7/2017
Robitussin is an over-the-counter cough medication which contains the drug dextromethorphan. This is a response to a recent e-mail I received on the subject.
I’ve previously mentioned some of my experiences with “robo-tripin” patients. I’ve been seeing this for many years now. The article is pretty good, except for one aspect. (1) In my experience, chronic dextromethorphan/codeine use does not induce aggressive behavior. It might lower inhibitions like alcohol but it is very different from the rage/anger/aggression of amphetamines (speed, cocaine, meth, crack…). It’s my opinion that this incident was caused by poor upbringing, bad entitlement and racial attitude and homophobia if dextromethorphan was the only drug on board.
Dextromethorphan has been available over the counter for 50 years or more. The fact that dextromethorphan differs in structure from codeine by 2 hydroxy (one oxygen attached to 2 hydrogen) groups became known on the streets and users found that they can get similar effects using dextromethorphan (legal and available without a prescription) as codeine (requires a prescription) by just increasing the dose.
Codeine-like drugs have way overtaken valium-like drugs as the most common prescribed drug in America. They are not stimulants but depressants in their general mechanism of action.
Codeine and its synthetic variants, hydrocodone, methadone, hydromorphone and oxycodone, are legal for the person to whom the prescription was written. There is a billion dollar industry in the US for legal and illegal codeine obtained in various ways.
For instance, a team may go to a medium-large town and break into a doctor’s office. They forge scripts found in the office and distribute them to street people to have filled. “Organizers”, kinda like what Obama was (but not necessarily implying Obama pushed drugs), go to derelict areas of a town and recruit low life types to hit the Emergency Departments with feigned and real complaints. Casts are cut off freshly broken extremities and the person is sent to the ED as if it was a fresh injury, then to the next ED and so on. Salvation Army and like shelters, food kitchens, and welfare housing are recruitment centers for these people.
The Urban Dictionary is indispensable, entertaining and scary. Slang used by kids changes, sometimes daily. I would venture to guess that 90% of the population below the age of 19 know of this use of dextromethorphan. Those that disagree just don’t realize the kid is lying.
Here is my most often told story of Robo-tripin.
One evening at work, a respiratory therapist came to me and said, “Doctor, you need to come to see this patient now. He isn’t breathing very good.”
I checked the patient out and sure enough, he wasn’t breathing at all! We quickly grabbed an Ambu bag and started to breathe for him. During my exam, I noted that he did have a pulse but was otherwise unresponsive. To determine unresponsiveness, the examiner inflicts painful stimuli and notes the response. Yup, I can make anyone wince and sometimes it’s even part of my job. He had no response. This was a young guy, 19-20 or so. So I said, “Looks like I’m going to have to intubate this fella.” At this point, I knew that he was in a coma but didn’t know why.
To intubate a patient, I put a plastic tube down their trachea which allows us to breathe for him/her until we can identify and hopefully reverse the problem. So I take my handy dandy laryngoscope (with decoder ring optional), which is basically a flashlight with the bulb at the end of a tongue blade extension at right angles to the handle, and insert it into the oral cavity. This guy’s muscles were flaccid and he offered no resistance. The blade-like portion is used to move the tongue out of the way (seems a problem with us humans that our tongue seems to get in the way of life all the time) and allows the provider a view of the vocal cords. The mission is to pass the plastic tube between the vocal cords when they open and into the trachea just below. The vocal cords are touched by the tube as it passes through.
Under normal circumstances, when that happens a nerve is stimulated and it sends a signal to the brain that results in a violent and forceful cough response. Think eating cookies and accidentally inhaling crumbs into the windpipe. In a comatose patient, the response does not happen.
Well, Robotrucker here, responded when I touched his vocal cords. He reached up (none of the others nor I expected this comatose patient to respond at all) and smacked the tube and laryngoscope from my hands and sat up. “Don’t do that!”, he exclaimed. He walked out of the ED under his own power about 45 minutes later.
This was an extremely unexpected event, but it has since happened to me several times. Something about this laryngeal reflex pops them right out of a coma. Not every time mind you, and not every patient is lucky enough to be found in time.
Life in the emergency department from your grumpy Uncle/Brother Dave.
- http://theconservativetreehouse.com/2012/05/24/update-26-part-2-trayvon-martin-shooting-a-year-of-drug-use-culminates-in-predictable-violence
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