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Dextromethorphan (dxm) is one of the active ingredients in many over-the-counter (OTC) cough, cold, and allergy medications. When used as directed on the packaging or by a health care provider, it suppresses coughs effectively and presents few harms.

Lately, though, reports of people using dextromethorphan recreationally — and undergoing some nasty side effects — have been increasing, particularly among high school students. Called "DXM," "DMX," "Tuss," "Robo," and a variety of other names, the stuff is most often guzzled in large quantities straight from the cough medicine bottle, despite its bitter taste and sticky, thick consistency. Many first-timers say chugging the fake-cherry goo is nauseating enough to turn them off once and for all. The drug can also be found in lozenge form (for treating coughs) or as a powder that gets mixed into beverages. For those who stick it out, and keep the stuff down, what follows is a variety of experiences, ranging from the mild to the painful and dangerous.

Anecdotes describe a series of plateaus of experience. At lower doses (still higher than the recommended for dxm's intended medical purpose), users usually feel dizzy, mild euphoria, or a stimulating effect. Some describe feeling like they're floating, which may not necessarily be pleasant. At higher doses, some describe the effects as feeling like being drunk and stoned at the same time, including a lack of coordination and mild hallucinations. Consuming even more dextromethorphan often induces vivid visual and/or auditory hallucinations and out-of-body experiences. One might feel completely disconnected from one's body and surroundings, with no sense of reality, time, or awareness of what you're doing (or having done to you). This is what's known as dissociation.

These dissociative experiences are often compared to those that people go through while using PCP or Ketamine (a.k.a., Special K), which makes sense since dxm appears to affect the same chemicals in your brain as these other two, blocking the re-uptake of the neurotransmitter dopamine.

It is especially at these higher doses that users feel dextromethorphan's effects as unpleasant, and also raise their chance of having unsafe side effects. Most people have at least some nausea and/or vomiting, even at the lower recreational doses. Other possible reactions are skin irritation, rash, and intense itching, sweating, slowed breathing, and irritability. With lack of coordination and dissociation also come the risk of falls, injury, scary psychological episodes, and victimization. There is also the possibility of overdose, coma, and even death.

These risks are compounded by mixing dextromethorphan with alcohol or other drugs, including some very dangerous effects if dxm is taken at the same time as some anti-depressant medications (this is true even if it's taken simply to treat a cough); using it in unfamiliar surroundings without someone who is sober and looking after your well-being; or, consuming large quantities of cough or cold medications that contain other ingredients in addition to the dxm. For example, some cold and allergy preparations contain ingredients that in large doses produce extreme laxative effects, while many include things such as acetaminophen, which can cause severe complications, possibly death, at high doses.

Also, if you have a history of asthma, diabetes, or liver disease, dxing is probably not for you. Since dextromethorphan inhibits coughing, it can be difficult to get rid of the mucus that is often a part of asthma, or even smoking. Most of the cough and allergy products that contain dxm contain lots of sugar, too, making it difficult to regulate blood glucose levels. According to the National Institutes of Health (NIH), dextromethorphan can also build up in the body and cause unwanted effects if your liver is not functioning to its full capacity.

Although dxm does not appear to be addictive, consistent, heavy abuse of the drug does appear to cause psychological dependence, which can be just as difficult to overcome as physical addiction. With this in mind, it's also important to think about what you're looking for in using the dxm. Is it the curiosity or thrill of being "sneaky" — with something people won't suspect? It does appear that for some people, easy access and legality are part of the draw of using dextromethorphan for fun. For this reason, in some countries, you now need a prescription to get the stuff, while in some states in the United States, dextromethorphan-containing products are kept behind the pharmacy counter and/or sold only to adults. Interested in the wacky effects and perceptions? Bonding with friends? If robo trippin', or using other drugs for that matter, is one of the only ways you and your friends have fun together, or if alcohol or other drug use is affecting your relationships, health, school work, and/or other goals, it may be time to look at your use and consider a change.

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