Users of products containing DXM are those that adhere to the manufacturer's suggested guidelines for dosages. Users consuming DXM-containing cough syrups (such as Robitussin) for medical reasons typically ingest 10 to 20 mg every four to six hours or 30 mg every six to eight hours. On the other hand, a single dose for recreational users can range from 240 to 1500 mg. Heavier users have been known to ingest up to 3 or 4 bottles a day—an amount that can induce a multitude of negative side effects. According to the DEA, Internet sites inform young users to "drink the syrup expeditiously in order to absorb enough DXM from the drink prior to the impending incidence of vomiting which will occur as a result of the ingestion of the large volume of syrup required for intoxication." In addition to traditional syrup forms, there is also evidence that DXM is being sold over the Internet in powder, capsule, and pill forms. These are snorted or ingested orally. Powders and pills have an effect similar to syrups without the need to consume large quantities of the substance in a small time period. Users can also find instructions on how to extract DXM from syrups and gel capsules on the Internet, thus enabling them to inject or orally consume this active ingredient.
DXM is a dissociative anesthetic that at high doses can create powerful psychedelic effects. It is sometimes compared to PCP and ketamine, which are also dissociative anesthetics. The effects caused by DXM use vary depending on the dose. Users often describe dose-dependent 'plateaus' that range from a mild stimulant effect with distorted visual perceptions to a sense of complete dissociation from one's body. Effects generally last for 6 hours, but will ultimately vary depending on the amount of DXM ingested and if it is used in combination with other drugs or chemicals. Other effects can include:
The level and likelihood of experiencing tolerance and dependence will ultimately depend on the dose and frequency of use. When it is abused regularly, DXM can actually cause some of the symptoms (i.e., insomnia and dysphoria) that it is designed to cure. In addition, high-dose chronic use of DXM can lead to the development of toxic psychosis - a mental condition characterized by a loss of contact with reality along with a confused state - as well as other physiological and behavioral problems. It is unknown, however, what effect infrequent use of low doses has upon the user, although anecdotal reports of prolonged use describe DXM as a drug with moderate physical dependence and tolerance. Most users that display symptoms of withdrawal will experience some form of anxiety, restlessness, insomnia, diarrhea, vomiting, severe weight loss, and upset stomach.
Dextromethorphan (Robitussin and other over the counter cough preparations) acts as a hallucinogen when taken in large doses. Dosing instructions are available online. Large doses also cause nausea and vomiting, loss of coordination, hot flashes, numbness, and a “horrible feeling” in users, yet repeated abuse is common. Effects may last for several hours. Robo-tripping has been implicated as a “gateway” to using other hallucinogenic drugs. If the cold medication contains Tylenol, or any other brand of acetaminophen, liver damage may occur.
The street names and slang terms describing DXM include:
Dex, Triple C’s, Skittles, Dexing, Robbo-trippin, Syrup head, Vitamin D, C-C-C, Drex, Red Devils, Tussin, Velvet, Poor Man’s X, 'Cidin