Dextromethorphan Addiction Statistics, Abuse, Symptoms & Side Effects

What is Dextromethorphan?

Dextromethorphan, also known as DXM, is found in many over-the-counter (OTC) cough medicines. Therefore, it is readily available for consumption. DXM is an anesthetic with dissociative properties. Dissociatives are a type of hallucinogenic that alters a person’s perception of sight and sound and, it creates feelings of detachment from their surroundings. It produces an effect similar to PCP and ketamine. There are also similarities to the properties of codeine. Dextromethorphan’s recreational popularity is highly prevalent with young teens and young adults. Getting a bottle of DXM is as simple as going to the grocery store and buying some type of cough suppressant.

When dextromethorphan is abused, it produces a euphoric high and hallucinations. In larger doses, the reactions are more similar to ketamine and PCP. DXM is manufactured as a white powder, but consumption is by swallowing gel capsules, tablets, or cough syrup. It is often mixed with alcohol and marijuana creating an even stronger and more dangerous effect. Dextromethorphan causes hallucinations, out of body experiences, and dreamlike visions. At high doses, the person is said to experience different worlds and contact with “superior” beings.

Dextromethorphan has five plateaus that correlate to the amount of DXM that is consumed and the anticipated reactions. Here are the five plateaus:

  • Plateau 1: Intake Amount – 1.5 to 2.5 mg/kg – Outcomes incorporate loss of balance, euphoria, slight intoxication, restlessness, intensification of emotions, increased body temperature, increased heartbeat, and alertness.
  • Plateau 2: Intake Amount – 2.5 to 7.5 mg/kg – Effects are analogous to Plateau 1 but include a detachment from external world, heavier intoxication, closed-eye hallucinations, choppy sensory input, and dreamlike state of consciousness.
  • Plateau 3: Intake Amount –  7.5 to 15.0 mg/kg – Outcomes now consist of flanging of visual effects, dreamlike vision, near complete loss of motor coordination, difficulty recognizing people or objects, abstract hallucinations, delayed reaction time, decision making impairment, inability to comprehend language, feelings of rebirth, short-term memory impairment, chaotic blindness, and/or feelings of peace and quiet.
  • Plateau 4: Intake Amount –  15.0 mg/kg or more – Occurrence may include increase of third plateau effects, perceptions of contact with “superior” beings, out-of-body experiences, rapid heart rate, loss of contact and control with their own body, changes in visual perception, complete blindness, lack of movement or desire to move, increased hearing, and other miscellaneous delusions.
  • Plateau Sigma: Intake Amount – 2.5-7.5 mg/kg every three hours for 9–12 hours; occurs by prolonging dosage. The existence of psychosis with auditory and visual hallucinations is what exemplifies plateau sigma. Users report this level of experience to be unpleasant. Often, body tendencies present themselves as auditory hallucinations; a person using the drug might hear a voice saying, “take a seat now, you’re worn out,” and feel prompted to obey rather than just feeling tired and sitting down.

Like other hallucinogens and dissociatives, DXM is not considered to be physically addictive, but it will cause a psychological addition. The effects of the drug last do not last as long as PCP or LSD, but for three or four hour period. The drug effect can be extended with continual intermittent doses. There are multiple street names for dextromethorphan. Some of them include: Dex, DXM, Skittles, Skittling, Triple-C, Tussin, Robo, and Robo-tripping.

DXM Addiction Statistics

It is incredibly dangerous to abuse dextromethorphan. Many people end up in the emergency room as a result. Yet it is so easy for someone to obtain a bottle of cough medicine. In recent years DXM has become available, primarily over the Internet, in bulk powdered form, and concern has grown over the non-medical use of DXM by teenagers. In May 2005, the FDA issued a warning about the dangers of DXM abuse involving over-the-counter products and DXM obtained from illicit sources [1]. Other statistics show:

  • In 2006, about 3.1 million persons aged 12 to 25 (5.3 percent) had ever used an over-the-counter (OTC) cough and cold medication to get high (i.e., “misused” the drug), and nearly 1 million (1.7 percent) had done so in the past year [4].
  • According to the Drug Abuse Warning Network (DAWN) for 2004, an estimated 16,858 emergency department (ED) visits involved pharmaceuticals containing dextromethorphan (DXM). This was just under 1 percent of all drug-related ED visits [2].
  • Among youths aged 12 to 17, females were more likely than males to have misused OTC cough and cold medications in the past year, but among young adults aged 18 to 25, males were more likely than females to have misused these medications [4].
  • The rate of emergency room visits resulting from non-medical use of DXM for those aged 12 to 20 was 8.0 visits per 100,000 population, compared with 2.5 visits or fewer per 100,000 for other age groups [2].
  • When taken in large amounts, though, DXM can produce hallucinations and a “high” similar to psychotropic drugs, such as phencyclidine (PCP) [3].
  • Emergency room patients aged 12 to 20 accounted for about half (51%) of the emergency room visits resulting from non-medical use of DXM, compared with 33 percent of DXM-related emergency room visits overall [2].
  • Among persons aged 12 to 25 who had misused an OTC cough and cold medication in the past year, 30.5 percent misused a NyQuil® product, 18.1 percent misused a Coricidin® product, and 17.8 percent misused a Robitussin® product [4].
  • The rate of ED visits resulting from any type of use of DXM among those aged 12 to 20 was 14.7 per 100,000 population, compared with 5.7 visits per 100,000 for the population overall [2].
  • Alcohol was implicated in 41 percent of ED visits involving non-medical use of DXM for those aged 18 to 20 and in 13 percent of visits for those aged 12 to 17 [2].

