Some users claim to see aliens conjured from the collective unconscious. Others temporarily lose their ability to walk. Some have written stories on the Internet: “I felt my soul being ripped from my body,” and, “Are you a vampire? No, I just met God.” But it’s not heroin or PCP they are taking – it’s cough syrup.

What is it ?
   Dextromethorphan (DXM), a synthetic drug chemically similar to morphine, was approved by the FDA as a cough suppressant in 1954. Drug manufacturers developed and began putting it in cough syrups in the 1970s as a suppressant that would be less addictive and have fewer side effects that the narcotic, codeine.
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x  When used at the recommended doses, it is a very effective cough suppressant. When taken at much higher doses, however, it acts as a disassociative anesthetic, similar to PCP and ketamine. At these high doses, DXM is also a central nervous system depressant. DXM is often used in combination with other drugs such as marijuana, ecstasy, or alcohol, which only increase the dangerous physiological effects.
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x  Poison control experts point to a four-fold increase in abuse cases since 2000, mostly involving school-aged youth and young adults, particularly among those who are part of the danceclub or “rave” scene. Intoxication comes from swallowing large doses of the cough syrup, known as “robo-dosing” or “robo-tripping” or taking hands full of cough suppressant pills, sometimes called “skittles” (because of an appearance similar to the popular fruit candy). Those who use the cough syrup to get high are sometimes called “syrup heads.”
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x  The drug creates a depressant effect, as well as a mild hallucinogenic effect, and is often used as an alternative to ecstasy. According to addiction experts, cough syrup’s inexpensive price and easy availability is attracting adolescents.

Street Names
   Dex, DXM, Robo, Skittles, Syrup, Triple-C, Vitamin D, Tussin

What does it look like ?
   DXM is the active cough-suppressant ingredient in more than 125 commercial cough remedies in the United States. It is found in some formulations of cough remedies sold under such brand names as: Robitussin®, Delsym®, Pertussin®, Drixoral®, Vicks formula 44®, Triaminic®, Coricidin®, Sudafed®, Contac®, and many generic brands. Most of these brands come in multiple formulations, and not each formulation contains DXM. Dextromethorphan-containing remedies often are labeled as “DX” or “Maximum Strength.” Each brand contains different quantities of DXM, with capsules, tablets, lozenges, and other “pills” containing about 20–30 mg. each. Most commercial cough remedies contain multiple active ingredients (to produce the advertised “multi-symptom” relief), and these other ingredients may create their own toxic effects when used in the high doses common among psychoactive users. Poison control experts consider the most dangerous in large amounts to be Coricidin HBP®, which contains an additional antihistamine that makes abuse far riskier than with other DXM products.

How is it used ?
   In the past, cough syrup was the most commonly abused form of the drug. Abusers consumed large doses—usually at least half an 8-ounce bottle—by drinking the liquid very quickly. (Consumption of large quantities of cough syrup induces vomiting. Thus, to achieve the desired effects, abusers must drink the product quickly enough to allow the body to absorb the DXM before vomiting occurs). Today, however, abusers use the Internet to not only buy DXM in pure powder form (which alleviates the vomiting), but to learn how to abuse it. Some sites even have online dosing calculators that coach abusers how much they’ll need to take for their weight to get high.

Effects & Risk
   Misuse of this legal drug is just as harmful as taking illegal drugs. The effects of DXM abuse vary with the amount taken. DXM abusers describe a set of distinct “plateaus” ranging from a mild stimulant effect or excitement with distorted visual perceptions to a sense of complete dissociation from one’s body. Since DXM’s psychoactive effects only kick in when massive amounts are consumed, common side effects blur together with symptoms of overdose.
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x  While under the influence of the drug, which can last for as long as six hours, DXM abusers risk injuring themselves and others because of the drug’s effects on visual perception and cognitive processes.
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x  High doses of DXM can cause the inability to move arms or legs or to talk, slowed breathing, permanent brain damage, cerebral hemorrhages, stroke, and even death (from stopped breathing.) In addition, individuals risk hypothermia (exceptionally high fever), particularly if they use the drug in a hot environment or while physically exerting themselves—such as at a rave or danceclub.
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x  Other risks associated with DXM abuse include nausea, abdominal pain, vomiting, irregular heartbeat, high blood pressure, headache, numbness of fingers and toes, loss of consciousness, seizures, and even death.
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x  Nationwide, thousands of overdoses have been reported by emergency room doctors. Authorities say DXM overdoses typically occur in clusters, as word of the drug spreads in a community’s middle schools and high schools.

Federal Classification
   DXM is not illegal. The drug is available without a prescription because, when used properly, it has proven to be a safe and effective means of cough suppression. Even though the drug is not regulated as a prescription drug, or as a controlled substance, being intoxicated on ANY drug in a public place can subject a user to prosecution for disorderly conduct, disturbing the peace, and similar violations. Those providing intoxicating doses of this drug to minors or to adults unaware of the dangers can be subject to prosecution under laws designed to protect juveniles and the general public.
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x  Reports of DXM abuse have resulted in monitoring by the DEA, and the drug could be added to the Controlled Substances Act if warranted.

Additional Online Resources
    DXM - An In-Depth Look
    Factline of Non-Medical Use of DXM
    Feds Investigate Teens’ Internet Drug Purchases
    Triple-C Fast Facts