Call Us to Find Treatment
866.323.5611


Bookmark and Share

OTC & Prescription Drugs

Dextromethorphan

Some adults have trouble believing that more than three million teenagers are abusing cough medicines and cold and flu tablets. It may be impossible for them to picture their teen chugging down three or four bottles of cough syrup or twenty or thirty NyQuils ® in one sitting. However, "robiting" as teens call it is one of the most common ways to get high.

In the early 2000s, many drug experts believed that the cough syrup fad was on the decline. However, the opposite scenario occurred, as usage kept increasing. A 2006 study called Monitoring Their Future found that four percent of eighth graders and seven percent of twelfth graders had tried cough medicines to get high. Between 1999 and 2004, usage increased tenfold, with 75 percent of abusers between ages 9 and 17 years old.

About seven percent of all drug-related emergency room visits in 2004 involved dextromethorphan, the hallucinogenic ingredient in cough syrups that teens seek, and 44 percent of those visits were about non-medical usages of that drug. It was also implicated in 14 percent of suicide attempts treated in ERs.

Dextromethorphan, or "DXM," is celebrated in teen culture. Some of rapper Pimp C's most popular music was about "Sizzurp," and his work was at the top of the Billboard charts when he died of a drug overdose involving DXM in December 2007. Teens share online information about how much cough medicine to take in order to achieve different levels of highs, and they buy it over the Internet in powder form.

DXM is a synthetically produced cousin of codeine and morphine. It is an antitussin or cough suppressant that works by reducing the sensitivity of the brain's cough control center. It replaced codeine in over-the-counter medicines in the 1970s.

Currently, the United States government is not regulating DXM under the Controlled Substance Act. However, the U.S. Drug Enforcement Agency is reviewing that decision because of the drug's widespread abuse among young teenagers.

Forms and Brands
DXM is an ingredient in over 120 common over-the-counter medicines. Most combination drugs for colds and flus contain DXM, including ones with trademarked names including Alka-Seltzer, Actifed, Bayer, Comtrex, Coricidin, Contac, Vicks, Pediacare, Theraflu, Sudafed, Triaminic, and Tylenol.

Any medicine with "tuss" in its name contains DXM, such as Robitussin, Pertussin, and Tussafed. Other common trademarked products are Benylin, Bromarest, Calmylin, Cardec, DayQuil, NyQuil, Delsym, Dimetane, Dristan, Dexan, Ornex, and Viravan.

DXM is sold illicitly over the Internet as a white powder that teenagers inject into their veins.

The street names for DXM are DM, CCC, Triple C, Skittles, Candy, Velvet, Rojo, Robo, and Poor Man's PCP. The name "skittles" comes from the fact that pills containing DXM can look like a popular, colorful candy.

Effects and Use
"Syrup-heads" drink entire bottles of cough syrup as quickly as they can without vomiting. They may take 20 to 30 pills containing DXM at one time, especially at raves and dance clubs.

The effect of the drug varies according to a person's body size and genetic makeup. It also depends upon the amount of drug ingested and whether the person has built up a tolerance to the drug.

In general, at 100 to 200 mg, DXM is a mild stimulant. At 200 to 400 mg, you may experience euphoria and hallucinations; at 300 to 600 mg, distorted vision and loss of motor control; and at 500 to 600 mg, a dissociative (out-of-body) reaction may occur. However, many people will experience only extreme nausea and vomiting or go into convulsions or comas. Between five to ten percent of Caucasians are "poor" metabolizers of DXM and at risk for serious side effects if they take it at levels above the medically recommended dose of 15 to 30 mg.

The drug takes between fifteen minutes and half and hour to take effect if taken by mouth. If injected as a powder mixed with water, the effect is quicker. Hallucinations, dissociative experiences, and feelings of euphoria can last up to six hours.

Even at prescribed levels, DXM causes dizziness, drowsiness, and lightheadedness. No one should drive or operate machinery while using DXM.

Dangers and Risks
Chugging cough medicines is extremely dangerous because users are not only taking in DXM at high levels, but other ingredients such as acetaminophen (Tylenol), ibuprofen (Advil), anti-histamines, guaifenesin, phenylpropanolamine, alcohol, chloroform, and non-narcotic opiates.

