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Cold Medicine and Cough Syrup Addiction and Abuse Resource Guide

Cold medicines sold over the counter (OTC) are largely considered to be safe. Those who are sick can take these medications without causing harm to their body. When taken like the instructions suggest, the dosage is safe.  When used correctly, OTC cold medicines are effective in the management of cold or flu symptoms. Prescription cough syrups function in a similar manner to OTC cough syrups. The only difference is that they contain stronger active ingredients. Some of these ingredients may have a higher potential for abuse. It’s possible to develop a psychological and physical dependence on these medications. Those who are addicted to cold medicines and cough syrups may need medical detox. The detox process can help ease withdrawal symptoms. It makes the addiction recovery process feel a lot more comfortable. Unfortunately, it’s possible to abuse not only prescription cough syrups, but OTC ones as well. It’s possible to develop both a physical addiction and a psychological addiction to both types of substances. Here’s what you need to know about an addiction to cold medicine or cough syrup.

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What Is the Difference Between OTC and Prescription Cough Syrups and Cold Medicines?  

So, what’s the difference between prescription cold medicines and OTC ones? Why do some medications need a doctor’s license while others don’t? Are they both the same thing? If not, what’s the difference? Let’s break this down. OTC medicines do not need a doctor’s prescription. You can get the medication from store shelves in a pharmacy. You can also often find them in supermarket or small convenience stores. These prescription medications can be used by more than one person. Patients usually purchase these medications from a self-diagnosis. For example, a person who is coughing or sick with the cold may decide to purchase OTC cold medicines or cough syrup on their own. It’s purely a self-care decision. On the other hand, prescription medications do need a prescription from a doctor. You could also have a licensed healthcare provider, like nurse practitioner, write a prescription for the medicine, as long as they under the authority of a doctor. Prescription medications cannot be found on store shelves. Instead, they can only be dispensed by a pharmacy. It’s also only for the person with the prescription. Not everyone can or should use it. So, why does one need to be more regulated than the other? Simple. Prescription medications tend to be stronger and more potent than OTC medicines. With that said, both types of cough syrups and cold medicines can be harmful to the body if they are misused. At times, the prescription medications may have a higher dose of the active ingredient. Abuse of cold medicines can lead to many dangerous side effects and consequences.

Common Active Ingredients in Either OTC or Prescription Cough Syrups

Both prescription and OTC cough syrups contain similar active ingredients. The most popular ingredient in OTC cough syrup is dextromethorphan. On the other hand, the most common active ingredients found in prescription cough syrups include promethazine and codeine. In general, the active ingredients found in prescription medications are a bit more potent than the ones found in OTC cold medicines. Let’s take a look at these active ingredients below.


Dextromethorphan is a drug found in more than 40 different over-the-counter cold medicines.  Dextromethorphan (DMX) is a cough suppressant. When taken in large amounts, this active ingredient can cause psychedelic reactions similar to the street drug PCP. This shows that OTC cold medicine abuse can be just as dangerous as the abuse of illicit drugs.  When compared to the risk and cost of using street drugs, OTC cold medicines are a cheap way to get a legal buzz. Dextromethorphan is a popular drug of choice for teens. From 2000 to 2010, there were more than 44,000 reported causes of DMX abuse. The drug is popular because of the psychedelic reaction and because it’s easy to get. Some people can walk into a supermarket and find DMX on the shelves. It is legal to purchase in every state except California, where it is illegal to sell to minors. DMX abusers experience a heightened sense of perceptual awareness and visual hallucinations. Although it’s possible of creating a strong high, DMX abuse can lead to some serious consequences. Long-term abuse can cause liver, kidney and brain damage. DMX can also cause an increase in blood pressure and respiratory distress.  Motor function may become impaired. Abusing DMX will also have a negative effect on the person’s lifestyle. Common changes are negative moods, dropping out of activities and withdrawal from relationships that were once important. Depression is a common side effect of abusing DMX. This is one of the most common co-occurring disorders associated with cold medicine addiction.


