DXM is short for dextromethorphan, which has expectorant and antitussive properties and is commonly found in many over-the-counter (OTC) cold and cough medications. It is also a drug of abuse, used for its dissociative properties. Teens and young adults use it most commonly in a practice called “skittling” or “robotripping.”
When taken in high doses, DXM can cause a euphoric high as well as auditory and visual hallucinations. The chemical structure of DXM is similar to opioid drugs, but the U.S. Drug Enforcement Administration (DEA) publishes that abuse of the drug is more likely to produce effects similar to ketamine or phencyclidine (PCP).
The journal Clinical Toxicology reports that DXM has an average elimination half-life of around three hours. This means the drug will stay active in the bloodstream for about six hours or so. DXM actually stays in the body much longer than this, however. The CYP2D6 system metabolizes it through the liver, and about 85 percent of the population in the United States rapidly metabolizes dextromethorphan into dextrorphan. People who metabolize it faster are more prone to abuse of DXM since the drug stops working much faster than may be desirable.
DXM can remain in the bloodstream in some form for between 11 and 22 hours for those who metabolize the drug quickly. It can stay there even longer, up to 33 hours, for those metabolize the drug poorly.
Drug metabolism of DXM and other medications can be affected by many different factors. This can influence how quickly the drug will process out of the body. Things to consider include:
Body mass can play a role in how much a drug will affect a person and at what levels. For example, a smaller person is more likely to become intoxicated at lower doses than a larger person, as the drug will hit the smaller person’s system more quickly. Muscle can actually speed up a person’s metabolic rate, so a lean person who has more muscle than fat may actually be able to burn off DXM more quickly than someone with a higher fat percentage.
Typically, women metabolize drugs more slowly than men, so DXM can stay in the body of a woman longer than a man. As a person ages, metabolism slows down, so DXM may remain active in the bloodstream longer in older individuals.
Hydration and food intake also can speed up metabolism and process drugs like DXM out of the body faster. Since DXM is metabolized through the liver and excreted in urine that is processed through the kidneys, functions of these organs are vital to the full elimination of DXM from the body. Illness or injuries to these organs can slow down or hamper regular metabolism. The higher the dose of DXM, the longer it can take to process out of the body.
DXM tolerance is also possible. This means that when a person takes DXM regularly, the brain and body can get used to it being active in the bloodstream. DXM can then be processed and metabolized faster. Once a tolerance is formed, higher doses are needed for the drug to work. Escalating the dosage then increases the length of time it takes for the drug to process out of the body and raises the risk of drug dependence and addiction. The National Institute on Drug Abuse (NIDA) warns that DXM is an addictive drug.
Detox of DXM can typically be accomplished in three to five days. Since DXM is an addictive substance that can lead to drug dependence with regular use, it can have some negative withdrawal symptoms when it processes out of the body. These symptoms can include depression, raised blood pressure, irregular heart rate, sweating, drug cravings, elevated body temperature, and concentration, memory, and thinking issues.
Detox is the time it takes for the drug to process out of the body fully. A medical detox program can offer medical care, support, and potentially medications to manage withdrawal. This can help DXM to process out of the body more rapidly and in a safe manner.
Drug tests help determine the presence of certain drugs. Some types can still detect drugs after they are no longer active in the body and have already processed out through detox. For DXM, the main types of blood tests that can pick up DXM are blood, urine, and hair tests.
Blood Drug Test
A blood test can only determine the presence of DXM if it is actually active in the body. Therefore, a blood test for DXM will only show a positive result up to 24 hours after taking the drug. If a blood drug test is being performed a day or two after taking a product containing DXM, the result will usually be negative. Urine and hair tests can detect DXM for longer.
Urine Drug Test
In general, DXM is detectable in urine for about three to five days on average. This means that after taking DXM, a urine-based drug test can still pick it up for several days.
Urine drug tests look for metabolites of specific drugs, which in the case of dextromethorphan is dextrorphan. DXM/dextrorphan is not one of the common drugs tested for on most standard drug tests as it is not an illegal drug. However, the DEA warns that sometimes DXM can show up as PCP on these tests. Per the Drug and Alcohol Testing Industry Association (DATIA), PCP can be detectable on a drug test for up to a week.
DXM also can show a false positive for an opioid drug since it is chemically similar to drugs like morphine. Opiate metabolites such as morphine can remain detectable in urine for two to three days.
To avoid a positive DXM urine drug test, stop taking it at least five days to a week before the test. Eating balanced and nutritious meals and drinking plenty of water can help to flush the drug from the body’s system. Exercise also can help to speed up metabolism.
Hair Drug TestAn analysis of hair for the purposes of a drug test can determine prior drug use for the previous month or even longer. Hair drug tests can show past drug use, and they are one of the least invasive forms of drug testing. According to Quest Diagnostics, a hair follicle drug test can detect drugs for up to 90 days after last use. Hair drug tests also have fewer privacy concerns and are harder to cheat. These tests help to establish patterns of repetitive drug use.
To ensure that a hair drug test is clean, individuals will need to allow at least three months for the hair to grow out enough so that drug use is undetectable through the hair follicle test. There is not much a person can do to make DXM process out of hair faster; the only thing to do is wait.
When preparing for a drug test for DXM, the first thing to consider is what type of drug test is being done. The next thing to be aware of is how long ago DXM was taken and how long it can be detected for. Blood drug tests show positive for the shortest amount of time, and hair tests the longest.
Urine drug tests are typically the most common drug tests. In preparing for this type of test, allow plenty of time for DXM to fully process out of the body. Medical detox can actually speed up the general detox timeline while ensuring the person is safe and supported during withdrawal.
(March 2014). Dextromethorphan. Drug Enforcement Administration. from https://www.deadiversion.usdoj.gov/drug_chem_info/dextro_m.pdf
(October 2008). Dextromethorphan Poisoning: An Evidence-Based Consensus Guideline for Out-of-Hospital Management. Clinical Toxicology. from https://www.tandfonline.com/doi/pdf/10.1080/15563650701606443
(September 2017). Dextromethorphan in Cough Syrup: The Poor Man's Psychosis. Psychopharmacology Bulletin. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601090/
(December 2017). Over-the-Counter Medicines. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines
(July 2010). Dextromethorphan Withdrawal and Dependence Syndrome. Deutsches Arzteblatt International. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925345/
Workplace Drug Testing. Drug & Alcohol Testing Industry Association. from http://www.datia.org/datia-resources/27-credentialing/cpc-and-cpct/931-workplace-drug-testing.html
The Benefits of Hair Drug Testing. Quest Diagnostics. from https://www.questdiagnostics.com/home/companies/employer/drug-screening/products-services/hair-testing/hair-testing-overview