There have been many drugs that have been suggested as treatments for opiate withdrawal to provide people with a way out of their dependence on narcotics. Dextromethorphan, a key ingredient in over-the-counter cold and cough remedies, has shown to be useful in offering some relief, but its potential for abuse and overdose has raised a lot of questions. 

What is DXM?

DXM refers to dextromethorphan, which is a cough suppressant (an antitussive) used for the treatment of the common cold.

When DXM is combined with guaifenesin (an expectorant that loosens congestion in the chest and throat, making it easier to expel mucus through the mouth), the product is sold as the popular cough medicine Robitussin. DXM is also the key ingredient in Vicks Formula, which is marketed and sold for the same purpose.

It should be noted that neither product containing dextromethorphan “cures” the common cold, as no such concept exists. Any cough or cold remedy, with or without DXM,  provide relief from the typical symptoms, giving the patient some comfort while the body’s immune system deals with the larger problem.

Other Uses of DXM

DXM has found uses outside of providing relief during flu season. It has been noted that it brings down feelings of acute pain without any significant side effects.

Unfortunately, there is an abuse potential for DXM. Because it is widely available, it is possible for the drug to be consumed in large amounts (in excess of 200 mg).

People taking this much DXM experience hallucinations and a feeling of disconnectedness from the real world. WebMD notes that this is similar to the effects of substances like ketamine and PCP, about which the U.S. Drug Enforcement Administration (DEA) has also issued warnings.

DXM and Opiate Withdrawal

Researchers have also looked at how DXM can help people going through opiate withdrawal. Symptoms of opiate withdrawal include the following:

  • Excessive tearing from the eyes
  • Runny nose
  • Chills and sweating
  • Poor sleep
  • Fatigue
  • Nausea and vomiting
  • Muscle aches

These symptoms are experienced in the first week to 10 days of opiate discontinuation, with other symptoms continuing for many weeks.

It is the mechanism of these opiate withdrawal symptoms that has opened the door to DXM being thought of as a potential treatment. In the International Journal of Clinical Pharmacology and Therapeutics, for example, researchers identified the three main processes that are responsible for the tolerance for opioids (the increasing threshold for their effects to be felt) and withdrawal symptoms.

In 1990, the International Journal of Clinical Pharmacology, Therapy and Toxicology wrote that certain antagonist drugs (substances that block specific receptors in the brain to stop a biological response), like DXM, can be used to reduce a person’s tolerance for opioids. This means that the person will not be compelled to take high amounts of the drugs to experience a baseline effect.

This was determined after a study reported that heroin addicts experiencing severe withdrawal, who were given 15 mg of DXM at six-hour intervals, had notably milder symptoms than patients who received other drugs. The only symptoms that were standard across all patient groups were vomiting and sweating. This led the researchers to suggest that such antagonists were useful in the treatment of opiate withdrawal and addiction.

Further Research on DXM for Opiate Withdrawal

The Psychopharmacology journal confirms that DXM is an antagonist like this, while also pointing out that high doses of the drug cause effects in line with those of other hallucinogens.

Other research has supported the idea of DXM being used as a treatment for opiate withdrawal. The Drug and Alcohol Dependence journal, for example, found in mice studies that the stronger the dose of DXM, the greater the reduction in the intensity of the withdrawal syndrome. Similarly, researchers writing in International Scholarly Research Notices suggested that DXM might provide an option for doctors to use non-opioid agonists to help their patients wean off their opiate addictions instead of using partial agonists and long-acting opioids like methadone — the use of which has proven controversial

Issues Surrounding DXM

Despite not being an opioid, DXM has its own side effects.

  • Dizziness
  • Nausea and vomiting
  • Drowsiness

A person who is going through opiate withdrawal might experience these very effects as the most common of withdrawal symptoms. For this reason, DXM should not be taken as a treatment for opiate withdrawal without the express consent and supervision of a doctor.

Opiate withdrawal is a very complicated process. Interfering with the resetting of dozens of bodily systems that have been twisted out of shape by opioid abuse can cause many other problems.

DXM can undoubtedly offer some relief from opioid withdrawal, but the potential for addiction and side effects should raise warning flags before any treatment decisions are made.

Signs of DXM Overuse

For this reason, it is important to know when the use of DXM and related products has become a problem. A person who is taking Robitussin or Vicks and exhibits the following signs might be in danger of using the medication beyond safe levels:

  • Dizziness
  • Confusion
  • Hallucinations
  • Increased heart rate
  • Slurred speech
  • Difficulty controlling movements

At extreme levels, patients might even lose their vision and experience seizures. The risk of this increases if the patient is on opioids at the same time, which is another reason why DXM should be used extremely carefully as a form of opiate withdrawal treatment. 

DXM Withdrawal

Anecdotal reports of casual recreational use of DXM suggests that it can also cause moderate amounts of physical dependence and tolerance, to the point where discontinuing DXM use can lead to its own withdrawal symptoms, including:

  • Vomiting
  • Diarrhea
  • Weight loss
  • Anxiety
  • Insomnia

The similarity in withdrawal symptoms can create significant complications in the use of DXM for opiate withdrawal.

Should it Be Used?

Stressed man with hands on his temples

Can DXM represent a step forward in opioid use disorder by mitigating the severity of withdrawal symptoms? Much research says yes.

The International Journal of Neuropsychopharmacology, for example, writes of evidence of low-dose DXM “as an adjunct in opioid-dependent patients undergoing methadone maintenance treatment,” and that it could be a potential therapy for decreasing opioid use in general.

Similarly, the Drug and Alcohol Dependence study quoted above mentioned that DXM was found to be “responsible for the attenuating effect on the intensity of opioid withdrawal symptoms.” 

But DXM is not a panacea. The Fix writes of “the dangers of DXM,” quoting local news organizations on their reports of teenagers being sent to emergency rooms after overdosing on the drug or combining it with other drugs, including opioids.

The ease of access to Robitussin or Vicks suggests that even though DXM doesn’t have the same stigma that methadone or buprenorphine has when it comes to medically assisted treatment, it still presents with considerable risks during opiate withdrawal.

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