DXM is a cough suppressor found in more than 120 over-the-counter (OTC) cold medications, either alone or in combination with other drugs such as analgesics (e.g., acetaminophen), antihistamines (e.g., chlorpheniramine), decongestants (e.g., pseudoephedrine), and/ or expectorants (e.g., guaifenesin). The typical adult dose for cough is 15 or 30 mg taken three to four times daily. The cough-suppressing effects of DXM persist for 5 to 6 hours after ingestion. When taken as directed, side effects are rarely observed.
DXM users can obtain the drug at almost any pharmacy or supermarket, seeking out the products with the highest concentration of the drug from among all the OTC cough and cold remedies that contain it. DXM products and powder can also be purchased on the Internet.
- CCC, Dex, DXM, Poor Man’s PCP, Robo, Rojo, Skittles, Triple C, and Velvet
- Cough syrup, tablets, capsules, or powder
Methods of abuse
DXM is abused in high doses to experience euphoria and visual and auditory hallucinations. Users take various amounts depending on their body weight and the effect they are attempting to achieve. Some users ingest 250 to 1,500 milligrams in a single dosage, far more than the recommended therapeutic dosages described above.
Illicit use of DXM is referred to on the street as “Robo-tripping,” “skittling,” or “dexing.” The first two terms are derived from the products that are most commonly abused, Robitussin and Coricidin HBP. DXM abuse has traditionally involved drinking large volumes of the OTC liquid cough preparations. More recently, however, abuse of tablet and gel capsule preparations has increased.
These newer, high-dose DXM products have particular appeal for users. They are much easier to consume, eliminate the need to drink large volumes of unpleasant-tasting syrup, and are easily portable and concealed, allowing an abuser to continue to abuse DXM throughout the day, whether at school or work.
DXM powder, sold over the Internet, is also a source of DXM for abuse. (The powdered form of DXM poses additional risks to the user due to the uncertainty of composition and dose.)
DXM is also distributed in illicitly manufactured tablets containing only DXM or mixed with other drugs such as pseudoephedrine and/or methamphetamine.
DXM is abused by individuals of all ages, but its abuse by teenagers and young adults is of particular concern. This abuse is fueled by DXM’s OTC availability and extensive “how to” abuse information on various websites.
- Confusion, inappropriate laughter, agitation, paranoia, and hallucinations
Other sensory changes, including the feeling of floating and changes in hearing and touch
Long-term abuse of DXM is associated with severe psychological dependence. Abusers of DXM describe the following four dose-dependent “plateaus”:
|Plateau||Dose (mg)||Behavioral Effects|
|2nd||200-400||Euphoria and hallucinations|
Distorted visual perceptions
Loss of motor coordination
- Over-excitability, lethargy, loss of coordination, slurred speech, sweating, hypertension, and involuntary spasmodic movement of the eyeballs
The use of high doses of DXM in combination with alcohol or other drugs is particularly dangerous, and deaths have been reported. Approximately 5-10 percent of Caucasians are poor DXM metabolizers and at increased risk for overdoses and deaths. DXM taken with antidepressants can be life threatening.
OTC products that contain DXM often contain other ingredients such as acetaminophen, chlorpheniramine, and guaifenesin that have their own effects, such as:
- Liver damage, rapid heart rate, lack of coordination, vomiting, seizures, and coma
To circumvent the many side effects associated with these other ingredients, a simple chemical extraction procedure has been developed and published on the Internet that removes most of these other ingredients in cough syrup.
DXM overdose can be treated in an emergency room setting and generally does not result in severe medical consequences or death. Most DXM-related deaths are caused by ingesting the drug in combination with other drugs. DXM-related deaths also occur from impairment of the senses, which can lead to accidents.
In 2003, a 14-year-old boy in Colorado who abused DXM died when he was hit by two cars as he attempted to cross a highway. State law enforcement investigators suspect that the drug affected the boy’s depth perception and caused him to misjudge the distance and speed of the oncoming vehicles.
Drugs with similar effects
Depending on the dose, DXM can have effects similar to marijuana or ecstasy. In high doses its out-of-body effects are similar to those of ketamine or PCP.
Legal status in the United States
DXM is a legally marketed cough suppressant that is neither a controlled substance nor a regulated chemical under the Controlled Substances Act.