Even one very high dose of acetaminophen can permanently damage the liver. A normal dose is between 325 to 1000 mgs; however, twenty NyQuils ® contain 6500 mgs. Acetaminophen combined with alcohol can cause permanent liver damage, and most teens drink when they are "syruping."

Ibuprofen (Advil) interacts with alcohol to cause stomach bleeding and ulcers.

Phenylpropanolamine (Sudafed PE ® ) decreases swelling in nose and ears. At high doses, it can cause hallucinations, dizziness, faintness, changes in heartbeat, seizures and slow breathing.

Since "robiting" is a new phenomenon, no one has studied the long-term effects of using common medications at such high levels. Many "syrup-heads" take 20 or more cold pills a day for months on end. Prolonged exposure to acetaminophen causes liver damage, and long-term usage of anti-histamines damages bone marrow and nerve cells and causes cardiovascular toxicity and high blood pressure. Some teens have died or suffered permanent brain damage from robiting.

Signs of Use
Teens use hallucinogenic drugs either by themselves in their rooms or at social settings like raves. The first kind of user is secretive and wants a lot of privacy. He or she may get high at night and then sleep all day. The party user has often found a new group of friends and is staying out all night.

The Partnership for a Drug-Free America has posted videos of teens who abused DXM. They tell how the drug took over their lives, often for years. They felt "chosen by God" and "enlightened."

Part of the problem is that this drug is available cheaply at any drug or grocery store, so every time they went out, they were tempted to buy it again. When they were using DXM, they said they were selfish, uncooperative, hostile, and mean to their parents and siblings. They lost interest in school and their grades fell. They stopped taking care of themselves. Many experienced major health problems, such as severe headaches, stomach cramps, problems with urination, and fevers.

Overdose
A teen overdosing on DXM may appear to be intoxicated or in a stupor. There may be a fever, numbness of toes and fingers, and facial redness. The person may lose all muscle coordination, stagger, and experience visual distortions, hyperactivity, restlessness, shallow breathing, vomiting, irritability, changes in heartbeat, seizures, and coma. At the highest levels of overdose, teens have lost their ability to move their arms and legs and to talk, and have suffered strokes and permanent brain damage.

If teens combine DXM with depressants, they can die from serotonergic syndrome.

An overdose of phenylpropanolamine is similar. The person will hallucinate, have seizures, dizziness, faintness, and slow breathing, along with upset stomach and tremors.

Taking antihistamines at high levels can cause convulsions, hallucinations, and/or coma.

People who are overdosing on acetaminophen may have sweats, diarrhea, cramps, convulsions, coma, blood in their urine, and black stool.

Another common ingredient in cold medications is Guaifenesin, an expectorant. At very high doses, Guaifenesin abusers may have difficulty breathing and may vomit. Allergic reactions can include closed throat, swollen lips, hives and rashes.

Ibuprofen at very high doses can cause convulsions, blurred vision, black stools, tight chest pain, psychosis, eye pain, nosebleeds and faintness.

Withdrawal and Treatment
There are very few studies on DXM withdrawal and treatment, but that is changing as more teenagers with DXM problems enter rehabilitation programs.

Physical withdrawal is usually not an issue, although many DXM teens will have developed serious health problems that need medical attention. Psychological dependence on DXM is hard to treat because of its easy availability and low cost. Teens must completely change their lifestyles and find new interests to fill the void in their lives that will be created when they stop using DXM.

Some teens have undiagnosed psychological problems such as depression or attention deficit disorder that led them to self-medicate with DXM. Often the underlying problem is an undiagnosed learning disability that has made it impossible for school success.

For these reasons, many teens benefit from going away to a therapeutic boarding school, where they receive intensive counseling on a daily basis. These schools often offer superior academic programs with a teaching staff trained to help teens with learning disabilities and other problems. Caring professionals can help a teen with a drug abuse problem develop new interests, set career goals, and catch up to their peer group.

