Dependence risk with chronic dextromethorphan abuse
‘Robo-ing’ patients may meet diagnostic criteria
Objects may appear disproportionately large or small. The normal rhythm of conversation may seem chopped into blocks of words, or words may echo. Users refer to this staccato or strobing quality of sound as “flanging.”13 The bodily experience has been described as dreamlike or as if standing on a wave.
The high at lower plateaus is generally described as a positive experience. However, some describe it as bizarre, weird, and disturbing. It can create panic, nausea, and vomiting.
Upper plateaus. Users consider plateaus 3 and 4 as less recreational and more “spiritual and introspective.”15 Substantial dissociation and hallucinations can occur with “heavy stoning”—which the NIDA defines as using 10 ounces or more of medication containing 15 to 30 mg of dextromethorphan.14 Web sites warn users not to try to attain the upper plateaus unless prepared to “sit it out” or be accompanied by a sober “sitter” to talk the user through a bad trip or get help if needed.13
RISK OF PSYCHOSIS AND DEATH
The upper plateaus of dextromethorphan abuse are described as “intense.” Users report hallucinations, time and space distortions, and out-of-body sensations. Some have reported contacting alien beings or spirits. Although some users report the higher plateaus as pleasant, others report them as “terrifying.”
Upper-level trips can result in panic attacks and psychosis. Case reports have documented dextromethorphan doses that resulted in emergency room visits for psychotic states. For example:
- an adult was treated in the emergency room for psychosis after consuming an estimated 711 mg of dextromethorphan from cough syrup16
- a 23-year-old was treated for agitation and hallucinations in an emergency room after consuming approximately 2,160 mg of dextromethorphan.17
Research is lacking on long-term effects of regular dextromethorphan use. One study reported birth defects in chick embryos exposed to dextromethorphan.18
Fatalities. Dextromethorphan-related deaths have been documented.19 Causes of death include respiratory arrest, seizure, aspiration, and drug-drug interactions.20 Because dextromethorphan is usually not taken in pure form, effects of other drugs in cough syrup—such as bromide or chlorpheniramine—may contribute to the risk of side effects or death.21
Related resources
- National Institute on Drug Abuse. Research Report Series. Hallucinogens and dissociative drugs. Accessed Jan. 4, 2005.
- LSD, PCP, ketamine, and dextromethorphan. Available at: https://www.nida.nih.gov/ResearchReports/hallucinogens/Hallucinogens.html.
- Nature and effects of dextromethorphan. Available at: https://www.drugabuse.gov/ResearchReports/hallucinogens/halluc4.html.
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
