DXM (dextromethorphan) is a medication people use to reduce coughing. It is commonly found over the counter in “tussin” medications. Illicit use of this medication can cause effects similar to psychedelic drugs, such as mushrooms and LSD.

Misuse of DXM can lead to tolerance and other issues. Knowing more about the effects of this drug can help people to determine when they need help.

What are the Signs of DXM Tolerance?

When someone is using DXM to experience a “trip,” they are usually sourcing it from extra-strength cough syrups, which contain about 3 mg (milligrams) of DXM per 1 ml (milliliter) of syrup, according to Psychology Today.

The dose of DXM taken plays a vital role in the effects that people experience when they use it. The dissociative effects that are also seen with other hallucinogens, such as ketamine and PCP (phencyclidine), can also be observed with DXM when someone takes doses of 4 ounces or more.

Two ounces may cause someone to experience distorted visual perception and a stimulant effect. However, at extremely high doses of at least 10 ounces, a person can experience a complete dissociation from their body.

DXM users might show the following symptoms, according to the Partnership for Drug-Free Kids:

  • Confusion
  • Blurry or double vision
  • Impaired physical coordination
  • Nausea and vomiting
  • Drowsiness
  • Disorientation
  • Dizziness
  • Slurred speech
  • Abdominal pain
  • Rapid heartbeat
  • Toe and finger numbness

DXM interacts with a person’s brain chemistry. When someone uses it regularly, especially at the high doses that people usually take with this drug, it can cause the brain to get used to the effects. This is what can lead to tolerance.

Several factors can contribute to how quickly someone develops DXM tolerance and the drug’s overall effects on a person, according to the Australian Government Department of Health. They include:

  • A person’s size, age, weight, muscle mass
  • The period of DXM consumption
  • The user’s mood or attitude
  • The environment in which the person consumes DXM
  • Their overall level of tolerance to drugs and medications
  • Whether the person has other psychoactive drugs in their system
  • The person’s expectations for the drug

Once someone has developed a tolerance of DXM, they will continue to increase their dose so that they can experience the same effects. Not only can this increase the severity of the potential side effects, but it also poses other dangers.

Taking higher doses of drugs increases the risk of experiencing an overdose. The exact dosage that causes an overdose varies among individuals. It depends on many factors, such as how long someone has been using the drug, if they are simultaneously consuming other substances like alcohol, and the person’s overall size.

What to do if You Experience DXM Tolerance

Those with tolerance or addiction to DXM often need help with finding recovery. Most people who seek treatment for DXM and other hallucinogens do so because they experience a “bad trip,” according to research published in Nederlands Tijdschrift voor Geneeskunde.

In most cases, acute treatment involves supportive care for the specific effects that someone is experiencing. There are cases when seizures or extreme agitation might be controlled with benzodiazepines, according to the Cleveland Clinic.

Benzodiazepines work to alleviate the sympathomimetic effects and anxiety. They might also assist with the increased heart rate and blood pressure that might occur with this type of drug, according to Medscape. In some cases, people are administered sodium nitroprusside for severely increased heart rate and blood pressure.

Once someone gets through detox, they can choose to attend an inpatient or an outpatient facility for addiction treatment. Inpatient care involves living in the facility where they are receiving treatment. Outpatient care means the person can live at home while still receiving treatment for addiction.

In addition to the medications given to treat a bad trip, there are other therapies people might benefit from that can be used throughout their treatment. These might include, according to the National Institute on Drug Abuse:

  • Behavioral counseling
  • Treatments that target withdrawal symptoms
  • Treatments for any additional mental health issues the person might be experiencing

The treatment plan is typically tailored to the needs of the individual. Factors like the length of their DXM use, how much they use, and their overall lifestyle are considered when creating a comprehensive treatment plan.

Do You Need a Break?

DXM can cause significant health issues for some people. Because of this, any person who has developed a tolerance to this drug should view this as a sign that their abuse of the drug is a problem.

