Over-the-counter (OTC) cough and cold medicines are safe and effective when they’re used as directed. But taking too much of them -- on purpose or by accident -- can make you feel high. That can lead some people to abuse them.
Before the FDA outlawed codeine in cough medicines in the 1970s, OTC cough medicines created a cheap and effective high. A drug called dextromethorphan (DXM) replaced codeine in cough medicines. At very high doses, it can mimic the effects of illegal drugs like PCP and ketamine.
More than 125 OTC medicines sold to treat the symptoms of cough and colds have DXM. It’s in common brands such as Coricidin, Dimetapp DM, Nyquil, Robitussin DM, Robitussin CF, and Robitussin Cough and Cold, as well as store brands for cough and cold medicines.
You might not think twice if you find these meds in your teen’s book bag, but you should be aware of their potential for abuse.
Teens are more likely to abuse cough medicines because they can get them easily and without a prescription. Kids can also learn online where to buy the drug and how to use it to get high.
Here’s what you need to know to prevent abuse and spot its warning signs, as well as some tips to help you talk with your child if you suspect they have a problem.
How Much Is Too Much?
A safe dose of products with DXM is usually 15 to 30 milligrams (mg) over the course of 24 hours. It usually takes more than 10 times that amount to make you high.
There are usually several stages of DXM intoxication, depending on how much you take. Effects can range from a mild “buzz” to an “out-of-body” feeling to hallucinations, paranoia, and aggression. They can last 30 minutes to 6 hours after you take the drug.
If you take that much and then get very active, your body can overheat, and you might get a dangerously high fever. This is especially a problem for teens who go to dance clubs, where they can be sold DXM which looks like illegal club drugs such as PCP. When you take DXM with other drugs or alcohol, it raises the odds of trouble.
DXM is usually found in medicines that have other ingredients to fight colds. Taking high doses of pseudoephedrine (a decongestant), acetaminophen (a pain reliever), and antihistamines (remedies for sneezing and a runny nose) along with DXM can cause other health problems, such as:
What Parents Can Do to Prevent Abuse
First, talk to your teen. As with most things regarding your children, you’re the first line of defense. Studies show that teens are half as likely to misuse drugs if their parents talk to them about the risks.
Mention cough medicine abuse specifically, and explain the dangers of misusing OTC medicines. Because DXM products are sold without a prescription, many teens mistakenly believe those medicines have few dangers.
The good news is that DXM abuse by teens is down by nearly half during the past decade or so. Many stores have started to keep these cough and cold remedies behind the counter to help reduce access and the potential for teen abuse of these medications.
Some makers of OTC medicines with DXM have put labels on their packaging warning about the potential for abuse. Many states have banned the sale of meds with DXM to minors.
Still, about one in 30 teens say they use DXM to get high, and one in four knows someone who does. Here’s some advice to help keep your children from abusing these medicines.
- Look in your medicine cabinet. Treat it like your liquor cabinet: Know what's in it, and keep track. You may need to move some medications to a place where your kids won't be able to get them.
- Get rid of medicines you don’t use. Don’t keep them around just in case. Many are probably expired, anyway. Buy only what you need, and dispose of what's left when you're feeling better.
- Think about your community. Even if your children are too young for drug abuse, what about your nieces and nephews? Or babysitters? By clearing your house of unnecessary medication, you're helping them, too.
- Monitor your child's internet use. Know what your child is looking at online. Some websites present, in surprising detail, information about cough medicine abuse with tips on specific dosages and brands.
- Model good behavior. Your kids take their cues from you, so don’t be careless with your own medication use. If you don't treat medications, including OTC drugs, with respect -- and use them only as recommended -- your children may not, either.
- Talk to other parents. Share what you know about cough medicine abuse with other parents, particularly the parents of your teen's friends. Coordinate your efforts. If you're cleaning out your medicine cabinet, get the parents of your child’s friends to do the same.
Know the Warning Signs
Your teen might be abusing cough or cold medicines if:
- You find empty boxes or blister packs of cold medicine at home or school.
- Cough or cold medicines go missing from your household.
- Their friends become unfamiliar to you, they give up long-term friends, their grades fall, or they lose interest in favorite activities.
- They have mood swings, such as becoming oddly manic or suddenly furious, sad, or listless.
- They spend more time alone, away from family.
- Their appearance changes significantly. They may wear the same shirt for days, stop showering regularly, or completely change their style of clothing.
