Robotripping on Dextromethorphan

How teens misuse an over-the-counter cough remedy which causes one to dissociate and hallucinate as if you’ve just taken ketamine or PCP

Disclaimer: Dextromethorphan is one of the few drugs I write about that I haven’t tried. It doesn’t sound like fun to me.

What are these nutty teens up to? Sure, in high school, I might have been spotted taking the occasional puff from a joint, and maybe a mushroom or two – all in the course of being a straight-A student. But “Robotripping?” Fuck no! Robotripping means binging on over-the-counter Robitussin, active ingredient: dextromethorphan (DXM), until you feel euphoria, hallucinate, dissociate, and experience profound disruptions in consensus reality. People frequently end up in the emergency department completely agitated and disoriented. The ages that succumb to the highest rates of dextromethorphan (Robitussin) misuse are ages 15-16. This can’t be good for brain or emotional development.

How many kids are actually partaking in this dangerous practice? Estimates of 5% are probably low, as mostly the severe cases get reported, when bad outcomes are encountered. Calls to poison centers for dextromethorphan are rising.

Why are teens chugging down this disgusting elixir of cough syrup? What do they think it doing for them?

What is dextromethorphan?

Dextromethorphan is an over-the-counter cough suppressant that is readily purchased in any major pharmacy chain or supermarket. There is no age limit to buy it and no I.D. is legally required (though some stores/states are cracking down). It is also easily bought on Amazon with no controls – there are literally dozens of selections. For example, the bottle pictured below contains 3000 mg of dextromethorphan – you can start to hallucinate and dissociate with doses in the 250-400 range. It is not expensive, and it can be delivered right to your doorstep.

One of many dextromethorphan products freely available on Amazon for kids to poison themselves with.

Original uses

Dextromethorphan was originally developed as an anti-tussive replacement for codeine. What we traditionally had been using, codeine, is extremely effective at suppressing cough, but it can cause euphoria and opioid addiction. Dextromethorphan doesn’t tickle the opioid receptors nearly as efficiently as codeine does, so it’s not addictive in an “I’m addicted to opioids” kind of way. In fact, in 2013, a randomized clinical trial found that dextromethorphan may reduce the overall discomfort and duration of withdrawal symptoms – an interesting potential indication to help with opioid addiction – but, beyond the scope of today’s missive.

At low doses, many of us take robitussin/dextromethorphan without any side effects and find it to be an extremely helpful remedy to suppress annoying coughing fits. It is quite safe in standard, recommended dosages. Dextromethorpan is also used in several new prescription medications, for different indications:

1) In 2010, the FDA approved the combination drug dextromethorphan/quinidine under the brand name Nuedexta for the treatment of pseudobulbar affect (difficult to control, laughing/crying that is present is certain neurological conditions).

2) The combination medicine dextromethorphan/bupropion is approved by the FDA for major depressive disorder under the brand name Auvelity. This implies that dextromethorphan does do something helpful with moods (which is likely part of why it is misused so frequently).

Harms

The use of dextromethorphan can cause psychological dependence in people who use it recreationally. It is extremely dangerous to combine DXM with alcohol, as it can additively suppress your respiration and sensorium. One should avoid taking DXM with grapefruit juice (and, likely, CBD, which can do the same thing) as grapefruit juice can inhibit liver enzymes and can drastically increase the levels of DXM in your blood stream. Dextromethorphan also can be dangerous if taken with an SSRI because it can cause “serotonin syndrome” (too much serotonin – very dangerous and unpleasant! Vomiting, diarrhea, confusion, agitation…).

Of course hallucinating and dissociating as if you were on higher doses of ketamine, nitrous oxide, or PCP engenders an entire host of other medical difficulties and physical dangers. Dextromethorphan can cause severe distortions of the visual field, distorted bodily perceptions, and a loss of sense of time. Users report a stimulant-like sense of euphoria. The experience is non-linear and is experienced in a sequence of increasingly weird and potentially scary “plateaus”. At high doses, dextromethorphine can facilitate communication with alien beings as well as a phenomenon known as “phlanging” – when time speeds up and slows down. At even higher doses, it can cause respiratory depression and seizures.

