Ten years ago, the Daily Herald reported a national story reporting a significant outbreak of teens abusing cough syrup containing dextromethorphan (DXM). More than 120 easily obtainable over-the-counter medicines include dextromethorphan, a cough suppressant that when taken in heavy doses can produce hallucinations and a loss of motor control, much as PCP does.
Unfortunately, again Chicago-area emergency rooms are seeing markedly increased numbers of these abuse cases. DXM overdoses typically occur in clusters, as word of the drug spreads in a community's middle schools and high schools. The clusters occur every five years or so, although DXM abuse occurs daily in this country.
The synthetic drug that chemically is similar to morphine was approved by the Food and Drug Administration as a cough suppressant in 1954. Drug manufacturers began putting it in cough syrups in the 1970s as a replacement for codeine. DXM is sold legally without a prescription because it does not make users high when taken in small doses. The recommended dose, about one-sixth to one-third of an ounce of an extra-strength cough syrup, contains 15 to 30 mg of DXM. The drug in larger doses can produce hallucinations, depressed breathing, elevated blood pressure and an irregular heartbeat.
Teens may see cough medicine abuse as safe since the product is cheap and available in any pharmacy. However, these overdoses can cause seizures, coma and even death. Emergency room clinicians should be vigilant in suspecting DXM recreational abuse, and parents should be aware of the availability and ease of abuse of these over the counter medications.
Dr. Charles Nozicka
Medical director, pediatric emergency medicine
Advocate Condell Medical Center