References
"Dextromethorphan," Drugs.com, posted at http://www.drugs.com/dextromethorphan.html
"DEXTROMETHORPHAN," U.S. Drug Enforcement Agency, Office of Diversion Control, posted at http://www.deadiversion.usdoj.gov/drugs_concern/dextro_m/dextro_m.htm
"Dextromethorphan," U.S. Library of Medicine and the National Institute of Health, MedlinePlus Drug Information, posted at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682492.html
DXM Abuse, Greater Dallas Council on Drug and Alcohol Abuse, posted at http://www.gdcada.org/statistics/dxm.htm
Emergency Room Visits Regarding Dextromethorphan, The Dawn Report, Issue 32, No. 206, posted at http://www.streetdrugs.org/pdf/TNDR10DXMforHTML.pdf.
Griffith, H. Winter (Editor). The Complete Guide to Prescription and Nonprescription Drugs. New York: Penguin Group, 2007.
"Guaifenesin", at Drugs.com, http://www.drugs.com/guaifenesin.html
Nizza, Mike. "Cough Syrup Abuse Worries," The New York Times, February 8, 2008.
"Phenylpropanolamine HCl Oral, Uses and Effects", at Web.MD.com, http://www.webmd.com/drugs/drug-21821-Phenylephrine+HCl+Oral.aspx?drugid=21821&drugname=Phenylephrine+HCl+Oral
Sink, Mindy. "At Your Drugstore: A Cheap and Dangerous High," The New York Times, June 15, 2004.
"What Every Parent Needs to Know about Dextromethorphan," The Partnership for a Drug-Free America, Parent Resources, posted at http://www.drugfree.org/Parent/Resources/Cough_Medicine_Abuse#.

Footnotes
1Nizza, Mike. "Cough Syrup Abuse Worries," The New York Times, February 8, 2008.
2Sink, Mindy. "At Your Drugstore: A Cheap and Dangerous High," The New York Times, June 15, 2004.
3DEXTROMETHORPHAN," U.S. Drug Enforcement Agency, Office of Diversion Control, posted at http://www.deadiversion.usdoj.gov/drugs_concern/dextro_m/dextro_m.htm
4Emergency Room Visits Regarding Dextromethorphan, The Dawn Report, Issue 32, No. 206, posted at http://www.streetdrugs.org/pdf/TNDR10DXMforHTML.pdf.
5Nizza, op cit.
6What Every Parent Needs to Know about Dextromethorphan," The Partnership for a Drug-Free America, Parent Resources, posted at http://www.drugfree.org/Parent/Resources/Cough_Medicine_Abuse#.
7Griffith, H. Winter (Editor). The Complete Guide to Prescription and Nonprescription Drugs. New York: Penguin Group, 2007, pg. 312.
8DEXTROMETHORPHAN," U.S. Drug Enforcement Agency, op cit.
9Griffith, H. op cit, pg. 883-884.
10"DEXTROMETHORPHAN," U.S. Drug Enforcement Agency, op. cit.
10Ibid.
11"What Every Parent Needs to Know about Dextromethorphan," op cit.
12Griffith, op cit, pg. 311.
13bid, pg. 114.
14"Phenylpropanolamine HCl Oral, Uses and Effects", at Web.MD.com, http://www.webmd.com/drugs/drug-21821-Phenylephrine+HCl+Oral.aspx? drugid=21821&drugname=Phenylephrine+HCl+Oral
15Griffith, op cit, pg. 108.
16DXM Abuse, Greater Dallas Council on Drug and Alcohol Abuse, posted at http://www.gdcada.org/statistics/dxm.htm
17"Dextromethorphan," The U.S. Library of Medicine and the National Institute of Health, MedlinePlus Drug Information, posted at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682492.html
18Ibid.
19DEXTROMETHORPHAN," U.S. Drug Enforcement Agency, op cit.
20"Phenylephrine HCl Oral, Uses and Effects", op cit.
21Griffith, op cit, pg. 106.
22Ibid, pg. 8-9.
23Griffith, op cit, pg. 114.
24What Every Parent Needs to Know about Dextromethorphan," op cit.