Tripping Over Robo-Tripping

Later this month an FDA advisory committee is scheduled to consider whether the agency should require a prescription for Robitussin, NyQuil, and other medications containing dextromethorphan (DXM), a cough suppressant that has dramatic psychoactive effects in large doses (starting around 10 times the normal dose). This week, in anticipation of the meeting, the FDA posted 135 pages of information about DXM, which you can peruse here (PDF). The case for scheduling DXM is weak, but that does not mean it will not happen. Other possibilities include banning sales to minors (a measure supported by the pharmaceutical industry) or putting DXM-containing products behind the pharmacist’s counter (which would mean they could not be sold outside drugstores).

"Although DXM, when formulated properly and used in small amounts, can be safely used in cough suppressant medicines," the FDA says, "abuse of the drug can cause death as well as other serious adverse events such as brain damage, seizure, loss of consciousness, and irregular heart beat." But this sort of thing does not seem to happen very often. "Considering its widespread over the counter (OTC) availability," the FDA concedes, "relatively few reports of serious abuse-related events involving DXM have been published."

DXM has been on the market since 1958, when the FDA approved it as a "nonaddictive substitute for codeine" (which was switched to prescription-only status in an effort to discourage nonmedical use). It is an ingredient in more than 125 OTC products. Yet the FDA cites only five deaths caused by DXM overdoses in the United States, all of them in 2005 and all of them involving not cold remedies but DXM powder purchased for recreational use. By contrast, aspirin causes hundreds of deaths every year.  

What about nonfatal events? According to the Drug Abuse Warning Network, there were 3,914 DXM-related emergency room visits in 2008, compared to 7,933 for pseudoephedrine and 39,215 for diphenhydramine, the antihistamine in Benadryl. And while the Drug Enforcement Administration says it is "concerned with the increasing abuse of dextromethorphan, especially among adolescents," the government-sponsored Monitoring the Future Study indicates that nonmedical use of "OTC cough/cold medicines" is down among eighth-graders and 12th-graders since 2006 (the first year the survey asked about this drug category) and up only slightly among 10th-graders, 6 percent of whom reported past-year use in 2009, compared to 5.3 percent in 2006.  

"Because of the drug's perceived safety, ease of availability, and desired psychoactive effects, it is sought after by those seeking to alter their mental state," the FDA says. It leaves out another factor in DXM's appeal to teenagers: the drug laws, which increase the cost, effort, and risk involved in obtaining safer alternatives such as marijuana. It's hard to for me to imagine that DXM would have much of a following in the absence of drug prohibition. Maybe I'm biased, since I do not even like the psychoactive effects of a therapeutic dose, which I find so unpleasant that I avoid products containing DXM.

But consider the DEA's description (included in the FDA packet) of "four dose-dependent 'plateaux'":

1st (100–200 mg): Mild stimulation
2nd (200–400 mg): Euphoria and hallucinations
3rd (300–600 mg): Distorted visual perceptions, loss of motor coordination
4th (500-1,500 mg): Dissociative sedation

Which, in the long tradition of anti-drug warnings that also serve as pro-drug publicity, makes DXM sound pretty appealing. A DXM powder user describes his experience here. The Partnership for a Drug-Free America tries to scare you away from the stuff here. Previous Reason coverage of DXM dread here.

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  • Max||

    ARFARFARFARFARFARFARFARFARFARFARF!!!!!!!!!!

  • ||

    Naw, that's Purple drank, Max.

    That's completely different.

  • Corduroy||

    Surprisingly, NPR was onto Purple Drank years ago. Must have been insider knowledge.

  • Joe M||

    It's not the fact that people can die of overdoses that's a concern. It's the fact that people can take it for pleasure.

  • Franklin Harris||

    +1

  • SpongePaul||

    not to mention the risk of death dose is 2,500 mg or 2.5 grams to 20,000 mg or 20 grms worth. which would be like 10 bottles of cough sryup to even approach risk of death, i do belive most would puke thier brains out before then, or fill up.

  • Chris Rock||

    How are black folks gonna get healthcare now?

  • ||

    Thanks alot, MC Chris.

    also, dramatic psychoactive effects in large doses

    If you count a sluggish waking dream as "dramatically psychoactive", I guess. And not the fun sort of dreams either, the boring tedious kind. Maybe I'm just confusing the terms psychoactive and psychedelic.

  • Joe M||

    You haven't taken enough. There's a strobe light effect that occurs in higher doses.

  • ||

  • Law Student||

    "Maybe I'm just confusing the terms psychoactive and psychedelic."

