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Triple C is otherwise known as dextromethorphan (DXM). Dextromethorphan is an over-the-counter (OTC) cough suppressant, found in cold medicine. The medicine helps to ease coughing due to a cold, flu, or another illness.
Dextromethorphan belongs to the medication class called antitussives. It is available alone or mixed in products with other medications, including antihistamines and decongestants.
Some products containing just dextromethorphan include:
Several brands have various products that contain dextromethorphan blended with other medications. These brands include:
Dextromethorphan abuse is sometimes referred to as robotripping or skittling. These terms come from the most abused products, Robitussin, and Coricidin.
Other street names for Triple C include:
The typical dose of dextromethorphan is 15 or 30 mg three to four times daily. The anti-coughing effects of the drug continue for five to six hours after oral use. When taken as directed by a doctor or medical professional, side effects are rarely reported.
Triple C is often abused in large doses by adolescents. A high dose of Triple C can lead to euphoria and visual and auditory hallucinations.
Dextromethorphan is usually taken orally as liquid cough medicine. More recently, abuse of Triple C tablets and gel capsules has increased.
DMX abusers also use Triple C powder sold over the internet. Likewise, Triple C is distributed in illegally manufactured tablets. These tablets contain just dextromethorphan, or they’re mixed with other illegal drugs like ecstasy or methamphetamine.
Triple C can provide side effects and symptoms, especially when taken in high doses.
Side effects of Triple C include:
People of all ages use Triple C, but abuse by teenagers and young adults is common. This abuse results from the easy access to Triple C and the extensive information available on how to abuse Triple C across various websites.
The powdered form of Triple C on the internet poses additional risks of abuse, due to the uncertainty of the dose and composition of the drug.
When ingested, Triple C abusers may experience a heightened sense of perceptual awareness. Users may also report altered time perception and visual hallucinations. In high doses, the effects of triple C are similar to drugs like ketamine and phencyclidine (PCP).
Abuse of combination dextromethorphan products can also lead to health complications from the other active ingredients in the solution. These health complications can include:
When combined with alcohol or other drugs, high doses of triple C are particularly dangerous. Deaths have been reported from such combinations.
Dextromethorphan is an over-the-counter medicine. However, it shows the potential for addiction and a high potential for abuse.
74.5% of dextromethorphan abusers reported to the California Poison Control System (CPCS) were aged nine to seventeen years old. The average age was 16 years old.Dextromethorphan Abuse in Adolescence, Archives of pediatrics & adolescent medicine, 2006
Most users do not become addicted to triple C. However, robotripping is unsafe. Regular use of triple C can lead individuals to develop a severe substance use disorder.
Anyone struggling with a triple C substance use disorder should visit their doctor or a healthcare professional for treatment advice. Substance addiction is a chronic disease. If left untreated, it can lead to disability or death.
Other substances are often misused along with triple C, which can make diagnosis and treatment more complicated. However, traditional methods of treatment of substance use disorders can help individuals learn to manage their addiction and to avoid relapse.
The most effective way to address substance addiction is to attend rehab. Cognitive-behavioral therapy at a rehab medical facility can help people change their views and behaviors towards triple C.
Contingency management is a reward-based scheme that can also help triple C abusers overcome their addiction.
Substance abuse disorders and mental illness often coincide. People abusing triple C may have co-occurring mental illnesses. These mental health disorders may include depression, anxiety disorders, or other mental health problems.
All individuals receiving treatment for triple C addiction should undergo a thorough assessment to evaluate for any co-occurring mental health disorders.
People experiencing both a mental illness and a substance use disorder often experience more severe and persistent symptoms. These symptoms can be more resistant to treatment than in people who have just one illness or the other.
Antipsychotic or antidepressant medications may be prescribed to alleviate any mental health disorders.
Here are some common questions and concerns relating to triple C.
When 1500 mg is taken or more, a person is likely to overdose on dextromethorphan. This amount is five to ten times the recommended dosage of any over-the-counter medication containing methamphetamine.
Large doses like this can lead users to experience dissociative sedation.
The intoxication of triple C from a nonmedical dose begins between 15 and 30 minutes after use. The effects usually last for around three to six hours.
However, dextromethorphan remains in the body for much longer than six hours.
Dextromethorphan metabolizes through the liver. Around 85 percent of the population in the United States quickly metabolizes dextromethorphan into dextrorphan.
People who metabolize dextromethorphan quickly are more prone to drug abuse since it stops working more rapidly than may be desirable. As a result, large doses may be taken.
For those that metabolize dextromethorphan quickly, the drug can stay in the bloodstream in some form for between 11 and 22 hours. For those that metabolize dextromethorphan poorly, it can linger for up to 33 hours.
Triple C cannot be detected on a standard urine drug screen. It can also give a false positive for PCP.
Linn, Kelly A et al. “"Robo-tripping": dextromethorphan abuse and its anesthetic implications.” Anesthesiology and pain medicine vol. 4,5 e20990. 14 Nov. 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358333/
Dextromethorphan, Drug Enforcement Administration, 2019, https://www.deadiversion.usdoj.gov/drug_chem_info/dextro_m.pdf
Bryner, Jodi K et al. “Dextromethorphan abuse in adolescence: an increasing trend: 1999-2004.” Archives of pediatrics & adolescent medicine vol. 160,12, 2006, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2257867/
Peter A. Chyka, Andrew R. Erdman, Anthony S. Manoguerra, Gwenn Christianson, Lisa L. Booze, Lewis S. Nelson, Alan D. Woolf, Daniel J. Cobaugh, E. Martin Caravati, Elizabeth J. Scharman & William G. Troutman, Dextromethorphan poisoning: An evidence-based consensus guideline for out-of-hospital management, Clinical Toxicology, 45:6, 662-677, 2007, https://www.tandfonline.com/doi/pdf/10.1080/15563650701606443
Martinak, Bridgette et al., Dextromethorphan in Cough Syrup: The Poor Man's Psychosis., Psychopharmacology bulletin vol. 47,4, 59-63, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601090/