Back in my college days, I used to hear tales about fellow teenagers tripping on Vicks VapoRub—an ointment that has become a staple in Indian households as a nasal congestive. They wouldn’t inhale the opaque substance to another dimension or coat their tongues with it, as one may imagine. The ingestion process was instead rooted in arguable creativity, backed with an effort to fly incognito. I’m talking about bread and biscuits. The over-the-counter (OTC) substance was slathered in copious amounts as condiments on food.

If you are someone keeping up with the ‘market trends’ in your campus, you would’ve heard whispers of a decade-old practice making a deadly comeback. Robotripping, skittling, dexing, tussin, velveting, triple C-ing—call it what you want, but teenagers are dosing on cough syrup in the pursuit of cheap highs again. This time around, however, pharmacies and law enforcement are hoping to terminate the trend for good.

Robotripping refers to the recreational use of dextromethorphan (DXM)—an active ingredient in several cough medicines. Remember how a spoonful of cough syrup usually makes us drowsy while nursing a cold? We’re then asked to ‘sleep it off’ in order to feel better. When ingested in large doses, on the other hand, the substance can cause psychedelic effects similar to those of traditional drugs like ecstasy—but with a deadlier catch.

Users who experiment with DXM often experience intense hallucinations, hyper-activity and a “sense of flying” that can be compared to an LSD trip. These effects, however, depend entirely on the dosage—which the Canadian Medical Association Journal divides into four stages called ‘plateaus’:

Plateau 1: A dosage of 100 to 200 milligrams of DXM (equals to 35 to 60 millilitres of syrup and four to six capsules) causes mild stimulation with an “uplifting effect.” Users at this stage describe feeling more energetic, social and talkative.

Plateau 2: A dosage of 200 to 500 milligrams (60 to 185 millilitres of syrup and seven to 18 capsules) is compared to alcohol intoxication with a noticeable decrease in motor and cognitive functioning. Mild hallucinations and imbalance are also common experiences here.

Plateau 3: A dosage of 500 to 1,000 milligrams (185 to 375 millilitres of syrup and 18 to 33 capsules) induces effects similar to those of ketamine and is enough to leave you incapacitated—with symptoms including intense hallucinations, altered consciousness, partial dissociation, panic and mania.

Plateau 4: A dosage of any amount more than 1,000 milligrams (375 millilitres of syrup and 33 capsules) will catapult users into a high that is hard to shake off and lasts longer than the effects of other plateaus. According to MDedge, some people have even experienced prolonged symptoms for over two weeks. Delirium and hallucinations can often trigger aggressive or violent behaviour at this stage—eventually paving the way to full dissociation and a loss of control over bodily movements. In extreme cases, robotripping can also result in toxic psychosis, characterised by confusion and loss of contact with reality as a whole. “Individuals experiencing substance-induced psychosis have trouble recognising their environment and communicating with others,” noted DrugRehab.com.

‘Psychosis with mere bottles of cough syrup?’ I hear you ask. Well, I regret to inform you that the list does not end there. In an effort to push boundaries of the euphoric high induced by the OTC medicine, our ancestors have been mixing them with other psychedelic substances to build an undesirable guidebook for others to follow. For starters, prescription-strength cough syrup is mixed with sugary sodas like Mountain Dew—to which hard candies like Jolly Ranchers are added to ‘enhance’ the flavour.

Nicknamed lean, sizzurp, purple drank and dirty sprite, the drink was initially popular among musicians in Houston who mixed Robitussin cough syrup with beer. Be mindful that lean is essentially a ‘subset’ of robotripping with symptoms and side effects of its own. Other spin-offs of DXM also include mixing it with everything from MDMA, ketamine and sassafras to heroin, cannabis and cocaine. Prescription medications like antibiotics, amphetamines, morphine, and fentanyl are also in the mix. What could possibly go wrong?

“DXM can cause serious interactions when combined with other substances and OTC or prescription meds,” writes Healthline, adding how robotripping with other central nervous system (CNS) depressants can intensify or prolong the effects of both—while significantly increasing one’s risk for respiratory arrest, overdose and death. The duration and severity of a robotrip also depends on one’s metabolism, body mass index (BMI), frequency and history of DXM use.

And even if you’re having a bad trip, there’s no surefire way of ending things sooner. You can only bet your luck at regulating it to stay safe instead. “Once you’ve taken it, you pretty much need to let it run its course,” Healthline continued. “Your best bet is to try to sleep it off. If you’re feeling really out of it and nauseous, sit upright in a comfortable chair instead of lying down in case you throw up.”

