The Medtox DARS (Drug Abuse Recognition System) team has uncovered an increasing trend of dextromethorphan (DM, DXM) abuse amongst adolescents and young adults. In the case of DM consumption, abusers seek out cough syrups that contain the drug; consuming all or part of the bottle. Often times, abusers will mix the cough syrup with alcohol for an enhanced set of effects. The intent of the abuser is to get high off of the hallucinogenic and dissociative anesthetic properties that the drug possesses.

A dextromethorphan caused drug high blends the qualitative aspects of drugs like L.S.D. and Ketamine into a unique set of sensations that are novel and cheap. At present, Robotussin DM is one of the better-known DM cough syrups, but Coricidin tablets and Delsym sustained release DM products are also popular. People who choose to get high on dextromethorphan are said to be “robo-tripping” or “dancing.” Codeine based cough syrups have a separate following of aficionados who prefer that drug’s opiate-styled high over that of a dextromethorphan “out of body” experience. There are other cough syrups that contain yet another sedative drug called promethazine (Phenergan). This drug when abused at high doses can cause experiences and feelings that are similar to high dose abuse of dextromethorphan.

In a Hotline call, a Southern California based probation officer called the DAR (Drug Abuse Recognition) Hotline in early April with a question about the use and abuse of dextromethorphan based cough syrups. The officer had just left drug court and had listened to a conversation that a drug court participant had with the judge. The probationer-client had explained that a recent arrest for drunk in public was not caused by a relapse to cocaine use; it was rather a case of accidental ingestion of a bottle of Robitussin.

Digging into the story, the magistrate in this case obtained an admission from the probationer. The probationer had actually developed a compulsive pattern of dextromethorphan consumption, one where she was steadily increasing the concentration and frequency of her drug consumption. The probationer remarked that she thought that the drug was safe because it’s availability as an over the counter cough suppressant. She went on to explain that the drug’s effects allowed her to distance herself from unwanted emotions and anxieties. She explained her experiences as being detached from the sights and sounds of things going on around her. The defendant said that she’d now learned that there is a limit to the amount of detxromethorphan that she can safely take. For this probationer, no amount of detxromethorphan cough syrup is safe to take. This probationer’s cocaine addiction had become redirected into the abuse of dextromethorphan. The probationer was returned by the court to a more intensive outpatient rehabilitative program.

Dextromethorphan (DM) is a drug that is widely, although infrequently abused, but the phenomenon stays well below the radar of most public and private drug abuse surveillance systems. Since MEDTOX DAR hotline inception, there has been a steady stream of callers who have asked for information about DM cough and cold tablet abuse. Most of the calls have dealt with adolescent and young adult use of the drug, but there have been some situations involving chronic use by adults. Because of its pharmacological characteristics, physical dependency to DM is unlikely. As this Hotline call reveals, some substance abusers may develop episodic use of this drug into a regular pattern of consumption that qualifies as an addiction.

Readers who would like to acquire more information about dextromethorphan drug abuse can receive assistance by contacting the MEDTOX DAR Hotline program at: darsprogram@mac.com.

Reproduced with permission from The MEDTOX® Journal