Dextromethorphan-containing cough medications have been used increasingly by teenagers as a cheap way to get high, but they carry a risk of hypertension (high blood pressure), accelerated heart rate and fever. An FDA (Food and Drug Administration) panel of experts has voted 15-9 against the proposal that would require all dextromethorphan-containing cough medications to have a doctor’s prescription.

Dextromethorphan is an active ingredient that is added to over 140 OTC (over-the-counter, no prescription required) drugs. Dextromethorphan abuse, sometimes termed robotripping, has become increasingly more common among teenagers.

The Advisory Committee’s (the panel of experts) recommendations are not binding; the FDA can ignore them if it so wishes, but it rarely does. The Committee was asked if dextromethorphan should be scheduled – a move aimed at reducing access to medications with potential for abuse.

Apart from the risks mentioned above, abusers of dextromethorphan can also suffer from the side effects of other ingredients present in some cough medications, such as acetaminophen (paracetamol), which can damage the liver.

According to the National Institutes of Health, in 2008 there were approximately 8,000 emergency hospital visits related to dextromethorphan abuse, 70% more than in 2004.

Another public body, the DEA (Drug Enforcement Agency) had asked the FDA to review dextromethorphan-containing medications, suggesting they become prescription-only drugs.

The view of a significant number of panelists was that the move would create a huge amount of extra paperwork for pharmacists and clinicians.

Dextromethorphan, also known as DXM or DM is a cough suppressant (antitussive) drug. It is one of the active ingredients in many OTC (over-the-counter) cough and cold medications, such as:

  • Robitussin
  • NyQuil, Dimetapp
  • Vicks
  • Coricidin
  • Delsym

There are also many generic labels.

Dextromethorphan is also an active ingredient in some other medications, such as those for the treatment of pain relief, and some psychological applications. It can be sold in lozenge, spray, tablet, and syrup form. In its pure form it is a white powder.

Recreational use (abuse) When used recreationally, which means exceeding label-specified maximum dosages, dextromethorphan may act as a dissociative hallucinogen – it produces hallucinogenic effects. The effects may be similar to such controlled substances as PCP (phencyclidine) and ketamine. It can produce distortions of the visual field, feelings of dissociation, alterations of bodily perception, excitement, and a loss of comprehension of time.

According to the National Drug Intelligence Center (NDIC):

The abuse of DXM (dextromethorphan) – a common ingredient contained in over-the-counter cough and cold medicines–is an increasing concern for law enforcement officers in the United States. Adolescents are the primary abusers of the drug, most likely because it is inexpensive and relatively easy to obtain. Additionally, because DXM is a common ingredient in many cough and cold medicines, many adolescents do not perceive any risk in abusing the drug. Compounding the problem is that few parents know about the potential for abuse of the drug.

According to the NDIC, the dextromethorphan abuser, who typically ingests increasing amounts to reach each succeeding plateau, experiences four possible plateaus:

  • Pateau 1 – mild inebriation.
  • Plateau 2 – similar to the sensation of alcohol intoxication. Sometimes mild hallucinations. Speech becomes slurred, short term memory may be temporarily impaired.
  • Plateau 3 – the abuser’s vision can become impaired, there is an altered state of consciousness.
  • Plateau 4 – an out-of-body experience, a dissociation of mind and body. Some or all contact with senses may be lost. Effects similar to those caused by ketamine or PCP (phencyclidine).

Sources: FDA, National Drug Intelligence Center, Medical News Today archives.

Written by Christian Nordqvist