What Is Cough Medicine?

The active ingredient in over-the-counter cough medicine is dextromethorphan. DXM is an antitussive, meaning it reduces coughing by blocking signals in the brain. It doesn’t actually treat colds or coughs. Many cough medicines blend dextromethorphan with cold, allergy and flu medicines such as antihistamines, NSAID pain relievers, expectorants, and other cough suppressants.

What OTC Cough Medicines Contain Dextromethorphan?

Four brand names use DXM as the main active ingredient. These cough medicines are particularly prone to abuse as drugs:

  • Robitussin 
  • Vick’s DayQuil
  • Delsym
  • Triaminic

Other brands include a smaller amount of DXM combined with other cold and flu medicines. They can also be used as a drug, especially if they are readily available in a medicine cabinet. These include:

  • Tylenol Cold and Flu
  • Sudafed PE Cold/Cough
  • Mucinex
  • Dimetapp
  • Coricidin
  • Theraflu 
  • Vick’s Children’s NyQuil Cold and Cough
  • PediaCare Children’s Cough

Brand names vary by region. Overall, more than 120 products in America contain DXM.

Are There Different Forms of Cough Medicine?

Many cough medicines come in the form of cough syrup, a thick liquid. Other forms include pills, liquid capsules, chewable pills, dissolving strips and lozenges.

What Is Cough Medicine With Codeine?

Prescription-strength cough medicine contains codeine as well as DXM. Codeine is an opiate that the body converts into morphine. For most people, codeine is a weaker opiate than heroin or oxycodone. However, some people’s bodies convert codeine to morphine quickly, producing an unusually strong effect.

Codeine helps suppress cough and relieve pain in cases of severe respiratory illnesses. Combined with DXM, codeine is a powerful depressant. Codeine cough syrup used to be sold in stores, but now it is only available with a prescription. The FDA is currently investigating the safety of prescription codeine cough medicine and has banned it for patients under 12.

Brand names for prescription codeine cough syrup include Tussionex and Tuzitra XR. The medication is commonly called promethazine and codeine or promethazine/codeine.

What Are the Different Street Names for Cough Medicine?

Slang names for OTC cough medicine as a drug include drank, candy, DM, CCC, velvet, tussin, drex, robo, and skittles. Ingesting cough syrup as a drug is sometimes referred to as ‘robotripping,’ or tripping on Robitussin. Certain slang names for abusing cough medicine more often refer to codeine cough syrup: lean, purple drank, and sizzurp.

How Can Cough Medicine Function as a Drug?

Cough medicine is more similar to addictive drugs than many people assume. DXM in cough medicine doesn’t soothe the throat like cough drops. Instead, it lessens coughing by altering nerve signals inside the brain.

The brain functions by releasing set amounts of chemical transmitters at certain times. These transmitters bond with receptors in the brain, setting off bursts of electricity that register to you as physical sensations and emotions. All drugs hijack this system by providing extra transmitters and overwhelming receptors. This causes short-term euphoria and long-term damage to the brain.

Once in the bloodstream, dextromethorphan crosses the blood-brain barrier. It then bonds to sigma opioid receptors. In proper doses, DXM only bonds to receptors that control coughing. This satisfies the receptors and stops the urge to cough.

In larger doses, DXM doesn’t bond only to the receptors that control cough. It floods the brain, interfering with other pathways such as sensory input and mood. This can cause hallucinations and altered perception, or ‘tripping.’ In high enough doses, DXM can bond with pathways that control essential functions that keep a person alive, such as breathing, heartbeat and temperature regulation.

How Do People Misuse Cough Medicine?

People misuse and abuse cough medicine by taking it in high doses or mixing it with alcohol. For treating coughs, DXM is only meant to be taken in three to four small 15-30 milligram doses spread out over 24 hours. One dose is only 5 milliliters, or one teaspoon of syrup. People who abuse cough medicine often take 10-40 times this dose at once.

The amount of cough syrup ingested determines both the intensity and nature of the cough medicine’s “high.” Remember that in the proper dosage, dextromethorphan has no psychoactive effects.

The major danger of abusing cough syrup is that drinking it or pouring it into an alcoholic drink makes it difficult to measure accurately. Cough syrup, and especially cough syrup and alcohol, is a much riskier drug than alcohol alone.

Alcohol poisoning occurs when the blood alcohol content reaches 0.30-0.40, which means a person has to drink at least four to five drinks in quick succession to poison themself. Contrast that with cough medicine, where just one teaspoon contains 25 milligrams of DXM. The difference between survival and coma or death can often come down to one or two swigs of cough medicine.

What Does a Cough Medicine High Feel Like?

Highs from dextromethorphan begin as a ‘buzz’ of euphoria. Then, the high becomes hallucinogenic, meaning that a person sees and hears things that are not there. The effects of DXM are comparable to PCP and ketamine, which are also hallucinogenic drugs.

