Dextromethorphan Abuse and Dependence in Adolescents

Abstract

Dextromethorphan, a semi-synthetic morphine derivative, is a widely available antitussive in many over-the-counter cough and cold preparations. When taken in large amounts, it produces a high and effects similar to PCP. Emergency room and poison control data suggest that abuse of this substance has increased in the past decade. Adolescents, particularly those with co-occurring psychiatric and substance use disorders, seem to be at higher risk for abuse of and dependence on dextromethorphan than children and adults. Multiple case reports, including the one presented here, have demonstrated the symptoms of intoxication, the potential for abuse, the development of dependence, as well as the acute physical withdrawal and prolonged psychological withdrawal syndromes that can occur with dextromethorphan-containing products. Screening for substance use disorders is important in patients with any psychiatric disorder and should include questions regarding over-the-counter medications. For patients who present with acute intoxication, management is mainly supportive. Similar to treatment of other substance use disorders, treatment of dextromethorphan dependence includes motivational interventions, psychosocial treatments to promote abstinence, and concurrent treatment of any co-occurring psychiatric disorders. In order to prevent over-the-counter medication abuse among young people, clinicians can educate patients and their parents about the risks of over-the-counter medicines and their safe storage. Further, legislation is being considered to limit access to dextromethorphan-containing products. (Journal of Dual Diagnosis, 6:266–278, 2010)