Cold Medicine Q&A

Promethazine by itself does not cause tolerance/dependence/withdrawal or addiction. However, promethazine is mixed with codeine in some cold remedies, and the combination is VERY addicting; codeine is an opiate like heroin and produces bad addiction. There was a drug “Purple Drank” which contained promethazine/codeine, a soda beverage and grape Jolly Rancher’s candy. If someone gets withdrawal from using promethazine/codeine, it means that the person has become addicted and needs treatment to stop using.

Many kinds of cold medicine can be abused. About 5% of teen girls use it when they’re aged 12 to 18 years. Mixing cold medicine to alcohol is adding one kind of high to another kind. Alcohol is a sedating drug in moderate doses. Many cold medicines contain dextromethorphan (DXM), a drug that is very similar in its effects to PCP (phencyclidine) and ketamine. They are “dissociative anesthetics” used in medicine to reduce awareness of pain and are used in pediatrics to assist in wound dressing and debridement. As medicines they are hard to use, with a narrow “therapeutic window:” the amount that is the right dose is close to an overdose. In cough syrup, it produces a unique kind of high (robo tripping, skittes), which isn’t all that pleasureable, although many people like the high. People with mental health problems get some relief of their symptoms, and these people are at the highest risk of becoming addicted to it. Repeated use should suggest that there may be a mental health problem like depression, anxiety, boredom, or trauma. True addiction to cough syrup is not common, but it is common for users to use it to find relief from mental distress. An overdose of cough syrup can be very dangerous: called a “K-Hole” is a terrifying period of panic, and intense dysphoria. Very unpleasant.

High dose alcohol will cause failure of the brain to record memories, a blackout, Ritalin users usually drink higher amounts and are more likely to have a blackout. Cough syrup contains dextromethorphan, a drug similar to ketamine. It produces “dream like” memories. If alcohol dose is high, a blackout is likely.

There are significant risks to abuse of most cough/cold medicines: if the cough medicine contains codeine, it should be avoided; also, if they contain ephedrine or other stimulant, the dose that makes you high can definitely cause serious medical problems, including death. Drugs containing dextromethorphan can produce a strange kind of high, with very high risk of a bad trip. DXM can be addicting. People who like to use cough syrup should definitely check the labels and if they don’t recognize an ingredient, don’t take it until the components are looked up and the dangers are understood. In high doses, they are dangerous, and potentially fatal or addicting. Most people don’t find the high very enjoyable; people with mental illness like these drugs “too much.”