The more DXM a person ingests, the more parts of the brain the drug interferes with. This leads to more intense effects at higher doses. The DEA studied these doses and broke down cough medicine highs into four phases, or ‘plateaus.’

First Plateau 

A moderately high abusive dose of DXM is between 100 and 200 milligrams. In this amount, the drug stimulates the nervous system and may bring on a small euphoric high. Most users quickly exceed this threshold.

Second Plateau 

Doses between 200 and 400 milligrams flood the brain with enough DXM to induce hallucinations. The euphoria and stimulant effects of the first plateau intensify.

Third Plateau 

Taking between 300 and 600 milligrams of DXM triggers the third plateau. DXM in the brain makes a person clumsy and uncoordinated, as if drunk. They also hallucinate visual distortions, meaning they’re unable to judge distances, heights, or spatial relationships. Euphoria persists, and a person may exhibit risk-taking behavior. The third phase brings a risk of serious bodily injury.

Fourth Plateau

This level can be triggered by any one 600-milligram dose or gradual doses totaling over 600 milligrams. Extreme sedation is the first warning sign of the fourth plateau. Taking this much DXM damages critical brain pathways, such as heart and lung function, and can cause the user to fall unconscious or into a coma. If the person stays conscious, the hallucinations intensify to the point where they may dissociate from reality.

Codeine cough syrup causes these effects as well because it contains DXM. However, codeine encourages people to ingest more cough medicine, especially if they have an opiate addiction. Codeine has its own harmful side effects that compound the dangers of excessive DXM consumption.

How Long Does a Cough Medicine High Last?

The effects of DXM can last 1-2 hours or up to 6, depending on how much cough medicine the person ingested.

Can You Stop a Cough Medicine High?

There’s no way to return from a plateau once a person crosses it. The only remedy is to remain still and wait. Dancing, running or engaging in physical activity can overheat the body and lead to serious health problems.

How Does Abusing Cough Medicine Damage the Body?

DXM abuse wreaks havoc on key pathways in the brain. An initial dose brings on a pleasant but mild sensation that often encourages a user to increase their dosage.

At moderately high doses, DXM activates serotonin receptors that make a person more likely to take risks. It blocks NDMA receptors responsible for memory and spatial awareness. At the same time, the drug disrupts other pathways in the brain responsible for motor skills and coordination. Driving, walking around outside or performing any physical activity during a cough medicine high may lead to serious injury.

At very high doses, DXM blocks transmitters that regulate body temperature, breathing and heartbeat. Hyperthermia, overheating leading to organ damage or death, can occur if a person is in a hot environment such as a club or crowd.

Can You Overdose on OTC Cough Medicine?

Yes, you can overdose on over-the-counter cough medicine.

What Are the Signs of a Cough Medicine Overdose?

600 milligrams of DXM is enough to trigger a fatal overdose in some people. That amount can be as little as half a cup of cough medicine. Signs of a cough medicine overdose include:

  • Rapid heartbeat 
  • Loss of consciousness
  • Fever
  • Trouble breathing
  • Psychosis 

The risk of overdose increases if the person took additional drugs, such as opiates or alcohol. Alcohol poisoning accelerates organ failure. Depressants such as Xanax also increase the risk of overdose.

Who Is Most Likely To Misuse Cough Medicine?

Cough medicine is readily available, so anyone can potentially abuse it. It’s not often a first choice of drug. Other inexpensive drugs such as alcohol, ketamine and methamphetamine are more addictive and produce more consistent effects.

The demographic most likely to misuse cough medicine is young people (ages 12-26). Half of all clinical cases of cough medicine poisoning occur in people ages 12-20.

Teens

A 2020 survey from the University of Michigan found that 3.7% of American teenagers had misused cough medicine to get high. That represented a slight increase from 2.9% in 2019. Troublingly, younger teens were misusing cough medicine as well. 4.6% of eighth graders reported trying to get high off of cough medicine.

It’s difficult for many teenagers to obtain common party drugs since they require connections to adult dealers. Cough medicine is easier to find. Those under 18 aren’t allowed to buy cough medicine in many areas, but it’s still common in the average household. In many cases, cough medicine is the first hallucinogenic substance teenagers have access to.

Teens can easily find information on how to abuse cough medicine, as well. Many articles online explain how to ‘trip’ on cough medicine, and the slang terms for cough medicine misuse appear in popular songs and media. Lines about ‘sizzurp’ or ‘purple drank’ were more popular in mid-2000s music than they are today, but songs such as Melanie Martinez’s cover of “Cough Syrup” still reference the drug by name.

College Students

Young adults may seek out codeine cough medicine as an alternative to buying illegal opiates from dealers. They also may get high on over-the-counter cough medicine or mix cough medicine into alcohol if they lack the social connections to purchase common street drugs.

People Addicted to Other Drugs

People with opiate addictions seek out codeine cough syrup to achieve an opiate high. Over-the-counter cough medicine can also be an alternative for people with addictions who aren’t able to access their preferred drug.

Is Cough Medicine Addictive?

