WHAT IS OVER THE COUNTER MEDICATION?
Over the counter (OTC) medications are those medicines which a person can get without a prescription, with the perception that they are safe to use for common health issues like colds, pain, allergies, and digestive problems.
ARE OVER THE COUNTER MEDICATIONS REALLY SAFE?
OTC medicine is generally safe when taken in recommended doses or as directed, but it is not safe at all when taken in more than the recommended doses. This means if it is taken in high doses, in the wrong combination, or in the wrong manner, it becomes dangerous. Abuse of intoxicating substances especially legal OTC medicine is one of the greatest risk factors among adolescents and young adults due to its easy accessibility and lack of monitoring policies. This can result in overdose, organ damage, addiction problems, and even early death.
OTC DRUGS THAT CAN BE ABUSED
OTC medicines that can be abused include the following:
• Cold and cough syrups
• Diet aids
• Analgesics or pain relievers
• Motion sickness aids
• Laxatives
• Caffeine
REASONS FOR ABUSE OF OTC MEDICINE
OTC drugs are abused due to easy accessibility, perception of safety, self-medication, curiosity, peer pressure, and low price. They are commonly used in large amounts intentionally for non-medical purposes or simply to achieve a high.
WHY COUGH AND COLD SYRUPS ARE MISUSED
Among all these medications, cough, flu, and cold syrups are misused for recreational purposes, which means they are taken for pleasure. In simple words, they are taken voluntarily without any medical reason to get an altered mental state or to achieve euphoria or hallucinations. These syrups are abused especially by youth and can be a gateway to abusing harder drugs or substances like codeine and alcohol in the future.
WHAT IS DEXTROMETHORPHAN (DXM)?
DXM is found in many OTC cold and flu medicines and cough syrups. Dextromethorphan is the d-isomer of a codeine analog of levorphanol. It is of synthetic origin and belongs to the morphine family. It is used as an antitussive agent and controls cough by depressing the cough center in the medulla. However, its cough-suppression potency is approximately one half that of codeine. It is devoid of analgesic properties. It is prescribed for dry cough. Psychoactive properties (a substance that affects brain function and produces alterations in mood, feeling, thinking, behavior, and awareness) of DXM are very mild in recommended doses, but in high doses, it produces a state of intense excitement (euphoria) and hallucinations. The effects of DXM are dose dependent, as listed below.
DXM DOSE PLATEAU
The dissociative and hallucinogenic effects of DXM vary with different dose ranges, which are divided into four plateaus. Each plateau produces different effects and experiences for a 70 kg person. Let’s check out the effects and risks of each plateau:
• 1st PLATEAU (MILD): A dose ranging from 100 mg 200 mg produces mild stimulation and slight intoxication with the risk of dizziness and vomiting.
• 2nd PLATEAU (MODERATE): Similar to alcohol intoxication, a dose range of 200–400 mg produces euphoria, mild hallucinations, slurred speech, and temporary impairment of short-term memory. It is a dream-like condition with the risk of motor function impairment and blurred vision.
• 3rd PLATEAU (STRONG): In this plateau, a person experiences effects comparable to ketamine or phencyclidine (PCP). A dose of 400–600 mg produces strong dissociation, intense hallucinations, and loss of motor coordination, along with a high risk of nausea and panic attacks.
• 4th PLATEAU (TOXIC): Doses from 500 mg up to 1500 mg can cause violent behavior, increased body temperature, blood pressure, and heart rate, lack of coordination, shallow respiration, diarrhea, psychosis, seizures, coma, brain damage, organ failure, and even death.
TOXICITY OF DXM WHEN COMBINED WITH OTHER DRUGS
DXM is also available in combination with other drugs, which can increase the risk of adverse effects by enhancing DXM’s effects:
• DXM with acetaminophen may cause liver damage.
• DXM with chlorpheniramine may increase heart rate and cause lack of coordination, seizures, and coma.
• DXM with guaifenesin may result in vomiting.
HOW ABUSE OF DXM CAN BE IDENTIFIED
Abuse of DXM can be identified if a person uses it without any medical need, takes higher doses, or frequently purchases the same product while showing mood swings or confusion.
IS THERE ANY RECORD OF DXM INTOXICATION?
DXM is considered a “legal high” among youngsters because it is an OTC cough medicine. It is widely abused by teenagers and is one of the cheapest ways to get high. It is now a drug of abuse for non-medical purposes. People may become addicted to DXM both behaviorally and physically over time. It is difficult to calculate how many deaths are due to DXM intoxication and how many people abuse it because it is an OTC drug and easily available from local pharmacies.
HOW ABUSE OF DXM CAN BE PREVENTED
Abuse of DXM can be prevented through educational sessions in which the risk factors of DXM abuse should be discussed.
CONCLUSION
As a cough suppressant, DXM shows minimal side effects at low, recommended doses. However, at psychoactive higher doses, many negative effects are associated with it. Use of DXM for recreational purposes is very dangerous and may lead to addiction, dependence, tolerance, acute and chronic side effects, and even death. In my opinion, there must be amendments in laws to enforce pharmacists not to sell it to teenagers and not to sell it without a prescription. Changes in the law will help protect children’s health and future. A review of these laws will assist in stopping abuse and illegal use of this medication as an entheogen (a substance used to induce spiritual experiences) or for recreational purposes.
FAQs
1. Is dextromethorphan (DXM) legal?
Yes, DXM is legal when used as directed in OTC cough and cold medicines. Misusing it for recreational purposes, however, is dangerous and illegal in many regions.
2. What are the first signs of DXM overdose?
Early signs include dizziness, nausea, confusion, rapid heartbeat, slurred speech, and hallucinations. Seek emergency care immediately if these occur.
3. Can DXM abuse lead to long-term health problems?
Yes. Chronic misuse can damage the brain, liver, and heart, and may lead to addiction and psychological disorders.
4. How can parents prevent teens from abusing cough syrups?
Keep medicines locked away, monitor purchases, talk openly about the risks, and seek professional help if abuse is suspected.
5. Are there safer alternatives for cough relief?
Yes. Honey (for children over one year), warm fluids, steam inhalation, and doctor-recommended prescription medicines are safer when used correctly.
DISCLAIMER
This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication.
CALL TO ACTION
Protect your loved ones by staying informed. Share this article to spread awareness about cough syrup abuse, and support regulations that keep dangerous substances out of the wrong hands.
REFERENCES
• National Institute on Drug Abuse (NIDA). Over-the-Counter Medicines – Dextromethorphan (DXM).
• U.S. Food and Drug Administration (FDA). Abuse of Dextromethorphan in Cough Syrups. • World Health Organization (WHO). Guidelines for the Regulatory Assessment of Medicinal Products for Use in Self-Medication.