Here We Go Again—Sizzurp and Robotripping
Yet another drug concoction to keep up with. Touted by Justin Bieber and Lil Wayne for years, we are just starting to hear more about it.
The drink has been abused as far back as the 1960s, originating with the blues musicians in Houston, Texas who would combine dextromethorphan (DXM) with beer. Over time, the recipe was modified to include codeine and by the 80s, it was adopted by the hip-hop musicians in the south. It gained popularity in the 90s in the underground rap scene in Houston. From there, it spread to nearby states including Lil Wayne’s home state of Louisiana.
What is Sizzurp?
Sizzurp is a pharmaceutical drug-infused drink that gets the user high. It is made by combining prescription-strength cough syrup with sugary sodas like Mountain Dew or Sprite, to which hard candies like Jolly Ranchers are added to increase the candy-like flavor. Slang names for sizzurp are “lean”, “syrup,” “barre,” and “purple jelly.” The most popular slang term is “purple drank,” so-called for the purple hue the cough syrup gives it.
The concoction is becoming more popular among teenagers because it is both affordable and easily accessible. In 2016, a study found that 5.5% of surveyed 12th graders had gotten high off cough syrup in one way or another.
Sizzurp contains narcotics that can become highly addictive. When combined with soda, energy drinks, alcohol or other substances, a user’s high can increase dramatically – and so can the risks of use. In most cases, effects include extreme euphoria, motor skill impairment, hallucinations, and more. More serious effects can include seizures and death.
The Contents of Sizzurp
“Purple drank” is made of multiple depressants which can synergize to cause:
- Respiratory depression
- Hypotension (dangerously low blood pressure)
- Sudden death
If other central nervous system depressants are thrown into the mixture, the consequences would be particularly bad.
Prescription cough syrup contains the active ingredients of codeine and promethazine. Codeine is part of a class of drugs called opiates. It is usually prescribed for mild to severe pain and produces euphoric side effects. Promethazine is a sedative antihistamine that is often used to treat motion sickness and insomnia and can enhance the effects of the codeine.
People typically sip the purple drank to experience the reported euphoria and dissociation. Promethazine acts as a sedative and the codeine creates a feeling of euphoria. These effects can last between 3 to 6 hours. Purple drank also goes by the name “lean” because, similar to being drunk, people often have to literally lean on something to stand up. Sizzurp is also sometimes used to dip blunts of marijuana before smoking or to help with the chest congestion that crack-cocaine users often experience.
Sizzurp and Robitussin
Over-the-counter cough syrups like Robitussin can also be used to make sizzurp, although purists argue that true sizzurp is made only using codeine with promethazine cough syrup, Sprite soda, and Jolly Ranchers. The effects of the Robitussin mixture is more hallucinogenic than euphoric.
Adding ingredients such as vodka and crushed painkillers can increase the impairment of motor skills as well as a general feeling of melancholy associated with a sizzurp high. This drink is highly addictive and codeine and promethazine can be deadly when mixed with alcohol or consumed in high doses.
It can cause increased heart rate, fever, and liver damage when consumed in sizzurp levels, which can reach 25 times the recommended dose. In May of 2013, Lil Wayne was hospitalized for seizures relating to his abuse of the substance. This led to multiple reports that the rapper came close to dying during the medical incident.
Sizzurp Overdose Signs
Because there is no way to know the exact soda-to-syrup ratio when mixing a drug cocktail such as purple drank, there is a high risk of overdose. Signs to look for include:
- Bluish-colored fingernails and lips
- Breathing problems
- Cold, clammy skin
- Loss of consciousness
- Muscle twitches
- Tiny pupils
- Stomach spasms
- Weak pulse
In 2014, pharmaceutical company Actavis stopped producing and selling its prescription-only promethazine-codeine syrup product due to the rise in recreational use. Unfortunately, this did not deter its use. People have reportedly stockpiled the promethazine-codeine cough syrup. It remains to be seen whether people seeking a similar high will come up with another cocktail with promethazine and other opioids.
Dextromethorphan—A “Household High”
The active ingredient in most over-the-counter cough syrups, Dextromethorphan (DXM) is a synthetically produced drug that is available in more than 140 over-the-counter cough and cold medicines. The fact that the medications are available without a prescription increases their accessibility for those looking for a “household high”(common household items that can be abused to get high). Parents and acquaintances often leave these substances around more casually than they would prescription medications.
