Dextromethorphan (DXM), is a common ingredient found in many over-the-counter cough and cold medicines, and is used as a recreational drug for its dissociative effects. Dextromethorphan has powerful dissociative properties when taken at doses well above the recommended therapeutic dosage for cough suppression. DXM addiction is sometimes referred to in slang form as robo-tripping, derived from the Robitussin brand name, or Triple Cs, which comes from the Coricidin brand because the pills are printed with “CCC,” which stands for Coricidin Cough and Cold.
DXM in low recreational doses (between 100–200 mg), is described as having a euphoric effect. With middle doses come more intense euphoria, vivid imagination, and closed-eye hallucinations. With high doses of DXM, there is a profound alteration in consciousness and users often report out-of-body experiences or temporary psychosis. Another characteristic of high doses of DXM as seen in DXM addiction is something called “flanging,” speeding up or slowing down of sensory input.
DXM Recreational Use and DXM Addiction
There are definitely specific groups that seem to be at a higher risk of DXM abuse and DXM addiction, including teenagers, alcoholics, and narcotic abusers. Other street names for DXM include: “Candy,” “C-C-C,” “Dex,” “DM,” “Drex,” “Red Devils,” “Robo,” “Rojo,” “Skittles,” “Tussin,” “Velvet,” and “Vitamin D.” And slang terms for abusing DXM are: “Dexing,” “Robotripping,” and “Robodosing.” Some findings suggest that DXM can produce ethanol-like effects in both alcoholics and non-alcoholics and can cause a mild form of craving in alcoholics. In 2005, following the deaths of 5 teenagers known to use DXM in pure powder form, the FDA expressed its concern about potential DXM abuse and DXM addiction.
Plateaus of DXM Use Leading to DXM Addiction
First plateau: alertness, restlessness, increased heartbeat, increased body temperature, intensification of emotions, euphoria, loss of balance, and mild inebriation similar to drunkenness.
Second plateau: effects are similar to the first plateau, but with heavier intoxication, choppy sensory input, a dreamlike state of consciousness, some detachment from outside world, and closed-eye hallucinations; slurred speech, mild hallucinations, short term memory impairment.
Third plateau: difficulty recognizing people or objects, chaotic blindness, dreamlike vision, inability to comprehend language, abstract hallucinations, delayed reaction time, decision making impairment, feelings of peace and quiet, near complete loss of motor coordination, short-term memory impairment, and/or feelings of rebirth. This third level is an altered state of consciousness and vision or other senses may be impaired.
Fourth plateau: loss of contact and control with their own body, changes in visual perception, out-of-body experiences, perceptions of contact with “superior” beings, lack of movement or desire to move, rapid heart rate, complete blindness, increased hearing, and intensification of third plateau effects. The fourth state, a person can lose contact with their body and with all senses shut off. This level of intoxication is similar to using PCP or to that of being in a K hole (overdose of ketamine known as Special K).
Plateau Sigma: occurs by prolonging dosage; marked by psychosis with visual and auditory hallucinations. Users report auditory hallucinations, for example rather than simply feeling tired and sitting down, a user might hear a voice saying, “sit down now, you’re tired,” and feel compelled to obey. These experiences are mostly described as unpleasant.
Symptoms of DXM Addiction
A survey of DXM users showed that more than half of them reported experiencing the following withdrawal symptoms for the first week after long-term and/or chronic use, or DXM addiction: fatigue, apathy, flashbacks, and constipation. Over a quarter of DXM users reported insomnia, nightmares, an inability to experience pleasure in usual activities, impaired memory, attention deficit and decreased libido. Other more rare side effects reported were panic attacks, impaired learning, tremor, jaundice, hives and muscle aches. Frequent and long-term usage at very high doses could possibly lead to toxic psychosis and other permanent psychological problems.