An over-the-counter medicine indicated to help with chest congestion at recommended doses, Robitussin Cough and Chest Congestion DM USP is also a widely abused street drug. It contains the active ingredients dextromethorphan (DXM), a cough suppressant, and guaifenesin, an expectorant which loosens phlegm in the lungs. DXM is responsible for the cough syrup's sought-after psychoactive effects when abused at high doses, and coupled with guafenesin, can cause harmful, potentially deadly effects.
DXM Effects
One of Robitussin's active ingredients, DXM produces psychoactive effects which vary according to the amount of the drug consumed, and which can last six or more hours. The Office of Diversion Control describes a system of four plateaus--or levels of effects--that outlines what someone may experience when abusing the medicine. With first-plateau doses ranging from 100 to 200 milligrams, DXM produces a stimulant-type "buzz," while second-plateau doses of 200 to 400 milligrams yield feelings of euphoria and mild hallucinations. When an abuser consumes third-plateau doses of 300 to 600 milligrams, he is likely to experience loss of motor control and extreme distortions in visual perceptions.
Dissociative Effects
At the fourth-plateau level of effects--with massive doses ranging up to 1,500 milligrams of DXM (nearly four bottles of Robitussin)--a state of dissociation is common. Dissociation is a partial or complete separation from reality, often coupled with a highly distorted or completely absent sense of time. Someone who has consumed 1,500 milligrams of DXM may have no idea where they are, what time of day or night it is, and may be unable to speak intelligibly. Along with Robitussin's dissociative effects at this plateau comes a heavy state of sedation, during which the abuser may become unconscious. The National Drug Intelligence Center reports that fourth-plateau doses of DXM can produce effects similar to the illegal drugs ketamine and PCP.
Effects of Guaifenisen
Guaifenesin is the second active ingredient in Robitussin Cough and Chest Congestion DM USP. Each recommended dose of the cough syrup which contains 10 milligrams of DXM also contains 100 milligrams of guaifenesin. Hence, an abuser will ingest 15,000 milligrams of guafenesin at a fourth-plateau dose of 1,500 milligrams of DXM. The expectorant chemical does not produce any hallucinogenic or euphoric effects, yet has one major side effect--vomiting. At high doses, this vomiting can be severe and occur repeatedly during the abuser's "trip."
Adverse Side Effects
Any of a host of adverse side effects can arise with use of Robitussin Cough and Chest Congestion DM syrup even at recommended doses, and the severity of these is greatly amplified as the amount consumed increases. According to the University of Maryland, abusers of Robitussin may experience side effects including rashes, sweating, hot flashes, increased blood pressure, and possible seizure. Abuse of the cough syrup may also result in brain damage--and even death. Seizures and unconsciousness can lead to fatal results with Robitussin abuse, however the dissociative effects can be equally deadly. The National Drug Intelligence Center reports a 2003 case in which two cars struck and killed a fourteen-year-old boy who attempted to cross a Colorado highway while under the influence of heavy doses of DXM.
References
- KidsHealth: Cough and Cold Medicine Abuse
- DEA Office of Diversion Control: Drugs and Chemicals of Concern - DEXTROMETHORPHAN
- University of Maryland Center for Substance Abuse Research: Dextromethorphan (DXM)
- LabelDataPlus: Robitussin
- National Drug Intelligence Center: Intelligence Bulletin - DXM (Dextromethorphan)