This chart is from my addiction textbook, and it outlines the dextromethorphan intoxication syndrome:

The addiction people make this look about as much fun as a root canal, but they, rightly, aren’t big on recreational intoxication in teens. (I believe in explaining the appeal of drugs, so we understand why people take them, not just fear mongering about the negative effects – this isn’t particularly effective).

Mechanistically, dextromethorphan works like ketamine and PCP in that it is a NMDA receptor antagonist. NMDA receptors are mediated by the neurotransmitter glutamate, which is the primary excitatory neurotransmitter in our CNS. Dextromethorpan is perfect for sneaky teens, including those in Juvie, because it doesn’t show up on drug screens. Intoxication starts within a few hours of consumption and lasts for up to six to ten hours.

I am not generally enthusiastic about “supply side” interventions to control drug use, such as the War on Drugs, trying to limit use by limiting supply, wiping out marijuana farms in Mexico with paraquat, incarcerating people for decades for dealing (when they need treatment for an addiction). I am much more supportive of “demand side” interventions such as educating and treating people and regulating their use.

However, in the case of dextromethorphan – restricting easy access to dextromethorphan would likely help rates of misuse go down. Some states have done this. As it currently stands, is just too easy to procure DXM. “We’re bored, let’s go to CVS and Robotrip for 8 dollars.” They need to put an age limit of 21 and require an I.D. Of course, people will still have dextromethorphan at home for when they get sick, so this wouldn’t be a foolproof plan. Maybe adults need to store it more carefully, like they hopefully do for opioids, benzos and other misusable drugs.

What is the appeal?

At low doses DXM causes stimulation and euphoria. Music sounds better to the listener (which is what cannabis does). At higher doses, people feel more intensive euphoria. Some describe this euphoria as like being on uppers and others like MDMA (ecstasy). As the dose goes up, people start to hallucinate and dissociate. This can either be very cool and interesting, or extremely weird and terrifying depending on the dose and the experience of the person taking it.

Here is a dose/effect chart:

Loss of motor coordination and out-of-body sensations is not my idea of fun!

Conclusion

I am not one to criticize anyone about drug usage. During my addicted phase – seventeen years ago - I would gobble or snort any drug that could possibly be misused. I was an adult, not a teen, and I had no control over it, and I caused plenty of mayhem as documented in my memoir, “Free Refills”. I can understand how it might be difficult for impulsive, bored teens to resist. I have also always been sympathetic to people’s right to experiment with their consciousness as long as they aren’t harming anyone (though, ideally, not teenagers, whose brains are still developing – they are harming themselves).

But – my question for the teens is: Why Robotripping? What a weird and dangerous activity. It doesn’t sound particularly fun. Don’t you have anything better to do?

This experience isn’t real – it’s just a drug effect. It’s not positive or beneficial like some drugs are, which can help you grow and change (e.g., like classic psychedelics, which are still not recommended for teens). The harms of DXM are real – things like mania, extreme agitation, psychosis, respiratory depression, and seizures. These outcomes could permanently harm your health.

Many teens are ending up in the emergency department, which also traumatizes the parents. It is dangerous and can be terrifying. Teens have died from DXM use.

I can understand the interest in experimenting and seeking out novel experiences. When I was a teen, my days were guided by boredom and any experience was to be tried. In retrospect, some of it was a big waste of time and other experiences were needlessly dangerous. Again, this isn’t truly a real experience, it is just a drug. It is your brain playing tricks on you because you’ve temporarily poisoned it with a weird cough syrup, exploiting a legal loophole, that has hallucinogenic properties. As such, is actually a pretty meaningless, but profoundly dangerous, activity. Embrace friends, school, and hobbies - not drugs! Just say wait (until you are older) and skip the Robotripping altogether.