Pseudoephedrine is another commonly abused over–the–counter medication. However, in recent years, this active ingredient is mostly found in prescription cold medicines. When pseudoephedrine is found in prescription cold medicines, it’s usually more potent. This is because this active ingredient can be quite strong. Abuse can also lead to some serious consequences. This drug is for allergies and sinus congestion. When used in large amounts, pseudoephedrine acts as a stimulant. Abuse of this drug can cause heart palpitations and anxiety. Loss of appetite, nausea and dizziness are also some common adverse effects. Those who take too much of this type of cold medicine will experience overdose symptoms like:

  • Convulsions (seizures)
  • Hallucinations
  • Increase in blood pressure
  • Irregular heartbeat or arrhythmia
  • Rapid breathing or shortness of breath

A pseudoephedrine overdose can be quite dangerous. It will require immediate medical attention. To give you a better idea of how strong pseudoephedrine is, consider this. Pseudoephedrine is used for compounding the street drug methamphetamine. That’s right. It’s found in meth.


Another popular active ingredient in cold medicine is diphenhydramine. This is a nonselective first-generation antihistamine. It has significant sedating and anticholinergic properties. This compound is found in many cold and allergy products. It can help suppress a nonproductive cough. Diphenhydramine acts on the medulla. It increases a person’s cough threshold. It can ease both chemical or mechanical respiratory tract irritation. It’s quite effective. With that said, this type of medication comes with some adverse effects as well. It can cause drowsiness, respiratory depression, urinary retention and blurry vision.

Codeine-Promethazine Combo

The codeine-promethazine combo is reserved for prescription medications only. After all, codeine is a narcotic. With that said, it functions in a similar manner to diphenhydramine. It surpasses both chemical and mechanical irritation of the respiratory tract. Codeine is an opioid, and will attach to opioid receptors in the central nervous system (CNS). When found in prescription medications, codeine has a low toxicity. This is because the dosage is fairly low. There is little risk of addiction. Unfortunately, those who abuse codeine will experience euphoric effects. At high doses, codeine is addictive and can cause many adverse effects, like dizziness, vomiting and sedation. In worst-case scenarios, it can cause respiratory depression. It’s incredibly easy to get addicted to a drug like codeine. After all, it’s an opioid. If you’re wondering whether you or a loved one is addicted, check out our addiction quizzes. They’ll help you figure out whether you have an addiction. You can also speak to one of our addiction specialists. They’ll assess your situation to see where you stand.

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The Sensation Surrounding ‘Lean’ or Purple Drank

If you’ve up-to-date on current rap culture, then you’ve probably heard many big name rappers, like Lil Wayne, mention the word ‘lean’. This drug of choice is prevalent in many rap and hip-hop songs played on the radio. You’ll hear Lil Wayne mention it in his song, ‘I feel like dying’, or A$AP Rocky rap about it in, ‘Purple Swag’. It seems like a lot of songs on the radio mention this homemade drug. What exactly is ‘lean’? Why is it so popular? Other names for it include purple swag, purple drank and sizzurp. This unique drink got its name for making people lean after drinking it. But, what is it exactly? Lean first originated from Houston, Texas. It’s a simple drink to make. Most of the ingredients can be found in a local supermarket. There’s nothing really fancy in it. To make this drink, you would pour the following ingredients together in a styrofoam cup:

  • Promethazine with codeine
  • Original sprite soda
  • Jolly rancher candies

The main ingredient is the promethazine with codeine. This is also known as cough syrup. The promethazine in the prescription cold syrup impairs motor skills. It causes the drinker to feel drowsy and disassociated with their body. This is where the name ‘lean’ comes from. The codeine, which is an opioid, creates a euphoric feeling. The jolly ranchers are just there for flavor. The most popular flavor is grape. The color for this jolly rancher is purple, which is just like the drink. Some people like to mix it up by using flavored sprite soda. The most prominent color in this drink is purple. This is the color of the cough syrup, which is why lean is also known as purple drank or the purple drink. People in different regions may also call this concoction by different names.

The Dangers of Lean

Although pop culture has popularized ‘lean’, this drink is actually quite dangerous. Most notably, this unique cough syrup cocktail claimed the life of DJ Screw. He overdosed on a codeine-promethazine-alcohol cocktail. Mixing cold medicine and cough syrup with other substances, like alcohol, is particularly dangerous. The most dangerous ingredient in ‘lean’ is the codeine. Codeine is a prescription opioid, and a Schedule II Controlled Substance in America. It has a high potential for abuse. This is the reason why many people who drink ‘lean’ get addicted to it. With that said, codeine is not the only dangerous ingredient found in ‘lean’. Too much codeine can cause side effects like cardiac and respiratory depression and failure. The prescription cough syrup also contains promethazine. Promethazine is a great ingredient for a cough syrup because it reduces congestion. It’s effective in small amounts. However, those who make purple drank will often consume large amounts. When a large dose of promethazine is consumed, the drug abuser is susceptible and vulnerable to many dangerous side effects. Some of these side effects may be permanent and irreversible. Some of the most common side effects of lean include:

