What Are Cough Medicines?
Millions of Americans take cough medicines each year to help with symptoms of colds. When taken as instructed, these medicines can be safe and effective. They become harmful when taken in a way or dose other than directed on the package. Several cough medicines contain psychoactive ingredients (mind-altering) when taken in higher-than-recommended dosages, and some people misuse them. These products also contain other ingredients that can add to the risks. Many of these medicines are bought “over the counter” (OTC), meaning you do not need a prescription to have them.
According to the scientific piece ‘Chronic addiction to dextromethorphan cough syrup: a case report’, published by the National Library of Medicine, serious drug abuse and addiction-related to dextromethorphan-containing cough preparations has been a problem in the United States since the 1950s, but few physicians are aware of it. Physicians must be alert to the type of substances and quantities used and misused by patients in obtaining a thorough routine history of over-the-counter medication use.
Two Commonly Misused Cough And Cold Medicines are:
- Dextromethorphan (DXM): cough syrup, tablets, and gel capsules. These OTC cough medicines are safe for stopping coughs during a cold if you take them as directed. Taking more than the recommended amount can produce a “high” and sometimes dissociative effects (like you are detached from your body).
- Promethazine-codeine cough syrup: These prescription medications contain an opioid drug called codeine, which stops coughs, but when taken in higher doses produces a “buzz” or “high.”
Street Names For Cough Medicine
- Black beauties
- Poor man’s ecstasy
- Red devils
- Robo, Robo-dosing, Robo-fizzing, or Robo-tripping
- Skittles or skittling
- Sizzurp or syrup
How Cough Medicines Are Misused
Cough medicines are usually sold in liquid syrup, capsule, or pill form. They may also come in powder. Drinking promethazine-codeine cough syrup mixed with soda (a combination called “lean” or “sizzurp”) was referenced frequently in some popular music beginning in the late 1990s and has become increasingly popular among youth in several areas of the country. Young people are often more likely to misuse cough and cold medicines containing DXM than some other drugs because these medicines can be purchased without a prescription.
Cough Medicines Effects On The Brain
When cough medicines are taken as directed, they safely treat symptoms caused by colds and flu. But when taken in higher quantities or when you don’t have any symptoms, they may affect the brain in ways very similar to illegal drugs, and can even lead to addiction.
All drugs, including cough medicines, change the way the brain works by changing the way nerve cells communicate. Nerve cells, called neurons, send messages to each other by releasing chemicals called neurotransmitters. These neurotransmitters attach to molecules on neurons called receptors. Drugs affect this signaling process.
DXM acts on the same brain cell receptors as hallucinogenic drugs like ketamine or PCP. A single high dose of DXM can cause hallucinations (imagined experiences that seem real). Ketamine and PCP are called “dissociative” drugs, which means they make you feel separated from your body or your environment, and they twist the way you think or feel about something or someone.
Codeine attaches to the same cell receptors as opioids like heroin. High doses of promethazine-codeine cough syrup can produce a high similar to that produced by other opioid drugs. Over time, it takes more and more of the drug to get that good feeling. This is how addiction starts. Both codeine and promethazine slow down activities in the central nervous system (brain and spinal cord), which produces calming effects.
Cough Medicines Effects On The Body
DXM misuse can cause:
- Loss of coordination
- Feeling sick to the stomach
- Increased blood pressure
- Faster heart beat
- Vision changes
- Slurred speech
- Feeling very excited
- In rare instances when DXM is taken with decongestants, lack of oxygen to the brain, creating lasting brain damage
Promethazine-Codeine Cough Syrup Misuse Can Cause:
- Slowed heart rate
- Slowed breathing (high doses can lead to overdose and death)
Cough and cold medicines are even more dangerous when taken with alcohol or other drugs. The long-term effects of cough and cold medicines are not known.
Effects Of Abuse
The effects of DXM have been compared to PCP and the anesthetic ketamine. All 3 are called dissociative substances. At high doses, they give the abuser a feeling of not being in one’s own body. DXM also causes hallucinations. The effects can last up to 6 hours. But that can vary. It depends on how much DXM is taken and what other drugs or chemicals are taken along with it.
Other effects of DXM include:
- Hot flashes
- Nausea, vomiting, and dizziness
- Lack of coordination
- Panic attack or seizures
- Impaired judgment
- Lethargy or drowsiness—or hyperactivity
- Slurred speech
- High blood pressure
- Rapid eye movement
- Racing or pounding heartbeat
- Paranoia and hallucinations
- Feeling of floating
Regular abuse of DXM at high doses can lead to chemical psychosis. That’s when a person loses contact with reality. They may need to be treated in a hospital. They may also need to take medicine.
Cough Medicine: Addiction & Overdose
High doses and repeated misuse of cough and cold medicines can lead to addiction. That’s when a person seeks out and takes the drug over and over again, even though it is causing health or other problems.
Misuse of promethazine-codeine cough syrup slows down the central nervous system, which can slow or stop the heart and lungs. Mixing it with alcohol greatly increases this risk. Overdose can be treated with CPR and certain medications depending on the person’s symptoms, but the most important step to take is to call 911. The drug naltrexone can be given to stop an opioid overdose if codeine was taken.
Many cough medicines contain a small percentage of alcohol. For most people, the amount is insignificant, but for recovering alcoholics, even a small amount could be problematic. Cold and cough medicines that contain alcohol such as Nyquil and Benadryl may be the first misstep that leads to relapse.
Besides just alcohol, cough syrups and medications can sometimes contain other ingredients that can be abused or used to get high such as dextromethorphan (DXM) or codeine. In some cases, some people can even become addicted to cough medicine if they consume it frequently and in large amounts. Teens and young adults are especially vulnerable to cough medicine abuse because it is easy to access and less intimidating than harder drugs like heroin or cocaine. One survey from 2019 found that 3.2% of 8th graders had admitted to misusing cough or cold medicine in the past year.
Recovering addicts should look for cold and cough medicines that do not use the potentially addictive ingredients mentioned earlier. Several brands offer cold and cough medicine for recovering addicts to use safely, but you will have to read the label to know for sure. Some products are also marketed specifically as being alcohol-free.
This advice extends to other medications as well such as nasal sprays, laxatives, or painkillers whether they are over-the-counter medications or not. People who have previously gotten prescription drug addiction treatment need to be especially careful as they may be more prone to abuse these products than others. You can also consult with your doctor or an addiction specialist to be safe.
Reclaim Your Life From Cough Medicines Addiction & Abuse
Cough Medicines addiction & abuse are serious conditions that can cause major health, social and economic problems that should not be taken lightly. We Level Up Treatment Center can provide you, or someone you love, the tools to recover from this by detoxification and treatment with professional and safe care. Feel free to call us to speak with one of our counselors. We can give you further information about the abuse of this drug. Our specialists know what you are going through. Please know that each call is private and confidential.
 Desai S, Aldea D, Daneels E, Soliman M, Braksmajer AS, Kopes-Kerr CP. Chronic addiction to dextromethorphan cough syrup: a case report. J Am Board Fam Med. 2006 May-Jun;19(3):320-3. doi: 10.3122/jabfm.19.3.320. PMID: 16672686. National Library of Medicine (pubmed.ncbi.nlm.nih.gov)