    You are.

  • ||

    Fair enough.

    The answer then would seem to be: teach your kids the difference, so they don't waste their time and money on DXM.

  • ||

    Yeah, I love getting high and really enjoy the occasional shroom trip. I have zero interest in chugging Robotussin until I get fucked up.

    Disassociatives in general -- PCP, Special K, etc -- sound pretty shitty to me actually. I like the mind/ego trip thing a lot more.

  • ♥♥♥||

    You should try it at least once. Its kind of like being on really weak versions of shrooms, grass, e, and acid all at once, except you're puking.

  • ||

    That sounds.....awful.

  • ||

    In my experience, its called "RoboFry" instead of "RoboTripping." Though I never tried it myself (or Dramamine, another fave OTC mindfuck) I heard about it from a guy at a keg party.

    He loved it, talked about how it was awesome to "robo-fry" and then drive all the way to Bozeman, Montana from Seattle (where we wuz at) because it made the trip "easier." He especially like it when driving over Gallatin Pass, which was in the midst of a blizzard, because the snowflakes flitting by the windshield - on the two lane highway late at night - looked like "Star Wars when they go hyperspace" in his words, which I'll never forget.

    I've always had that guy and his story stuck in my head when I go down a two-lane road late at night in the winter, especially when someone else goes by in the other direction. I always think to myself Does that guy think he's piloting an X-Wing fighter as he goes by?. I wonder...

  • mr simple||

    A fighter that size couldn't get this deep into space on its own. It must have gotten lost, been part of a convoy or something.

  • ||

    Look, he's heading for that small moon...

    I think I can get him before he makes it...

    That's not a moon...that's a space station

  • ||

    I've got a bad feeling about this...

  • ||

    Skiing I could see.

    What, he can't have the same experience on a snowboard?

    I've done some weird downhill myself on occasion.

  • ||

    How does the fucking drug war escalate in terms of "let's ban everything ever or make it at least prescription only" even as MJ seems to be getting nearer and nearer to legalization?

    Oh, I know: the fucking scumbags at the FDA/DEA/etc need to justify their existence.

  • Joe M||

    If only we could somehow turn the public education system against them, and give them busy work to kill time.

  • The Gobbler||

    S.A.R.E.

    (State Abuse Resistance Education)

  • Paul||

    I'd respond in detail, but I'd sound like a broken record.

  • .||

    If you say "fucking" enough times it will go away.

  • ||

    SEE?! Swear words DO have power! Thank god for the FCC!

    (Just kidding. Yo, Fuck the FCC)

  • ||

    I am endlessly amused by the precious little flowers that can't handle swear words. OH NOES THE WORDS BURN UR EARS

    Lighten up, Francis. Oh, and fuck you.

  • Citizen Nothing||

    I can't for the life of me get that Cee Lo song outta my head.

  • BakedPenguin||

    Parasitic Baby linked the Flaming Groovies below. It's not bad - like a middling Stones track from the same era, and you can dance to it, so I gave it a 7.

  • .||

    I am endlessly amused by the precious little flowers

    Endlessly? Maybe you should get out more. But I thought we were "precious snowflakes." Anyway, I like flowers. They last longer.

  • Virginia||

    Wow, the criticism section of PDFA's wiki page is wholly underdeveloped.

  • ||

    Can't hyperventilation cause psychoactive effects? If so, should air be regulated?

  • The Gobbler||

    NO SPINNING!

  • EPA||

    "If so, should air be regulated?"

    Fuck yeah!

  • ||

    They already tried this year...Cap n' Rape

  • ||

    Wait. "Plateaux?" What are they, French? Is that some sort of medical terminology? Where's Dr. Maximus?

  • Yar||

    You know, just this morning I was worrying that our overlords in Washington had not been doing nearly enough lately to infantilize us. Silly me.

  • Dello||

    "Although DXM, when formulated properly and used in small amounts, can be safely used in cough suppressant medicines," the FDA says, "abuse of the drug can cause death as well as other serious adverse events such as brain damage, seizure, loss of consciousness, and irregular heart beat."

    Uh, isn't all of this true of overeating as well?

    Looks like we definitely need to keep food behind the counter...

  • Kelly Brownell||

    I agree wholeheartedly.

  • The Gobbler||

    Doctor: Well Good morning Mr. Gobbler, what can I do for you today?
    The Gobbler: Doc, I need a sandwhich bad.
    Doctor: but I just wrote you a script for a foot-long Subway sandwhich yesterday. Did you eat the whole thing already?
    The Gobbler: Bad, doc, real bad.

