There are many reasons to avoid abusing Dextromethorphan

Dextromethorphan is known to cause many negative effects and deaths have been reported from its use. In 2003, a 14-year-old boy in Colorado who abused dextromethorphan died when he was hit by 2 cars as he attempted to cross a highway.
 
State law enforcement investigators suspect that the drug affected the boy’s depth perception and caused him to misjudge the distance and speed of the oncoming vehicles.
 
Who do people addicted to illicit drugs get their drugs from? A friend? A spouse? A family member? A drug dealer?
 
Where do people addicted to illicit drugs get their drugs from? A secret hideout? An obscure location? Nightclubs? Bars? Schools? The workplace? ……..or, from home! Prescription pills and over-the-counter medications stored in medicine cabinets are examples. Also, laundry detergent pods and air dusters found in homes.
 
For people who do not use drugs, the source of these addictive substances tends to be a little bit of a mystery. It is common to hear family members of patients say: “I have no idea where he even buys these drugs from!”
 
Some drugs like cocaine, methamphetamine, heroin, and ecstasy may be hard to come by. But some other addictive substances lay in plain sight.
 
Cough and flu medications are examples of some substances which can be addictive. These are very easy to get. They are common in most home medicine cabinets. The ease of being able to buy them from supermarkets, pharmacies and from the internet also does not help.
 
Dextromethorphan (DXM) is the active ingredient in these over-the-counter medications. It gives people a high and induces euphoria. Long term use of high doses can be habit-forming.
 

What is Dextromethorphan?

DextromethorphanDextromethorphan is a cough suppressant found in more than 100 over-the-counter (OTC) medications. These OTC medications treat colds, flu symptoms, fever, aches, runny nose, and congestion. Dextromethorphan is available in liquid form, tablets, capsules, and powder.
 
DXM-containing medicines are safe used short-term as directed. Their prolonged use and abuse may result in serious health risks including addiction.
 
Addiction to dextromethorphan is uncommon but does happen. It is usually regarded as a substance with a moderate likelihood of causing addiction. Regular use of this substance over long periods to get high may lead to being dependent on it. Abuse of dextromethorphan is more common in people between 12-25 years old.
 
This substance can be misused without suspicion from family or friends. It is inexpensive, legal and easy to get. This explains the reason why this addiction occurs more in teenagers.
 
Dextromethorphan is obtainable either alone or in combination with other medications such as:
  • Antihistamines (e.g. chlorpheniramine)
  • Analgesics (e.g. acetaminophen)
  • Decongestants (e.g. pseudoephedrine)
  • Expectorants (e.g.guaifenesin)
These DXM-containing medications help with cold and flu symptoms when taken as prescribed. They also have the added advantage of helping people fall asleep at night. Unfortunately, this sedative effect may lure some people to taking larger doses.
 

Common Street Names

Dextromethorphan has several common street names. Some of such names are:
  • Robo
  • CCC
  • Poor Man’s PCP
  • Dex
  • DXM
  • Velvet
  • Triple C
  • Rojo
  • Skittles

 

How is Dextromethorphan abused?

cough syrupThe recommended dose of several OTC cough and flu medications is 10 to 30 mg taken 3-4 times daily as needed. The largest dose recommended is 120 mg in 24 hours.
 
Taken as directed, side effects are rare. The cough-suppressing effects of dextromethorphan may last for about 5-6 hours.
 
People who abuse dextromethorphan may take doses as high as 250 mg to up to 1500 mg per day. It is not uncommon to hear people addicted to dextromethorphan consuming up to 4-5 bottles of cough syrup daily.
 
In the past, dextromethorphan abuse has involved consuming several bottles of cough syrup. More recently, abuse of the tablets, gel capsules and powder has increased. These usually are more concentrated with high doses of dextromethorphan.
 
Dextromethorphan powder poses a unique risk to the user due to the uncertainty of what it contains and the dose of dextromethorphan it contains. This risk is further heightened when the powder is snorted. Besides swallowing and snorting, some users also inject dextromethorphan.
 
Such high-dose dextromethorphan products are much easier to abuse. Because they eliminate the need to drink large amounts of unpleasant-tasting syrup. They are also easier to conceal, allowing the abuser to continue to use throughout the day, at work or school.
 
The abuse of dextromethorphan is particularly dangerous when combined with alcohol.
 

What is Robo-tripping?

The street names for the illicit use of dextromethorphan are “Robo-tripping,” “skittling,” or “dexing.” There are several DXM-containing OTC products available. Some are NyQuil, Robitussin, Coricidin, Benylin, Mucinex, Vicks, Delsym and TheraFlu.
 
High doses of dextromethorphan cause euphoria as well as visual and auditory hallucinations. Very high doses of dextromethorphan act as a dissociative anesthetic, producing psychedelic effects.
 