Continued use will result in needing increasingly higher doses. This could eventually lead to an overdose. According to MedlinePlus, overdosing on this drug might cause the following symptoms to present:

  • Bluish lips, fingernails
  • Coma
  • Seizures
  • Dizziness
  • Low or high blood pressure
  • Vomiting and nausea
  • Increased body temperature
  • Breathing difficulties
  • Blurry vision
  • Constipation
  • Drowsiness
  • Hallucinations
  • Muscle twitching
  • Rapid heart rate
  • Palpitations
  • Intestinal and stomach spasms

While an overdose is among the most dangerous reactions to DXM, other things can happen that should convince someone to stop using this drug. When someone is abusing this drug, they can start to experience some of the issues that DXM is actually used to treat, such as dysphoria and insomnia.

When people chronically use this medicine in high doses, there is a risk of them developing toxic psychosis, according to the Encyclopedia of Drugs and Alcohol. This condition is characterized by someone losing contact with reality. They also tend to experience a confused state and various other behavioral and physiological problems.

After regular use, it is possible to experience withdrawal from DXM if people have developed an addiction to or dependence on this drug. The symptoms may include the following, according to the Center for Substance Abuse Research:

  • Anxiety
  • Insomnia
  • Vomiting
  • Upset stomach
  • Restlessness
  • Diarrhea
  • Severe weight loss

Little research has been done on DXM withdrawal. Because of this, it is unknown how long the effects might last, but it is known that the severity of the symptoms varies.

Those who believe they have developed tolerance to DXM should not hesitate to consult with a substance abuse treatment professional. These professionals can guide them in finding the resources necessary to overcome their dependence on this medication.

DXM Dangers

DXM addiction is real, and knowing the signs of DXM addiction is vital if you or someone you love has been abusing over-the-counter medication. The drug was released in the 1950s and soon became a drug of abuse that was removed from the market. However, manufacturers decided to redistribute the medicine in a way that altered the taste. It was extremely unpleasant in the hopes it wouldn’t be abused. With that, it opened the door to be abused again, mostly by the younger generation. Since DXM is not a controlled substance and can be purchased at a pharmacy without a prescription, the potential for abuse is even higher. 

Those who use the drug in high doses are at a much higher risk of developing a dextromethorphan tolerance. DXM is produced from a derivative of morphine. However, it’s much different from opioids like Norco, Percocet, heroin, or morphine. When DXM is used as directed, it has few side effects. However, the more it’s taken, you must pay attention to DXM addiction signs. 

For some, they might need to stop for a DXM tolerance break because of prolonged use. In some cases, it may require DXM addiction treatment if you try to take a break and you can’t. Don’t let its OTC stature fool you – this can be a serious drug when abused. As was mentioned above, because it’s so easy to get a hold of, abuse can be widespread. The recommended dose of DXM varies between 15 mg and 30 milligrams, but for those who look up a DXM tripping guide, they’ll find they need to take much more than that to “robotrip.” 

There are four levels of abuse that occur with the drug. The four levels include the following:

  • The first level: The most basic level of abuse happens when someone takes between 100 mg and 200 mg of the drug. At this stage, people report feeling stimulated and ready to take on tasks.
  • The second level: The following plateau consists of taking doses between 200 mg and 400 mg. At this stage, individuals report effects of euphoria and intense visual hallucinations. When you reach this stage, operating heavy machinery can be extremely dangerous or even life-threatening. 
  • The third level: At this level, dosages consist of 300 mg to 600 mg. When using DXM at this level, euphoria, hallucinations, and significant perceptual distortions of objects in the visual field will occur. You will also have significantly impaired motor functions and coordination. 
  • The fourth level: Considered the most dangerous level, once someone takes 600 mg or more of DXM, they will experience extreme hallucinations, sedation, and dissociative effects. At this point, the chances of overdoses are high. Dissociative effects have also been reported where the individual feels they leave their body and that everything around them isn’t real. This is extremely dangerous. If someone you know has taken this much, you must monitor them to ensure their safety. If not, please call 911 immediately.

Signs of DXM abuse are similar to other drugs. They include dizziness, nausea, and hot flashes. Similar to any other substance use disorder, you’ll also experience the following:

  • Dextromethorphan tolerance
  • A strong desire or compulsion to use the drug
  • Reduced ability to control how much of the drug you use
  • Physical withdrawal symptoms when you lower the dose or stop it altogether
  • Using pattern that causes you to neglect other areas of your life

If you’ve developed a substance use disorder involving DXM, it might be time to get help. You might think to yourself that because it’s over-the-counter, you can’t be addicted; that’s not true. If you feel powerless, it’s time to seek the help you need before it’s too late.

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