  • ||

    Sandwhich? Do you mean sandwitch? Or maybe sandwits?

  • The Gobbler||

    I don't eat at subway so I don't know how they spell it.

  • ||

    Sandtits.

  • The Gobbler||

    That sounds kinda scratchy.

  • Parasitic Human Baby||

    I never tried the Robo but I used to pound those little bottles of terpin hydrate elixir w/ codeine. Can you sill buy that shit just by asking the pharmacist and signing the book?

  • BakedPenguin||

    Depends on the state you're in. And I mean the geographic entity, not your mental condition.

    ...although if you walk in already high, I doubt you'll get any.

  • Parasitic Human Baby||

    I used to drink it all the time when I was in college in Florida.Went back as often as the law allowed to about 4 or 5 different pharmacies.

  • BakedPenguin||

    Yeah, what I've seen online basically suggests it's all up to the state. Federal law allows codeine syrup sales (in small doses, sign the book), but state law may differ.

    I don't think Florida allows it anymore.

  • Zeb||

    DXM also tastes horrible. There are reasons why few people use it in high doses. If you could get mushrooms or acid easily, no one would use it recreationally.

  • T||

    Okay, kids have been slamming 2 bottles of Robo and going to class since I was in high school. Surely everybody in authority didn't just notice a phenomenon which has been going on for at least 25 years? Because if that's the case, what a bunch of dumb fuckers.

  • Bingo||

    25 + 18 = 43

    So its pretty likely that the people now employed in regulatory agencies saw their peers doing it years back and want to ban it. This also applies to whoever asked why the drug war was escalating on medicinal substances when marijuana was close to legalization. 25 years of propaganda against mood altering substances means that the kids that grew up true believers in the war on getting high are now working their way into senior positions in the bureaucracy.

  • In Time Of War||

    Well, thank God the 60's generation is in power so we can finally get sensible drug laws.

    Fucking useless, dirty hippies.

  • Michael||

    Slightly O/T: Perhaps reason could look into the recent developments in Chicago involving a secret meeting between police Supt. Weis and gang leaders? This "summit" seems to have been inspired by one Professor David Kennedy on whom I've been able to find scant background info. His claim of a 40% reduction in Cincinatti's murder rate attributed directly to the implementation of his program seems somewhat implausible. http://www.suntimes.com/news/m.....02.article

  • nodrog||

    The New Yorker ran a fairly in-depth profile of David Kennedy in their June 22, 2009 issue. The full text requires a subscription.

    http://www.newyorker.com/repor.....t_seabrook

  • Metazoan||

    First they come to make sure my nose stays stuffy, now I have to cough all the time too.

    Assholes.

  • Parasitic Human Baby||

    Not a Robo song butThe Flamin' Groovies seem appropriate somehow.

  • Abdul||

    FDA says. It leaves out another factor in DXM's appeal to teenagers: the drug laws, which increase the cost, effort, and risk involved in obtaining safer alternatives such as marijuana.

    I'm in favor of legalizing pot, but "It's safer than getting gooned up on cough syrup" may not be our best argument for that.

  • ||

    That doesn't mean it's an inaccurate statement though. That "spice" shit -- which freaked the fuck out of this seasoned stoner and generally sucked -- would never exist if it weren't for cannabis prohibition.

  • Abdul||

    Well, spice has a legitimate use: deep space navigation between worlds in Dune.

  • ||

    Whew, good call.

    What I'm waiting for is that Nuke shit from RoboCop 2.

  • CAW||

    Or some Substance D.

  • ||

    This is no doubt going to raise the price of Flaming Homers.

  • Appler||

    Just got a new iPad. Always nice to read HNR at the bar, but.....NO ALT-TEXT seriously diminishes my experience!

    Is there a work-Around?

  • Appler||

    Just got a new iPad. Always nice to read HNR at the bar, but.....NO ALT-TEXT seriously diminishes my experience!

    Is there a work-Around?

  • BakedPenguin||

    Jacob Sullum didn't add any alt-text to the photo. If you're not getting any for any photos, try right-clicking for a context menu, maybe it will show up in Apple's equivalent of "properties"

    Note: Wintel user, in case that wasn't already obvious.

  • ||

    Don't be silly, BP. iPad users don't have access to things like context menus and "settings". Instead they get something that "just works" -- in one ultra-specific, non-customizable manner.

  • ||

    Apple. Simple. For simple people.