Cough medicine isn’t physically addictive like meth, cocaine, alcohol or heroin. Like any mind-altering substance, though, it’s possible to develop an emotional dependence on cough medicine and abuse it repeatedly. Frequent users experience withdrawal symptoms when they stop using the drug.

How Does Cough Medicine Interact With Other Drugs?

Cough medicine has harmful interactions with many other substances.

Cough Medicine and Alcohol

Alcohol increases cough medicine’s harmful short-term effects of impulsiveness, dizziness, and poor motor control. It also damages the memory centers of the brain alongside DXM. Blackouts are a common result of combining cough medicine and alcohol.

Cough Medicine and Antidepressants

Taking cough medicine with antidepressants such as Prozac or Zoloft can cause serotonin syndrome — a poisonous level of serotonin in the brain. This serious condition causes agitation, shivering, overstimulation, fever and seizures. It can be fatal if untreated.

Cough Medicine and Xanax

Xanax depresses the nervous system in similar ways to DXM, halting vital functions such as heartbeat and breathing. Taking Xanax and cough medicine together can lead to coma or death.

What Are the Long-Term Health Risks of Cough Medicine Abuse?

Taking cough medicine to get high is dangerous in the short term, but there are long-term health repercussions as well. Frequent use causes liver damage, especially in cough medicines that contain acetaminophen (Tylenol). Mixing cough medicine with alcohol damages the liver further.

Cough medicine abuse can also cause high blood pressure and increase a person’s risk of heart attacks. Some people report psychosis and hallucinations persisting after the cough medicine high wears off.

Does Cough Medicine Abuse Show Up on a Drug Test?

According to a triple-blind study, a single recommended dose or even a double dose of over-the-counter cough medicine won’t produce a positive result on a drug test. Excessive doses past that point may test positive for PCP, as DXM is a chemically similar substance. Cough syrup with codeine will cause a positive result for opiates on a drug test.

High levels of DXM remain detectable in a urine test for 2-5 days after the last dose. Codeine shows up on a urine drug test for 48 hours after the last dose.

What Are the Signs That Someone Is Abusing Cough Medicine?

Short-term signs that someone has abused cough medicine include:

  • Smell of cough syrup on the breath
  • Dizziness
  • Poor coordination
  • Irritability or agitation
  • Slurring speech
  • Seeming ‘drunk’ without alcohol
  • Hallucinations

Signs of long-term cough medicine abuse are similar to the general signs of long-term drug use. They include:

  • Acting withdrawn
  • Poor grades in school or poor work performance
  • Loss of interest in hobbies and activities
  • Irritability and poor mood
  • Impulsive or self-destructive behavior
  • Using or buying cough medicine while not appearing to be sick

If you suspect a loved one is using cough medicine to get high, get them the help they need to overcome substance abuse.

How Can Someone Get Clean From Cough Medicine and Other Drugs?

Cough medicine, both over-the-counter and prescription, is a dangerous drug. It’s vital to get clean to minimize the risk of injury, long-term liver damage, and death. Even though cough medicine is a legal substance, excessive doses mimic the effects of illegal drugs.

Professional help is a proven way to get and stay clean from cough medicine and other harmful drugs. At Clean Recovery Centers, our three-phase approach begins with an inpatient detox. OTC cough medicines can cause painful withdrawal symptoms similar to other drugs. In phase two, long-term substance abuse treatment begins, including residential stays and mental health programs. Proven therapy techniques in phase three address the root causes of the addiction to help prevent relapse.

Addiction is too large and destructive a problem to face alone. Cough medicine abuse in teens can lead to many physical and mental health problems down the line. In adults, cough medicine abuse usually accompanies other problems with drugs and alcohol. Contact us at Clean Recovery center for help battling addiction to cough medicine and other harmful substances.

Sources:

  • https://www.seattletimes.com/life/wellness/cough-medicine-creates-dangerous-interaction/
  • https://medlineplus.gov/druginfo/meds/a682492.html
  • https://pubmed.ncbi.nlm.nih.gov/7584765/
  • https://nida.nih.gov/research-topics/trends-statistics/monitoring-future
  • https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-evaluating-potential-risks-using-codeine-cough-and-cold-medicines
  • https://professionals.optumrx.com/content/dam/optum3/professional-optumrx/news/rxnews/drug-safety/drugsafety_prescriptioncoughandcoldmed_2018-0112.pdf
  • https://www.healthline.com/health/robotripping#plateaus
  • https://seabrook.org/blog/addicted-to-cough-syrup/
  • https://www.dea.gov/sites/default/files/2020-06/DXM-2020.pdf
  • https://www.therecoveryvillage.com/codeine-addiction/xanax-and-codeine/
  • https://pubmed.ncbi.nlm.nih.gov/17523589/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550161/
  • https://kidshealth.org/en/parents/cough-cold-medicine-abuse.html
  • https://medicine.yale.edu/news/yale-medicine-magazine/article/from-cough-medicine-to-deadly-addiction-a-century/

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