When it comes to illicit trends, especially inexpensive and incognito highs, it typically only takes one curious teenager for the rest to follow blindly. Spending a huge chunk of their time at home over the pandemic, the demographic is now reporting a rise in cases of robotripping. I mean, they can literally get their hands on the substance with a simple raid of a bathroom cabinet or desk drawer. Even if their homes run out of cough syrups or capsules, they can always just hop their way down to the local chemist to avail the OTC medicine.

“For young people, consuming cough medicines in high doses is a bit of excitement, danger and risk when they are partying with friends,” said Doctor Hester Wilson, an addiction medicine chair at the Royal Australian College of General Practitioners (RACGP). In an interview with WAtoday, she highlighted how such medicines are perceived as ‘safe’ because they’re readily available at a chemist and ingested by the general public in recommended doses without a prescription.

When it comes to overdosing on DXM, Doctor Wilson mentioned how general practitioners in Australia are also witnessing patients who have developed a dependency on cough mixtures. “Rikodeine does have codeine in it which can be addictive,” she said. “I have someone I’m seeing who is drinking four bottles a day. They are racing from pharmacy to pharmacy every day. The addiction has overtaken their life.”

In July 2021, Governor Mike DeWine signed a new law limiting the sale of cough suppressants in a bid to curb abuse by minors in Ohio. Dubbed House Bill 9, it sought to prohibit the sale of the substance to those under 18 without a prescription. According to reports by the Substance Abuse and Mental Health Services Administration (SAMHSA) at the time, those aged between 12 to 26 are the most likely to abuse DXM. In Perth, pharmacists are increasingly refusing to dispense OTC syrups to teenagers over concerns that they are mixing it with soft drinks to make lean.

Despite these efforts, however, Doctor Hester highlighted how cracking down on the medication is not the ideal solution. “If they ban it, young people will move on to something else,” she told WAtoday, adding how the world has changed and access to information—including ways to get high—is literally at their fingertips aided by the space-age technology called the internet. “We need to teach them online literacy and educate teenagers about risk and understand that 15 year-olds have developing brains and haven’t learned how to put the brakes on,” she continued.

As for Stephen Bright, a senior lecturer at the Edith Cowan University, the ‘OTC’ status of such medicines should not be revoked in Australia. “Making them prescription-only medicines would place additional strain on an already-stretched healthcare system by those people who do need them,” he said. Andrew Ngeow, the branch president of Pharmacy Guild of Australia, additionally highlighted how cough medicines’ ‘Schedule 3’ rating meant that they currently don’t require a prescription but could only be purchased from a pharmacist.

“S3 must be stored to prevent any physical access by the public, for example, behind the counter so a patient cannot self-select,” he continued. And this is exactly where the ideal source of regulation lies. “Pharmacists will ask a series of questions to validate the patient has symptoms to match the medicines they are requesting. If pharmacists have concerns about the potential misuse of medicines such as cough medicines they can withhold supply.”

With other countries yet to follow through and take a stand, it’s essential for parents to familiarise themselves with the tell-tale signs of robotripping. Back when the trend made a dreaded comeback in the early aughts, Nadine J Kaslow, chief psychologist at Emory University in Atlanta, warned parents to be on the lookout for changes in their child’s functioning. The list included a sudden drop in grades, sudden loss of friends, increased and decreased sleeping hours and loss of appetite. A sudden addiction to texting and internet surfing, with Google searches for phrases like ‘cheap way to get high’ can additionally steer them to how-to sites written by other teens.

“Most parents are concerned about pornography and online pedophiles. What they don’t realise is the preponderance of pro-drug use information on the internet,” warned Steve Pasierb, president and CEO of the Partnership to End Addiction, to ABC News back in 2010. “It’s not on their radar screen, because no one did it when they were growing up.”

Eleven years later, the situation seems to be pretty much the same. Although researchers have trained AI models to predict designer drugs before they even hit the market, the abuse of the ones that are literally under our noses are concerningly out of the loop. With annual drug overdose deaths hitting a record level high in the US, concern about robotripping seems to be more relevant than ever. Though the prevention of the illicit practice begins at home, it’s not too late for authorities to jump on and do their bit worldwide—in hopes that the demographic doesn’t jump onto the next trend they come across and decide to revive.