  • ||

    RIGHT CLICK hahaha that's rich

  • ||

    The problem is that the alt text attribute is technically the wrong place to be putting witty/pithy comments about images. Alt text is meant to be descriptive of the actual content, much like the traditional Ron Bailey descriptions. If you actually give a shit about markup (admittedly and even smaller portion of the population than those who care about libertarianism), you would put your witty asides as part of the title attribute. The title attribute could also be added to links, making another avenue to fish for the LOLZ.

  • Oranger||

    Just got a new iPad. Always nice to take it up the ass from steve Jobs, but.....NO ALT-TEXT seriously diminishes my experience!

    Is there a reach-Around?

  • ||

    There's an app for that.

  • Steve Jobs||

    Not on MY platform. Try Android.

  • ||

    And politicians wonder why health care keeps getting more and more expensive.

  • IceTrey||

    "abuse of the drug can cause death as well as other serious adverse events such as brain damage, seizure, loss of consciousness, and irregular heart beat."

    So can drinking too much water.

  • Warty||

    If they ban all the unpleasant highs, like robotripping and stevia, won't that encourage kids to do the fun shit? If you're breaking the law, you might as well do some shit that's worth it.

  • ||

    +1. I never understood the idea of getting fucked up for its own sake. Shouldn't things like fun and enjoyment enter the picture somewhere?

  • SpongePaul||

    i do think you meant "salvia" not "stevia. Salvia is the pyshoactive mint. stevia is a sugar substitute.

  • Joe M||

    It's SALVIA, not stevia. Stevia is the natural zero calorie sweetener, although it's recommended for use with the classic salvia bolus.

  • ||

    I bet Warty typed what he meant and meant what he typed. He's on the cutting edge.

  • The Gobbler||

    That's why he's my favorite H&R poster.

  • ||

    Grr.

  • BakedPenguin||

    I've heard some people enjoy salvia. I don't think I've ever heard of anyone enjoying datura.

  • Joe M||

    Most people don't enjoy watching someone smash a large rock into the roof of a car for three hours straight, and then realizing it was their self.

  • SIV||

    And water tastes better too.

  • Dylboz||

    I wouldn't want to "dilute" myself into thinking I was a better copy editor, like the guys over at the Partnership for a Drug Free America. Sheesh.

  • Dylboz||

    From http://www.dxmstories.com/dxm_powder.html :

    "But really, I was just diluting myself and I wasn’t a better artist and I wasn’t a better writer, you know?"

    Water has the same dangerous potential. Literally.

  • Bill C.||

    I drank DXM once, but I never swallowed.

  • Tony||

    I always swallow. Always.

  • ||

    This just in! FDA discovers that over the counter drugs are still drugs! News at eleven!

  • ♥♥♥||

    If you're going to get fucked up on DXM, get the pills. It's much easier than drinking cough syrup. Also, make sure you don't get any medicine with acetaminophen.

  • Bikerider||

    Remember Y2K when some folks were stockpiling water and canned goods because civilization was going to end?

    I guess they can clear out the canned goods and stock up on cough medicine, incandescent light bulbs, saturated fat, corn syrup and cigarettes because free civilization might really be ending this time. These soon-to-be-banned products will be a much better investment than gold.

  • ||

    Government run drug programs: Rising prices, artificial scarcities, dangerous products for the children available OTC, whole forests of paperwork to fill out. No babes.

    Pablo's drug-non-subsidy programs:
    Falling prices, product gets better and better every year, convenience of purchase anytime, anywhere. No paperwork. Babes everywhere.

    The best run program to get drugs to market at the lowest possible cost is the one that - surprise - is not run by the government.

  • Stephen||

    That "plateau" stuff is lifted directly from Erowid and other pro-drug websites...I remember reading it 5-10 years ago when I was tryna get high.

  • lunchstealer||

    Aw, sweetie, I bought that for colds, not so you could make Nyquiladas!

  • ||

    The FDA is unconcerned, however, about the fact that DXM has been shown to be a CRAPPY cough medicine--codeine is WAY better, and in general is very safe in the dosages prescribed.

  • Denise Krochta||

    I see that everyone here thinks this is all a joke. You are all very lucky that your lives have been untouched by the devastation that addiction can bring to families and loved ones in general.
    I, too , have judged and had my time of being flippant about the subject. My perspective has changed. I don't believe for a minute that you are better than I am or that I am better than you all are. Be grateful that you still ca n believe that this is fodder for light banter.
    I'll relay your messages to all the mom's whose kids are hallucinating from this stuff or are in jail. Those who have lost their kids don't need to see this.

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