Poison control centers report a four-fold increase in over-the-counter cough syrup abuse cases since 2000, mostly involving school-aged youth. The active ingredient in over-the-counter cough syrups being abused is dextromethorphan (DXM). Dextromethorphan (DXM) is a synthetic drug that is chemically similar to morphine. It was developed in 1954 as a cough suppressant. It has been widely used as a cough suppressant in over-the-counter cough and cold medications since the 1970s. It was developed to be a cough suppressant that would be as effective but less addictive and have fewer side effects than codeine.

When taken at very high doses, it acts as a disassociative anesthetic, similar to PCP and ketamine. At these high doses, DXM also acts as a central nervous system depressant. At very high doses it may also have a hallucinogenic effect and is used as an alternative to ecstasy. Dextromethorphan is also known by the street names Dex, DXM, Robo, Skittles, Syrup, Triple-C, Vitamin D, and Tussin. Intoxication with DXM is known as robo-tripping or skittling. The low-cost and easy availability of these over-the-counter products makes it attractive to adolescent substance abusers.

DXM abusers describe a set of plateaus varying with the amount taken. These range from a mild stimulant effect with distorted visual perceptions to a sense of complete disassociation from one's body. High doses can cause the inability to move one's arms or legs or even to talk, slowed breathing, permanent brain damage, cerebral hemorrhage, stroke, and death from loss of breathing. DXM abuse can cause abdominal pain, vomiting, irregular heartbeat, high blood pressure, and seizures.

There are over 125 commercial cough and cold products available in the US. Many of these contain other ingredients as well as DXM. When taken in large doses, these other ingredients often also cause toxicities. Often DXM abuse is accompanied by alcohol, marijuana, ecstasy and other substance abuse which increases the danger. Because of the ease of access to over-the-counter products, parents should be aware of suspicious behaviors that may signal DXM abuse. Use of street names for cough and cold medications, signs of intoxication, and the presence of multiple cough and cold products should be warning signs for parents.

Reference: http://www.gdcada.org/statistics/dxm.htm.

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