-- It's the DM in cough syrups and the "cough" or "tuss" portion of most other over-the counter-cold treatments.
Most people have taken dextromethorphan, a cough suppressant, sometimes abbreviated as DXM, at some point in their lives, usually to lessen the symptoms of the common cold.
Some, however, purposefully disregard the recommended dosage guidelines of this antitussive in order to achieve euphoric effects.
Last week, Worcester District Attorney Joseph Early Jr.'s office released a report revealing Eric Stafford, the Fitchburg man fatally shot by Fitchburg police on March 19 after he charged at them with a machete, was under the influence of a large amount of Coricidin Cough & Cold, commonly referred to as "Triple C," during the attack.
Dr. Christopher Rosenbaum, a medical doctor and assistant professor of emergency medicine and medical toxicology at the University of Massachusetts Medical School in Worcester, said the hospital regularly sees cases of emergency-room patients who have ingested several times the recommended dosage of dextromethorphan -- so many, in fact, he cannot count the number of cases he's seen in the past year alone.
"It's a common presentation at the ER," he said. "We see it all the time."
Rosenbaum said the ease of accessibility of the drug, particularly for young people, is the culprit for its abuse. He pointed to teenagers and college students as the primary users, though the age range of abusers
he has encountered has varied greatly. "People use it to get high, for an out-of-body experience similar to ketamine," he said, comparing it to a general anesthetic primarily used on children and animals, which has similar dissociative qualities.
Rosenbaum said the effects of "robotripping," as it is commonly called, could range wildly, from mild intoxication to complete unresponsiveness, depending on the dosage.
The results, as with any hallucinogenic substance, can often be unpredictable, as in the case of Stafford earlier this year. Accounts included in that report recalled Stafford as being stable prior to this event and suggested his use of the substance caused him to experience severe paranoia and delusions of grandeur.
Coricidin's website acknowledges the widespread recreational abuse of its products and has a section dedicated to educating parents and alerting them to potential warning signs their children may exhibit, such as use of these products outside of the cold and flu season, continuing to self-medicate after symptoms have subsided and cold remedies seeming to disappear from medicine cabinets.
It also warns improper use may result in "impaired judgment and mental performance, loss of coordination, dizziness, nausea, hot flashes, dissociation and hallucinations."
Rosenbaum said too much dextromethorphan, especially in someone taking selective serotonin reuptake inhibitors (SSRIs), commonly used as antidepressants, can also cause serotonin syndrome, an excess of serotonin in the central nervous system.
Other adverse effects, such as hyperreflexia, or overactive or overresponsive reflexes, and hypertonicity, increased tension of the muscles, are also possible, he said, along with fever and agitation.
To curb recreational use, Worcester County Sheriff Lew Evangelidis suggested treating the sale of products containing dextromethorphan similarly to those with the nasal decongestant pseudoephedrine may eventually be necessary.
Because much smaller amounts of dextromethorphan are needed to achieve a high and it requires no additional processing (pseudoephedrine does), Evangelidis believes it will be much harder to track frequent buyers who only need to purchase one bottle or package at a time rather than several.
Evangelidis is worried kids experimenting with legal highs will lead to harder drugs, and said those who chase highs often turn to crime and violence. He has been addressing these concerns by educating children through his Face2Face drug-prevention program, in which he visits schools to talk to kids about the effects of drug and alcohol abuse.
Most recently, Evangelidis focused on "bath salts," currently legal amphetamine derivatives that look like epsom salts. He said he has not included cough-medicine abuse in his program yet, but likely will.
"We have the obligation to protect society from these dangers, especially youth, by staying ahead of the curve and being aware of the new and somewhat inventive ways they are getting high," he said. "If this is being abused, we have to consider some sort of regulation for the greater good."
Though there is not much pharmacies can do currently to track frequent cough-medicine buyers, some have set age restrictions. According to CVS Pharmacy spokesman Mike DeAngelis, the company set regulations in place in 2007 to stop those under the age of 18 from purchasing products containing dextromethorphan at all of its stores nationwide.
"A register prompt blocks the sale of any age-restricted item, whether it be tobacco or cough medicine, until a proper date of birth is entered into the system," he said.
DeAngelis said some CVS stores have already voluntarily moved dextromethorphan products behind the counter as a loss-prevention measure in areas experiencing high theft rates.