Dextromethorphan (DXM) is a substance present in many over-the-counter (OTC) medications, often under brand names such as Robitussin, Vicks, and Theraflu. It can also be found in various forms, including liquid, gelcaps, and tablets. Reports of abuse by DXM by teenagers reach back several decades.
Despite this, many parents remain relatively unaware of how problematic DXM misuse can become. According to statistics by the National Capital Poison Center, approximately 6,000 teenagers visit an emergency room each year related to DXM abuse. While suicide or self-harm is relatively rare, excessive DXM doses can cause hallucinations and psychotic symptoms that could lead to adverse consequences.
The Problem’s Scope
According to the National Institute on Drug Abuse (NIDA), about one-third of teens report knowing a person who has abused products containing DSM. Just over 3% of adolescents in the U.S. report having abused cough and cold medications. DXM abusers commonly report experiencing a broad range of effects. Doses 3-4 times the label’s recommended allowance can produce results similar to those of alcohol.
DXM can lead to highs similar to PCP (phencyclidine, Angel Dust) when used in extremely high doses, including hallucinations, euphoria, dissociative feelings, and near-death or out-of-body experiences.
Many OTC medicines containing DXM also include other substances such as pain relievers, decongestants, and antihistamines. Excessive doses of any of these elements come with their own set of risks. For example, acetaminophen is detrimental to the liver in extreme amounts, and antihistamines can also produce hallucinations. Moreover, combining these ingredients can compound the overall risk of dangerous effects.
One of the main reasons teens misuse these drugs is that they may be more easily accessible than alcohol and illicit drugs. For many young people trying to get high, DXM suffices when they can’t obtain more preferable substances. Also, in the last few years, social media has brought a whole new element to the DXM user community—people can share experiences and recipes and urge others to do the same. The Internet is remarkably influential for vulnerable teenagers, especially when it is their primary socialization method.
Mixing Alcohol and DXM
Both alcohol and DXM are central nervous system (CNS) depressants, meaning they reduce the brain and spinal cord’s neuronal activity. Using two CNS depressants together enhances their actions, potential side effects, and risks, often far more significantly than using either independently.
It is nearly impossible to separate the “purely” physical effects from the mental effects associated with any medication, drug, or other substance. The effects of drugs or alcohol happen due to an interaction between the drug’s metabolization in the body and the cognitive and emotional impact associated with the substance’s physical process.
When substances are used in conjunction, these interactions become even more complicated. The idea that consuming any substance can produce “purely physical effects” or purely mental effects” is not accurate, as these categories do not exist in the real world. Moreover, all behaviors, responses, and so-called physical states represent a combination of biological processes and cognitive or emotional mechanisms, even if people are not overtly aware of these ramifications.
The Drug Enforcement Agency (DEA) reports that the effects of abusing DXM vary significantly by the amount of the drug being used. At recommended dosages, which are typically 15-30 mg every four hours, there are few mild side effects and extremely uncommon detrimental effects except for rare allergic reactions. When people use DXM over and above its prescribed dosages, numerous varied types of effects can transpire, depending on the dosage:
- Using 100-200 mg of DXM often leads to mild to moderate stimulant sensations. Ingesting this level of the drug and additional alcohol consumption would lead to feelings of stimulation being canceled out or suppressed by the CNS depressant effects of alcohol. This would result in a more significant experience of sedation.
- Using between 200-400 mg of DXM can result in hallucinations, most often visual in nature. Using this amount of DXM with an excessive amount of alcohol would most likely worsen hallucinations and possibly lead to extreme psychosis.
- Using 300-600 mg of DXM may result in lethargy, sedation, and significantly impaired motor coordination and reaction times. Using this amount of DXM with alcohol could lead to more severe sedation, impairments with motor coordination, extremely slurred speech, detachment from reality, delusional behaviors, and unconsciousness.
- Taking more than 600 mg of DXM typically results in extreme sedation and dissociative effects, such as out-of-body experiences or as if things are not real. Taking this amount of DXM with alcohol would most likely induce severe lethargy, disorientation, and potential unconsciousness or coma, leading to severe damage to the brain or even death due to profound respiratory suppression.
The potential interaction between alcohol and DXM largely depends on the amounts of the drugs being used. As one takes higher amounts of DXM, even a minimal amount of alcohol could significantly interact. Combining DXM with alcohol can also lead to several other potential effects, including the following:
- Extreme nausea and extended periods of vomiting even with low doses of DXM
- Hot flashes, high blood pressure, increased heart rate, dizziness, and agitation
- Elevated body temperature and blood pressure
- Anxiety and panic attacks
- Dissociation and derealization
- Potentially fatal seizures
What Loved Ones Can Do
Even with restrictions in place, there is always the possibility for mistakes. Parents and caregivers unaware of the risks of medications containing DXM may have them accessible in their family’s medicine cabinet. Experts urge parents to monitor all medications in the home and never leave prescription or over-the-counter drugs with abuse potential available to teens.
Getting Help for Substance Abuse
If your teen has anxiety, depression, or any other mental health condition, don’t assume that they haven’t been considering or engaging in self-medication through drug or alcohol use. Like other potential signs and symptoms of substance abuse, it is essential not to ignore mood, behavior, or social group changes.
Ultimately, robotripping is potentially dangerous behavior and may need to be subject to professional treatment, especially if the person affected by it has been abusing other substances. Just Believe Detox and Just Believe Recovery centers are specialized substance abuse treatment facilities that offer multifaceted programs. Services featured in these programs include behavioral therapy, individual and family counseling, group support, relapse prevention, aftercare planning, and more.