Chronic Addiction to Dextromethorphan Cough Syrup: A Case Report

Abstract

Background: 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.Methods: We describe the case of a 66-year-old clerical worker who ingested 4 to 16 oz of dextromethorphan on a regular basis over an 8-year period. We consulted with our local Poison Control Center and undertook a literature search to research previous reports of similar cases to identify the features that would aid physicians in recognition and management of this problem.Results and

Serum metabolic changes in rats after intragastric administration of dextromethorphan

“…Dextromethorphan, as an over-the-counter medicine, is often rationalized by its users as being safer, easier to obtain, widely accessible and undetected on routine drug screening; furthermore, confirmed dextromethorphan dependence is rarely reported in the literature (Bryner et al, 2006;Desai et al, 2006;Navarro, Perry, & Bobo, 2006;Shin, Lee, Kim, Nabeshima, & Kim, 2008;Logan, Goldfogel, Hamilton, & Kuhlman, 2009). Metabolomics is a newly emerging omics approach to the investigation of metabolic phenotype changes induced by environmental or endogenous factors (Patti, Yanes, & Siuzdak, 2012;Deng et al, 2015aDeng et al, , 2015bWang et al, 2015aWang et al, , 2015bWen et al, 2015Wen et al, , 2016aWen et al, , 2016b.…”

Neuropsychopharmacological understanding for therapeutic application of morphinans

“…However, the DM dose for the neuroprotective effect is much higher than the cough suppressant dosage. Clinically, high doses of DM can produce psychotropic effects (Wolfe and Caravati, 1995; Desai et al, 2006). Furthermore, DM has been recognized as the object of drug-seeking behaviour in several countries (Cranston and Yoast, 1999; Chung et al, 2004).…”

Is Dextromethorphan a Concern for Causing a False Positive During Urine Drug Screening?

“…17 There are reports of DXM causing false positives during the initial screen with most reporting false positives for PCP. 4,[18][19] Desai and colleagues found that a 66-year-old woman who had chronically ingested large amounts of DXM in order to induce euphoria, tested positive for PCP from her urine toxicology screen. 19 It has been suggested that DXM can also cause false positives following the initial screen for opiates due to structural similarities, though according to the literature, no conclusive evidence has supported these claims.…”

“…4,[18][19] Desai and colleagues found that a 66-year-old woman who had chronically ingested large amounts of DXM in order to induce euphoria, tested positive for PCP from her urine toxicology screen. 19 It has been suggested that DXM can also cause false positives following the initial screen for opiates due to structural similarities, though according to the literature, no conclusive evidence has supported these claims. 17,20 On the contrary, a study by Storrow and colleagues showed that adults who ingested doses of 20 mg and 40 mg did not test positive for opioids.…”