In lower doses, dextromethorphan may have effects like marijuana or ecstasy. In higher doses, it causes out-of-body effects (dissociation). These effects are like those produced by ketamine and PCP. This is likely the reason dextromethorphan is sometimes referred to as Poor Man’s PCP.
 
Dextromethorphan usually provides its recreational effects in a non-linear fashion. This means its effects occur in varied stages known as “plateaus.” There are 4 plateaus which manifest with different effects and experiences:
 
Plateau 1. 100-200 mg: this dose tends to cause mild to moderate stimulation
 
Plateau 2. 200-400 mg: this causes euphoria and hallucinations (seeing, hearing and feeling things that are actually not there). Visual hallucinations tend to be the most common.
 
Plateau 3. 300-600 mg: leads to lethargy, sedation, more distorted visual perceptions and loss of motor coordination. Also, impaired response times. 
 
Plateau 4. 500-1500 mg: doses this high result in extreme sedation and out-of-body sensations (dissociation). This might cause users to feel as though they are leaving their bodies or as though things are not real
 
The effects of dextromethorphan can begin within 15 mins of consumption and may last as long as 6 hours. It may present with confusion and a distorted sense of reality. This may lead to psychological and behavioral issues.
 
You should never mix high doses of dextromethorphan with alcohol! DXM and alcohol are both central nervous system depressants. This means they both decrease the activity of the cells in the brain and spinal cord. This multiplying effect enhances the side effects and potential dangers.
 

History and Statistics

Dextromethorphan is a synthetic drug that was discovered in the 1940s and has been used to make medications as far back as the 1960s. DXM was approved as a solution to the problems associated with the use of codeine as a cough suppressant. The issues of concern with codeine were drowsiness and addiction.
 
During the 1960s, dextromethorphan became available over the counter in tablet form. It was removed from shelves because of abuse.
 
The chemical structure of DXM is similar to a derivative of codeine, known as levorphanol. Despite this similarity in chemical structure to opioids, DXM has a different effect on the brain.
 
Abuse amongst teenagers is quite common. According to a 2017 University of Michigan survey, about 3.2% of high school seniors reported misusing cough or cold medications in the past year. Abuse of these products was more common among 12th-grade students than the abuse of sedatives or Ritalin.
 
The Drug Abuse Warning Network’s Dawn Report showed that persons between the ages of 12 and 20 years old accounted for more than half of emergency room visits for non-medical use of dextromethorphan.
 
SAMHSA’s 2008 National Survey on Drug Use and Health (NSDUH) states that in 2006, 3.1 million Americans between 12 and 25 years old had ingested cough and cold medicine recreationally. Adolescents aged between 12 and 20 years made up 51% of hospitalizations from DXM overdose.
 
The Monitoring the Future Survey from 2011 reported that 2.9% of 8thgraders, 4.3% of 10thgraders and 5% of 12thgraders abused DXM cough and cold medicines that year.
 

What are the symptoms of Dextromethorphan abuse?

DXM acts by blocking receptors in the brain known as NMDA receptors.
 
Some of the effects of dextromethorphan when taken in high doses include:
  • Impaired judgment
  • Confusion
  • Increased blood pressure (hypertension)
  • Increased heart rate (tachycardia)
  • Out-of-body experience
  • Hallucinations
  • Blurred vision
  • Dizziness
  • Dilated pupils
  • Hot flashes and sweating
  • Nausea
  • Dry mouth
  • Altered perception of time
  • Decreased cognitive ability
  • A floating sensation
  • Paranoia
  • Panic attacks
  • Rapid eye movements (nystagmus)
  • Inappropriate laughter
  • Agitation
  • Lethargy
  • Slurred speech
  • Blackouts
  • Skin rash and itching
  • Mood swings
  • Behavioral changes
People who abuse dextromethorphan may also present in other ways. These include a change in physical appearance, changes in eating pattern, changes in friends and social network, loss of interest in hobbies and family activities, financial distress, poor hygiene and decrease in work or academic performance.
 
Prolonged use at high doses may eventually lead to tolerance, dependence, and addiction.
 
NyQuil Was My Gateway Drug is a story that gives a personal account of addiction to this substance.
 

What are the symptoms of dextromethorphan withdrawal?

Tolerance and dependence can lead to withdrawal symptoms in users who do not consume DXM. Withdrawal usually starts within a few hours of last use and typically peaks within about 3 days.
 
Such withdrawal symptoms which you may experience include:
  • Nausea and vomiting
  • Restlessness
  • Anxiety
  • Difficulty sleeping
  • Upset stomach with diarrhea
  • Cravings
  • Weight loss
  • Tremors
  • Cold flashes

Overdosing on dextromethorphan

Deaths have been reported from combining high doses of dextromethorphan with alcohol and other drugs. About 5-10% of Caucasians are poor DXM metabolizers. This means such people are at increased risk for overdoses and deaths.
 
In 2014, the American Association of Poison Control Centers reported 45,748 cases of DXM poisoning, with 6 deaths.
 
