Understanding DXM: The Over-the-Counter Hallucinogen Popular Among Teens

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Dextromethorphan, commonly known as DXM, has emerged as a significant concern among parents, healthcare providers, and educators due to its popularity as a recreational drug among teenagers. Originally approved by the FDA in 1958, DXM is found in over 70 over-the-counter (OTC) cough and cold medications, designed to suppress coughing safely and effectively when used as directed. However, its misuse for hallucinogenic effects poses serious health risks and has led to increased scrutiny and calls for education and prevention​​​​.

What is DXM?

DXM is a cough suppressant ingredient in many OTC cold medications, including well-known brands like Robitussin, Delsym, and Coricidin. It’s effective in managing symptoms of the common cold or flu by reducing activity in the brain that causes coughing. When used as prescribed, DXM is considered safe with minimal side effects. However, the substance becomes dangerous when consumed in large doses, leading to serious side effects and even addiction​​.

DXM Misuse and its Effects

Teenagers and young adults seeking a cheap and easily accessible high misuse DXM by consuming it in significantly higher doses than recommended for cough suppression. This misuse can cause a range of adverse effects, including hallucinations, delusions, paranoia, cognitive impairments, and in some cases, dangerous behavior due to disconnection from reality. The euphoria and altered states of consciousness associated with DXM misuse are sometimes compared to the effects of more potent drugs like PCP and ketamine, highlighting its potential for harm​​​​.

Trends in DXM Abuse

Although DXM abuse peaked around 2006, it remains a concern due to the ease of access to OTC medications containing the drug. The majority of DXM misuse cases involve adolescents between the ages of 14 and 17, a critical developmental period when teenagers are more likely to experiment with substance use. This demographic shift underscores the importance of monitoring and education to prevent DXM misuse among youth​​.

DXM Overdose and Addiction

Overdose incidents involving DXM often require medical intervention, including emergency department visits. Symptoms of an overdose can range from respiratory and cardiovascular problems to neurological issues like seizures and coma. Addiction to DXM is a growing concern, with individuals displaying a pattern of compulsive use despite facing negative consequences. Treatment options for DXM addiction include evidence-based methods such as cognitive-behavioral therapy and family therapy, aimed at addressing both the substance use disorder and any underlying mental health issues​​​​.

Preventing DXM Abuse

Prevention efforts focus on education about the dangers of DXM misuse, monitoring teenagers’ access to OTC medications, and fostering open communication about the risks associated with recreational drug use. Parents and caregivers play a crucial role in prevention by keeping track of medications in the home and being vigilant about their children’s online activities, as some websites provide information on how to misuse DXM​​​​.

DXM’s status as an easily accessible OTC medication underscores the need for comprehensive strategies to prevent its abuse among teenagers. Education, monitoring, and open dialogue about the risks of recreational drug use are essential components of a holistic approach to addressing this issue. By understanding DXM’s potential for misuse and implementing preventative measures, we can protect young individuals from the harmful effects of this over-the-counter hallucinogen.

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Clinical Director

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Jeff Swem, SUDRC

Director of Operations

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Understanding DXM: The Over-the-Counter Hallucinogen Popular Among Teens

Phil Castagnola

Case Manager

Philip was born and raised in San Diego. He grew up with parents who were functioning alcoholics /addicts. This led to adopting a faulty belief system from a very early age that using drugs and alcohol was an acceptable way to live. The belief system made it normal for him to begin using substances at the age of 15.
Philip has been a surfer his entire life and competed professionally for a few years in his 20’s. He has primarily worked in the surf industry. He eventually opened his own surf shop (Select Surf Shop) in the early 2000’s. His addiction eventually got the better of him and after losing his business and his family in 2006 he spent the next 3 years in and out of rehabs trying to recover. His substance abuse issues eventually landed him in federal prison. He used his time wisely and started working the steps of alcoholics anonymous and completing an 18-month treatment program. 
Philip was the primary caregiver for his mom who was permanently bedridden for the last 4 years. When covid hit he decided to pursue one of his goals and began going to school to become a substance abuse counselor.

After struggling with substance abuse issues for over 20 years philip now has 1 years of continuous sobriety and works a program of recovery givi4ng back to other addicts and alcoholics through sponsorship in the program of AA.

Philip studied AODS at San Diego City College and he is now completing his internship here at Coastal Detox of Southern California.

Philip’s main passion is sharing his experience, strength and hope with others who struggle with substance abuse issues. Helping others through their journey of getting and remaining free of their bondage of addiction.

Kay Saffe LPCC

Clinical Director

Kay Saffe grew up in Miami, Florida and is a first generation American with Argentinian roots. She struggled with drinking and substances, especially throughout her youth. Today, she has been in recovery for years and strives to prioritize her spiritual, mental, and physical health.

A lifelong athlete and ocean lover, she moved to San Diego to pursue a Master’s degree in counseling at the University of San Diego and progress her surfing. She has spent years working as a surf instructor and therapist, working with local non-profits that treat at risk individuals and families in English and Spanish. She incorporates a mindful and holistic approach to therapy. She is passionate about positive psychology and helping others through their recovery journey.

Jeff Swem, SUDRC

Director of Operations

Jeff was born and raised in San Diego, and spent much of his youth living blocks from where our residential housing is located.  He spent his teenage years skateboarding up and down the surrounding streets, and enjoying the Pacific Beach life in the 80’s/early 90’s. 

Jeff got to know the darker side of addiction early in life, with three near-death experiences in a row happening within a year.  He “settled down” into alcohol, and later in life became a professional brewer, but that too proved to be too cunning, baffling, and powerful a draw.  During Covid, he felt no choice but to surrender, and made the decision to get sober.  He attended a similar program to our own, and after completing the 30 days inpatient and attending IOP aftercare, he was able to forge a strong foundation of sobriety.  He has not found a reason to pick up a drink since the day that he checked into that detox.  After quitting the brewing gig (because of course, he had little choice there), he enrolled in the AODS program at City College with his sights on a new career of helping others.  Having completed the requirements involved, he went on to earn his certification in California for Substance Use Disorder Certified Counselor.

Jeff is married to his wife of nearly 25 years with a 21 year old daughter and 18 year old son, and thanks to the 12 steps, surrounding himself with a caring and supportive sober community, and coming to terms with his alcoholism, is able to lead others struggling with addiction through example and personal experience.