When you think of drugs that are addictive or abused, you probably think of street drugs like cocaine or heroin. But the most commonly abused drugs in America may already be in your house, innocently disguised as cough medicine. In the past, cough medicine abuse mainly involved prescription cough medicines that are in the same drug family as heroin. However, it now includes over-the-counter (OTC) cough medicines with dextromethorphan (DXM). In large doses, DXM can cause hallucinations, making it a common drug of abuse for teens looking for a cheap and easy high. Cough Medicines With Codeine Like heroin, codeine is a narcotic derived from opium. These drugs are called opiates. Codeine can cause a feeling of well-being called euphoria. It can also cause physical and psychological addiction. Once people become addicted, they will have withdrawal symptoms similar to those of heroin users if they stop. Codeine is a powerful cough suppressant. Cough syrups with codeine are available without a prescription after registering with the pharmacy in most states. (Some states require a prescription.) Some brand names for these drugs include Guiatussin with Codeine, Tussi-Organidin-S NR, Robitussin AC, and Mytussin AC. Codeine is the most commonly ingested opiate in the world, partly because of its use in cough syrups. It’s also among the many drugs of abuse for 1 out of every 6 teenagers — usually before the age of 15. In large doses, codeine can cause itching, nausea, headache, low blood pressure, and trouble breathing. Cough Medicines With Hydrocodone Hydrocodone is another powerful opiate often used in prescription cough medicines. It is the most frequently prescribed opiate in the United States and the second most common drug of abuse, according to the Drug Enforcement Agency (DEA). Hydrocodone is available illegally on the street and on Internet sites. Brand name cough medicines with hydrocodone include Tussionex, Donatussin MAX, Entuss, Hycotuss, and Kwelcof. A 2012 report found that close to 4% of 12 th graders in the United States abuse hydrocodone. If a person becomes addicted to hydrocodone, the body builds up tolerance to the drug quickly and requires more and more to get high. In 2011, there were more than 82,000 emergency room visits due to hydrocodone overdose. Cough Medicines With Dextromethorphan Dextromethorphan is not a narcotic and is available over the counter. It came to market as an OTC alternative to codeine in 1958. DXM is now an ingredient in nearly 100 cough and cold preparations, including popular cough syrups, such as Triaminic and Robitussin. It is not physically addictive like opiates, but it is dangerous when abused. As many as 1 in 20 teens admit to using DXM cough medicine to get high. At a normal dose, DXM is a safe cough suppressant. At 25 to 50 times the normal dose, DXM can cause hallucinations and an altered state of consciousness similar to the effects of phencyclidine (PCP). It’s hard to take that much cough syrup without gagging or vomiting. But pure forms of DXM powder are now available on the street with names like red devils, dextro, robo, and skittles. There are also websites that tell kids how to extract pure DXM from OTC drugs. Side effects from DXM in large doses can last up to 6 hours. They may include nausea, vomiting, seizures, high blood pressure, panic attacks, and impaired judgment. Regular abuse of DXM can lead to psychosis (break from reality) that may require hospitalization. A hidden danger of abusing DXM is taking too much acetaminophen along with DXM. Acetaminophen is the active ingredient in Tylenol, and is also in many OTC cough and cold medicines. In large doses, acetaminophen can cause irreversible liver damage. Avoiding Cough Medicine Abuse and Addiction If you get a cough medicine prescription from your doctor, take it only as directed. If you buy an OTC cough and cold preparation, use it only as instructed on the label. Check with your child’s doctor before giving a cough medicine to a young child. The American Academy of Pediatrics does not recommend any OTC cough and cold medicines for young children. Here are other tips to stay safe: Watch for warning signs of cough medicine abuse, such as empty cough medicine boxes, missing medications from medicine cabinets, behavior changes, unexplained requests for money, and use of slang terms like skittles, dexing, and robo-tripping. Monitor the websites your children are visiting. Keep track of all cough medicines at home and don’t stock up. Don’t allow kids to keep medications in their room, backpack, or school locker. Talk to kids about the potential dangers of cough medicines. Many kids and adults assume that because it is a cough medicine or an OTC medicine, it must be safe. Set a good example by using all medications, including cough medicines, responsibly. Key Takeaways Prescription cough medicines with codeine and hydrocodone are narcotics. They can cause physical and psychological addiction. OTC cough medicines with dextromethorphan are not narcotics, but they can cause hallucinations and are a common source of OTC drug abuse in teens. Know the dangers of cough medicines and teach your children about them. Keep track of cough medicines in your home, watch for signs of drug abuse, and monitor your computer for use of websites that sell or promote cough medicine abuse.