Dextromethorphan (DXM), the active ingredient in cough suppressants, has long been abused by teens looking for a cheap, accessible, high. But the danger comes when users take multiple times the recommended dose.

It’s a story that sent the local news swarming: Five Students in Marin County Hospitalized After Cough Syrup Overdose. The teaser is easy to imagine: “The dangerous new drug that’s sending teens to the hospital—it’s legal, lethal, and could be in your medicine cabinet.” Yet, aside from the classification of a “new” drug, that description isn’t overly dramatized. Dextromethorphan (DXM), the active ingredient in cough suppressants like Coricidin and Robitussin has long been abused by young adults looking for a cheap, accessible high. To achieve the desired high, however, users must take multiple times the recommended dose for treating colds, in some cases an entire pack of gelcaps or entire bottle (or two) of syrup. This leaves people who abuse the medication, frequently teenagers and young adults, walking a fine, potentially fatal line.

Just ask Mark Dale of San Rafael, California. On April 30, 2010, Mark noticed that Nic, his teenage son, seemed disoriented, was slurring his words and struggling with communication and mobility. Nic had consumed two bottles of Robitussin. He was rushed to the emergency room where his heart rate was 250. “They told me that he was either going to stroke out or have a heart attack,” Dale said. “They weren’t sure they were going to be able to save him. It took 14 hours to bring him down.” That was the first of Nic’s two nearly fatal DXM overdoses.

The Substance Abuse and Mental Health Services Administration (SAMHSA) asserts thatone million youth and young adults ages 12 to 25 in the United States misuse over-the-counter (OTC) cough and cold medicines that contain dextromethorphan each year. Non-medical (or recreational) use of DXM results in approximately 6,000 emergency department (ED) visits annually in the U.S., with adolescents (ages 12 to 20) accounting for almost 50% of those ED visits.

Although not as well-known as other drugs of abuse, abusing OTC cough medications like Robitussin and Coricidin isn’t new. And while it likely isn’t the primary substance of abuse for most high-school students, it is a phenomenon that seems to be increasing throughout the country, with potentially lethal consequences for those who partake. Annie Arens, a Medical Toxicology fellow at UCSF notes that in the last few years, calls to the California Poison Control Center about teens abusing Coricidin have jumped from 3% to 25% of all calls to the Center.

Unlike “sizzurp” AKA “purple drank” (the cough syrup combination of codeine and promethazine), medicine containing DXM is frequently sold over-the-counter (though in some states, including California, you need to be 18 years old to purchase it). These medications are frequently stolen from pharmacies, leading some to keep them in a locked cabinet, but these policies vary. Further, the fact that the medications are available without a prescription increases their general accessibility to those looking for a “household high” (common household items that can be abused to get high). Unaware of their potential to be abused, parents and acquaintances often leave these substances around the house, more casually than they would prescription medicines more often associated with abuse.

The effect experienced from the abuse of DXM (found in NyQuil and Robitussin, in addition to Coricidin) is categorized/assessed in four stages, outlined as follows:

1. Mild stimulation

2. Euphoria and hallucinations

3. Dissociative out of body state

4. Complete dissociation with unresponsiveness Read more “the fix”…