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Cough Preparations

Many cough preparations, especially cough suppressants, contain codeine or DXM (Dextromethorphan). Codeine and other opiates are very effective cough suppressants, but they are addictive. DXM, a powerful psychoactive drug, is particularly addictive. Cough syrup abusers can obtain the drug from their doctors by complaining about coughs and other cold symptoms. Ingredients in many cough preparations are considered to be dangerous in combination with other drugs, particularly antidepressants (including SSRI medications and MAO Inhibitors), antihistamine allergy medications, and Yohimbe.

Addicts commonly point to three reasons for using cough syrup:

It's legal (and therefore more acceptable)
It's low-cost or free
It's seen as being safer than other drugs of abuse.

Methods of Use

Some addicts drink cough syrup undiluted or mixed with sodas. Others soak marijuana joints with the syrup. In some cities, an underground black market has developed for selling syrup. DXM can also be extracted from cough preparations and taken orally, injected, and occasionally freebased.

Types

Examples of cough preparations include Drixoral Cough Liquid Caps, Robitussin AC, Dectuss, Phenergan with Codeine, Phensedyl, and Pherazine with Codeine.

Effects on the Central Nervous System

DXM exhibits cough-suppressant functions by activating specific opioid receptors (sigma opioid receptors) in the central nervous system. In this sense, DXM functions like Ketamine or PCP. The sigma opioid receptor has been implicated in many of the symptoms of schizophrenia. DXM also affects receptors in the part of the brain called the cerebellum, which plays a role in coordinating movement. The involvement of cerebellum receptors may account for reports of peculiar reactions to movement among persons abusing cough syrup.

Intoxication

Cough syrup abusers use the drug to obtain a marijuana-like high with occasional auditory hallucinations and pleasurable reactions to movement. Other less desirable effects depend on the dose taken:

Depression
Dilated pupils
Dissociation
Dizziness
Fever
Hallucinations
High blood pressure
Hot and cold flashes
Impaired judgment
Memory disturbances
Nausea and other gastric disturbances
Panic attacks
Psychotic episodes
Rash
Sexual dysfunction
Sweating
Tachycardia (increased heart rate)

Life Risks

Aside from the risk of addiction, cough syrup use is associated with increased fatigue, poor coordination, constipation, urinary retention, and other problems. Overdose deaths have been reported. As mentioned above, DXM may be particularly dangerous in combination with other medications or substances, including:

"Non-drowsy" antihistamines (allergy medications) such as Claritin, Seldane, or Hismina
MAO inhibitors (a certain class of anti-depressant)
SSRI antidepressants, such as Desyrel or Serzone
The herb Yohimbe / yohimbine

Any of these substances in the system at the same time as DXM can be fatal!

Withdrawal

Withdrawal from cough syrups can cause a range of unpleasant and dangerous symptoms, depending on the content dosage of the preparation. DXM withdrawal is characterized by depression and difficulties with thinking and memory.

Warning Signs

A person who is addicted to cough preparations may:

Frequently purchase over-the-counter cough preparations
Buy cough preparations at different stores

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