Causes of Dextromethorphan Addiction

Someone abusing dextromethorphan should not create a physical dependency on the drug. The especially realistic potential is with creating a psychological addiction. It can be easier to develop a psychological dependency since access to DXM is as near as the convenience store, and all one has to do is drink a lot of cough suppressant. The sense of euphoria and hallucinations are enticing to anyone suffering from severe depression or anxiety or a recent traumatic life event. Also, the desire to revisit dream like visions and out of body experiences can lead to abusing it again and again. The DXM trip in general lasts three to four hours, but it can be made to last longer with repeated doses. Dextromethorphan tolerance is quickly developed, and for day to day users, withdrawal symptoms such as anxiety, amnesia, and psychosis can develop.

Signs of Dextromethorphan Use, Addiction and Dependence

When abusing dextromethorphan, it is likely a physical dependence will not be developed, but a psychological dependence is a real possibility. The euphoric high and psychedelic experiences can make it extremely easy to become psychologically reliant. Some of the signs people exhibit when using DXM are:

  • Speech difficulty
  • Psychosis
  • Pupil dilation
  • Zombie-like walking
  • Diarrhea
  • Body itching
  • Upset stomach, vomiting
  • Dizziness
  • Rash, red blotchy skin
  • Fever
  • Tachycardia (racing, pounding heart)

Dextromethorphan Effects

Several side effects exist as a result of abusing dextromethorphan. Not only is the mind affected, but the physical body is affected as well. A DXM trip (a drug induced experience) will normally last three or four hours, but it can last longer. It is based on the amount that has been used.

Listed are some of the psychological effects from DMX use:

  • Psychosis
  • Amnesia
  • Dissociation from body
  • Anxiety
  • Euphoria
  • Depression
  • Confusion
  • Auditory hallucinations
  • Visual hallucinations
  • Feelings of merging with adjacent objects like a couch or bed

Here are some of the physical effects:

  • Decreased sexual functioning (difficulty achieving orgasm)
  • Zombie-like walking
  • Immobilization
  • Sensory distortions
  • Speech impairment
  • Analgesia (inability to feel pain)
  • Memory loss
  • Blurred vision
  • Nausea
  • High blood pressure
  • Dizziness
  • Rash, red blotchy skin
  • Fever
  • Tachycardia (racing, pounding heart)

The unwanted side effects of abusing dextromethorphan can eventually last for the rest of the user’s life. The brain damage and memory loss can become permanent. The abuse of DXM may be linked to Olney’s Lesions, which are lesions on the brain that affects emotional behavior, memory, and cognitive ability. Being addicted to dextromethorphan will also have a negative effect on friends and family, as well as career opportunities and financial stability.

Dextromethorphan Withdrawal

Even though abusing dextromethorphan does not develop into a physical addiction, it can still produce some physical withdrawal symptoms. If a user abruptly quits using DXM, they likely will experience insomnia, restlessness, depression and diarrhea. The primary attention will be on dealing with the psychological dependency and helping the person to not rely on DXM to function normally.

Dextromethorphan Addiction Treatment

As with other hallucinogens and dissociatives, there are not any pharmacological treatment aids that can help with a DXM dependency. However, in an overdose situation, Naloxone is considered to be an antidote. A psychological addiction to dextromethorphan is hard to quit. It takes a time and commitment to overcome an addiction. Trying to stop using DXM to feel normal will need the help of loved ones and professionals. The person abusing dextromethorphan needs to find a licensed treatment center, but the first and hardest step is asking for help.


[1]: Federal Drug Administration –

[2]: Drug Abuse Warning Network (DAWN)

National Survey on Drug Use and Health (NSDUH) –

[3]: National Institute on Drug Abuse (NIDA) –

[4]: National Survey on Drug Use and Health (NSDUH) –

[5]: The Vaults of Erowid –

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 1, 2014
Published on, Substance Abuse Help