Generally, DXM overdose does not result in life-threatening consequences or death. Most of the reported deaths are due to ingesting dextromethorphan in combination with other drugs. Deaths from DXM consumption also occur from impairment of the senses, which leads to accidents. Some users appear intoxicated when they consume high doses of this substance.
 
Dextromethorphan overdose can lead to:
  • Drowsiness
  • An intoxicated appearance
  • Hallucinations
  • Difficulty breathing
  • Loss of muscle coordination
  • Hyperactivity and restlessness
  • Fever
  • Numbness of toes and fingers
  • Facial redness
  • Bluish tint under the fingernails, on the lips and tip of the nose
  • Brain damage
  • Strokes
  • Seizure
  • Coma
  • Death
 
DXM-containing products often contain other ingredients. These include acetaminophen, guaifenesin, and chlorpheniramine. In high doses, these substances can produce their own negative effects. Such symptoms include damage to the liver, lack of coordination, vomiting, increased heart rate, seizures, and coma.
 

What is the legal status of dextromethorphan in the United States?

DXM is a legally marketed cough suppressant in the United States. It is neither regarded as a controlled substance nor a regulated chemical under the Controlled Substances Act.
 
Due to its abuse potential, several states now have legislation on dextromethorphan. The goal is to limit how much DXM-containing medications someone can buy at a given time. In some states, sellers have to check for identification before selling. The goal is to ensure only legal adults buy these substances
 

Treatment of dextromethorphan Addiction

Dependence on dextromethorphan can cause significant impairment. This may need treatment in a professional setting. Most people who use this substance, however, do not become addicted to it. It is important to seek professional help if addicted.
 
Treatment for dextromethorphan may be done in an outpatient or inpatient treatment facility. The choice depends on the level of severity, the individual and the circumstances. Detoxification and behavioral therapy are the 2 main focuses of treatment.
 
Detoxification from dextromethorphan can be made more comfortable with “comfort medications.” These medications help with symptoms like nausea and difficulty sleeping. There are no specific medications to help with withdrawals from DXM. 
 
Evidence-based therapies such as cognitive behavioral therapy and contingency management help with sobriety. Cognitive behavioral therapy helps to change cognitions, expectations, and behaviors associated with the misuse of drugs. Contingency management provides rewards for abstinence and other positive behaviors during the course of treatment.
 
Behavioral treatment may be done as individual or group therapy. The goal is to help you understand your addiction and address your behaviors related to addiction. It also helps to build a good social support network to help you avoid relapse.
 
Other behavioral therapy components include analyzing relapse situations, role play to prevent relapse, social competency training, relaxation techniques and activating personal resources, especially as regards the individuals own coping mechanisms.
 

Conclusion

Dextromethorphan (DXM) is a cough suppressant and opioid derivative. It is used in several over-the-counter medications such as NyQuil, Robitussin, and Coricidin HBP.
 
When taken as directed to treat cough and cold, dextromethorphan is safe and not habit-forming. However, when taken in large doses or administered via alternate methods such as injecting or snorting, there can be negative consequences.
 
Dextromethorphan has several street names including Robo, CCC, Poor Man’s PCP, Dex, DXM, Velvet, Triple C, Rojo, and Skittles.
 
The abuse of dextromethorphan is more commonly observed in teenagers, likely due to ease of access and low cost. The ease of obtaining DXM-containing products from home medicine cabinets, supermarkets, and pharmacies make it easy to abuse. “Robo-tripping” is a street term used to describe taking high doses of this substance to experience euphoria and an out-of-body experience.
 
Tablets, gel capsules, and powder can also be obtained from the internet. These come with their unique problems. Modalities of use like snorting and injecting can be fatal. Dextromethorphan is also available as sprays and lozenges.
 
Consumption of low doses of dextromethorphan can present like marijuana and ecstasy. Higher doses can present as an out-of-body experience known as dissociation. These effects are similar to those produced by ketamine and PCP.
 
People who abuse dextromethorphan may present with impaired judgment, confusion, increased blood pressure, increased heart rate, out-of-body experience, hallucinations, blurred vision, dizziness, hot flashes, sweating, nausea, altered perception of time and decreased cognitive ability
 
Other symptoms include floating sensation, paranoia, panic attacks, rapid eye movements, inappropriate laughter, agitation, lethargy, slurred speech, mood swings, and behavioral changes.
 
Overdosing on dextromethorphan can lead to strokes, brain damage, seizures, coma, and even death.
 
Treatment of dextromethorphan addiction can be done outpatient or inpatient depending on the individual, the severity and the circumstance. The mainstays of treatment are detoxification and evidence-based therapies such as cognitive behavioral therapy and contingency management.
 
Have you had a personal experience with dextromethorphan? Do you know someone who struggled with this addiction? Help someone today by sharing your experience in our comments below. Sharing this article on social media may also go a long way in helping someone in distress.