- They start eating a lot more or less, or you notice weight changes.
- Their sleep pattern changes. Depending on the drug being abused, they might suddenly seem to sleep all day or never seem to sleep at all.
- They become more secretive about after-school activities or strangely anxious if you get near their belongings.
- They often ask for cough or cold medicine. If your teen is always demanding medicine for a cough, it could be a sign of drug abuse.
- They get unexpected online purchases at home.
Teen slang for cough medicine abuse
You may also overhear your teen using or see them texting terms such as “skittles,” “robo-tripping,” “triple-C,” or “dexing.” These words are some of the many terms for cough medicine abuse. By educating yourself in drug slang, you can help protect your child.
Here’s a rundown of some common terms for cough medicine abuse.
- Dex or Drex. Cold and cough medicines with DXM.
- Dexing. Getting high on products with DXM.
- Orange crush. Some cough medicines with DXM. The name may stem from the orange-colored syrup -- and packaging -- of brands like Delsym.
- Poor man's PCP, or Poor man's X. Products with DXM, since they're cheap but can cause effects similar to those of PCP or ecstasy at high doses.
- Red devils. Coricidin tablets or other cough medicines.
- Red hots. Capsules or tablets with DXM. The term comes from their resemblance to the candy.
- Robo. Usually a reference to cough syrup with DXM. It derives from the brand name Robitussin, but it is common slang for any cough syrup.
- Robo-dosing. Abusing products with DXM.
- Robo-fizzing. Combining cough medicine with soda or alcohol.
- Robotard. Someone who abuses DXM.
- Robo-tripping. Abusing products with DXM and, specifically, the hallucinogenic trips that people get at high doses.
- Rojo. Cold and cough medicines with dextromethorphan. "Rojo" is Spanish for "red," and refers to the color of many syrups and gelcaps.
- Skittles. Usually refers to Coricidin tablets with DXM, which are sized and shaped similarly to the candy.
- Skittling. Another term for abusing products with DXM. It applies specifically to using Coricidin tablets.
- Syrup head. Someone who uses cough syrups or other products with DXM to get high.
- Triple Cs or CCCs. Coricidin tablets with DXM, which have three small Cs printed on each tablet for "Coricidin Cold and Cough."
- Tussin. Cough syrup with DXM.
- Tussing. Using products with DXM. It refers to cough syrups such as Tussin or Robitussin.
- Velvet or velvet syrup. Cough syrup with DXM.
- Vitamin D. Medicines with DXM, often Robitussin products.
What to Do if You Suspect Abuse
Although you may hear your teen use slang for cough or cold medicine abuse or see other warning signs, it doesn’t always mean your teen is abusing these drugs. After all, teen slang, mood swings, changes in sleep patterns, and secretiveness are a part of adolescence.
But if you do find evidence of abuse, it may be time for a talk with your child. Here's some guidance on what to do before you confront your son or daughter about OTC cough medicine abuse.
- Don’t react impulsively. Don’t storm into your teen's room and start yelling. Your teen may get defensive right away. Instead, take some time to think about what you want to say.
- Gather evidence. You don't need solid proof that your child is abusing drugs, but you may feel more confident if you have some evidence for your accusation. This might be an empty bottle of cough medicine you find in your teen's room or in the medicine cabinet. But it might just be observations you've made that fit with OTC drug abuse, like odd behavior changes.
- Be prepared to have a discussion. Your job now is not just to pass judgment, mete out punishment, and leave the room. You need to talk to your teen. It may take some work -- and a few tries -- but you need to explain why you're so concerned about OTC drug abuse.
- Know what your policy is. Before you start the conversation, settle on a firm set of household rules concerning drug abuse. Spell them out clearly. You also need to know exactly what your plan is should the rules be violated.
- Get support. You'll feel more confident if you have backup. Obviously, you and your spouse should be on the same page. But you might also find it helpful to talk over the situation with others -- friends, a therapist or counselor who specializes in drug abuse, or a clergy member -- before and after confronting your teen.
- Choose the right time. Don't delve into this discussion abruptly, 10 minutes before the bus arrives, or when your teen is in the middle of playing a video game. Do it when you'll both have the time to hash it out. Certainly, don't try to engage if your teen actually seems high.
- Make the conversation the first of many. Even if your teen earnestly agrees to stop OTC medicine abuse, it's not over. The same reasons or pressures that led your teenager to start abusing drugs in the first place are still there. You should check in regularly and have an ongoing dialogue.