  • Confusion
  • Hallucinations
  • Night terrors
  • Seizures
  • Wheezing

Promethazine is a strong sedative. When combined with codeine, its effects are enhanced. Much like with codeine, it’s possible to get addicted to promethazine. Those who develop an addiction to prescription cough syrup will experience withdrawal symptoms when they try to quit. These withdrawal symptoms can be quite intense and overbearing. They make it difficult for drug addicts to get sober. Lean is also dangerous because there is no set standard for the drug. Its potency will depend on who is mixing the drink. Some people can make it very strong, while others can make it fairly weak. There’s no telling whether the drink in a person’s hand is going to be strong or weak. Due to this reason, it’s also easy to overdose on this cocktail.

What Are the Side Effects of Abusing Cold Medication/ Cough Syrup?

The side effects of cold medicine or cough syrup abuse will differ based on the active ingredients found in the medicine. For example, DMX can cause hallucinations and out-of-body sensations that are similar to ketamine and PCP. Short-term side effects can last as long as 6 hours. With that said, many cold medicine side effects are similar to one another. Some of the most common short-term side effects to be expected include:

  • Blurred vision
  • Confusion and Paranoia
  • Dizziness
  • Impaired judgment
  • Irregular heart beat
  • Profuse sweating
  • Restlessness
  • Slurred speech
  • Shortness of breath
  • Vomiting and nausea

The type of side effects to be expected will also depend on the length of the cold medicine abuse as well as the dosage taken. There are many different types of side effects that can be expected. The intensity of the side effects will also vary from person to person. Some people will struggle with the side effects more than others. It may be due to one’s biological makeup or genetics.

The Dangers of Mixing Cough Syrup or Cold Medicines with Alcohol

Serious interactions can happen when mixing alcohol with drugs.  Combining street drugs or even prescription drugs with cold medicines can cause permanent damage to your body and mind.  All cold medicines have other drugs added to provide relief for symptoms that accompany a cold. Antihistamines, decongestants and fever reducers, are only safe when taken as prescribed.  There is no way of knowing how your body will react when you overdose on cold medicine. Using alcohol to enhance the effect of your cold medicine can prove to be fatal. Combining any drug with alcohol can be lethal, so it’s best to avoid alcohol when taking cold medicine. Different types of cold medicines and cough syrups will have different drug interactions with alcohol. For example, both codeine and alcohol are depressants. This means that both substances will magnify the effects of one another. Each substance works on a different part of the brain. Codeine binds to opioid receptors, while alcohol mainly influences the GABA receptors. Both substances affect dopamine and serotonin levels. Long-term abuse will cause these neurotransmitter levels to go haywire. Those who mix alcohol with cough syrup or cold medicine are much more likely to experience overdose symptoms. The effects of each substance are magnified. There’s no telling just how intense the effects can be. Similarly, those who mix alcohol with a stimulant may be just as likely to overdose. They don’t realize just how much of each substance they are taking. The different substances may dim the effects of one another. As a result, the drug addict may end up taking too much of one substance.

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Get the Help You Need with Cough Syrup Addiction Treatment

Although cough syrups and cold medicines are effective in treating colds, you need to be careful not to abuse these drugs. Non-compliance with dosage or non-adherence to a schedule can lead to drug addiction. In high doses, both OTC and prescription cold medicines can create euphoric sensations. Unfortunately, since OTC cold medicines are easy to get, they’re quite popular, especially among the younger generations. These medicines are also fairly cheap. They’re a legal and inexpensive way of getting high. An addiction to cold medicine is dangerous to your health, and maybe even to your life. If you or someone you know is struggling with addiction to cold medicine, get help. Professional treatment from a drug rehab center will do wonders in helping you wean off of cold medicines and cough syrups. Depending on the intensity of the addiction, you may or may not need detox. Ashwood Recovery is here to help you and your loved ones overcome addiction and other disordered behaviors. Our counseling programs have already helped many of our clients get their lives back. Call us now to start your journey to recovery today. Don’t let addiction and other dangerous behaviors go untreated, and cause extreme emotional, mental and physical hurt and harm to yourself and those around you.