Dextromethorphan Abuse

[IUemt]

CBS Evening News did a story on Friday about a still ever growing trend of DXM abuse among teenagers and posting their 'trips' on youtube and myspace to brag about them. When I was still in high school, it seemed to be a pretty mild problem, and I rarely heard about it. How often are you guys seeing this in your service, or have you ever? Are there any protocols established for a treatment of this particular overdose, or is it a standard OD protocol? Here's the story:

Video: http://www.cbsnews.com/sections/i_video/ma...tml?id=3959430n

Article: http://www.cbsnews.com/stories/2008/03/21/...in3959347.shtml

[Scaramedic]

[AZCEP]

New issuing of the appropriate signage for these individuals, but this is not an isolated situation. DXM is popular because of the narcotic type effects it causes, but is becoming more difficult to obtain.

Standard overdose treatment with a trial of Narcan works just fine.

[firedoc5]

I got in on the very last of the story. But anymore kids are learning what to look for on the label that is mandatory. They look for the drowsiness warning and such. And you know kids think, ''if a little does good, a lot does better.''

[gvandellen]

Old problem new hype....I'm 34 and I was drinking Robi DM when I was 18. Do the math. It's nothing new and most people don't OD on DM.

[Dustdevil]

LOL! I saw the perfect application for that sign a few weeks ago. Vivi and I were driving down a dark, unlit stretch of highway one night, and the brake lights ahead of us all start coming on for no apparent reason. As we got closer, we could see some shadowy movement moving across the road in front of the cars. When we got closer, we saw four teenage boys, with skateboards in their hands and their pants literally around their ankles, shuffling (you can't really "run" like that) across the busy highway, reaching the curb, and then pulling their pants back up. Stupid is too kind of a word for that.

[triemal04]

Ahh...good old robotripping. Haven't thought about that in years. Or heard of it for that matter. If you're in an area where people are still taking Ecstacy with any frequency you may also run into this there; not uncommon for the pills to be cut with, or contain pure DXM.

Most common problems that I've seen occur with this are visual disturbances (not really hallucinations), N/V, lethargy, ataxia, and occasional some decrease in LOC. Haven't seen it cause respiratory depression, but then I wasn't always looking for that.

The treatment really is going to be supportive care for the most part; if it's actually causing respiratory depression narcan may or may not be effective (DXM does act on some opiate receptors although it generally doesn't cause any type of normal opiate effects), but it'd be worth trying I suppose. Anti-emetics...maybe some fluid...if you're using charcoal maybe, but if you're there then it's most likely way to late for that anyway.

DXM is a serotonin reuptake inhibitor, so it has the potential to cause problems if the pt is taking the wrong type of meds (antidepressants).

Emedicine has a decent article that talks about DXM. http://www.emedicine.com/ped/TOPIC2717.HTM

[bryan20w]

It is my understanding that dextromethorophan is a synthetic opiate, and i do know through practice that in the event of an overdose you do get the classic resp depression, and naloxone will work to reverse the effects.

[AnthonyM83]

Seen this only once, but it is more prevalent in the last few years according to cops. There have been changes in the last few years in which medications are available on the shelves on stores like Target and which you have to ask for at the counter.

The kids I got were two brothers who were ...well best explanation is "totally tripping out". They had nystagmus, unsteady gait, they'd zone out, looks of amazement at everything they saw, kept laughing at what they did. Couldn't understand the dangers of it.

One said it would help him do his HW assignment of poetry writing like some famous poets who wrote under the influence....had to remind him some of them died of suicide. Ages 12 and 13 I think.

[AZCEP]

It is my understanding that dextromethorophan is a synthetic opiate, and i do know through practice that in the event of an overdose you do get the classic resp depression, and naloxone will work to reverse the effects.

DM is not an opiate in the true sense of the term. It does not come from, nor bear the same chemical makeup of true opiates. It will bind to narcotic receptor sites, but it is poorly antagonized by naloxone/nalmefene/naltrexone. It is reasonable to try some of your available antagonist, just don't expect it to work very well.