What is Robotripping?
“Robotripping” is slang for getting high on DXM. Dextromethorphan is a drug of the morphinan class with sedative, dissociative, and stimulant properties. It is a cough suppressant and an ingredient in many over-the-counter cold and cough medicines. It is best known by its trade name Robitussin.
Any time a cold or cough medicine has the letters DM after its name, it means that dextromethorphan has been added. Too much DXM can lead to a host of side effects, including hallucinations, disorientation, and a sense of flying.
While Sizzurp frequently involves the use of prescription-strength cough suppressants, individuals can also use lesser-strength suppressants such as DXM. An individual can either drink DXM straight or mix it with other substances like they would when using Sizzurp. Either way, some of the most common side effects of robotripping include:
- Auditory and visual changes
- Psychological dependence
- Loss of coordination
- Liver damage
- Rapid heart rate
It is important to understand that the use of Sizzurp (or even straight dextromethorphan) can lead to an episode of robotripping. It only takes one time robotripping to produce one or more of these dangerous effects. In some cases, although rare, robotripping can even lead to death.
The more DXM you take, the more severe your symptoms will be. In extreme cases, robotripping can result in toxic psychosis. This is characterized by individuals being confused, losing touch with reality, trouble recognizing their environment and difficulty communicating with others.
How Long Does a Robotrip Last?
According to a 2014 study published in the journal Anesthesiology and Pain Medicine, DXM effects typically last from 2 ½ to 6 hours. However, they can linger for much longer if used with other drugs. Some people experience more intense robotrips than others. Factors that influence the experience include the person’s metabolism, weight, history of DXM use and frequency of DXM use.
The effect experienced from the abuse of DXM is categorized in four stages, called “plateaus.”
- Mild stimulation
- Euphoria and hallucinations
- Dissociative out of body state
- Complete dissociation with unresponsiveness
You have probably never considered that you can overdose on an over-the-counter cough medication. You can overdose on DXM the same way you overdose on any drug. When a person consumes too much dextromethorphan, an overdose can occur. While people can get high on DXM, those who overdose can suffer from the following life-threatening symptoms:
- High or low blood pressure
- Blurred vision
- Rapid heartbeat
- Bluish lips and fingernails
- Slowed breathing
- Nausea and vomiting
- Elevated body temperature
The Popularity of Robotripping Among Teens
DXM is not regulated by the Controlled Substance Act. This means it is legal to purchase in the United States. Fifteen states have banned sales of DXM products to minors, but that hasn’t stopped many teens from accessing the drug.
Teens abuse products containing DXM to experience hallucinations. Products can be purchased from friends or over the internet. Others steal the products from stores. Coricidin HBP Cough & Cold, also called “triple C,” is a popular cough medicine of abuse among minors.
According to the 2017 Monitoring the Future survey, about 3.2% of 12th-grade students reported misusing cold or cough medications in the past year. Some students use dextromethorphan throughout the day to maintain a consistent high. Long-term misuse of DXM can cause learning problems, memory impairment and eventually addiction.
Tolerance, Dependence, and Withdrawal
Codeine is a habit-forming opioid pain reliever. Taking more than prescribed can easily lead to dependence and addiction. It is also possible to build a tolerance to sizzurp which also puts you at a greater risk for overdose. Withdrawal from purple drank can be very uncomfortable. Symptoms of withdrawal are:
- Anxiety and irritability
- Sleep problems
- Teary eyes and runny nose
- Muscle aches
- Faster heartbeat
- Nausea, diarrhea, vomiting
- Chills or goosebumps
Support and treatment for individuals affected by the misuse of codeine, including its compound formulas, are available through several sources. Formal drug and alcohol treatment centers, support groups such as Narcotics Anonymous, private clinics, the involvement of general practitioners, and online groups are all viable treatment avenues.
Those affected by codeine abuse have been recognized as a hard-to-reach group who may not want others to know about their misuse and may not present themselves to formal treatment service.
Habitual users of dextromethorphan can develop symptoms that meet the criteria for dependence. It is considered non-addictive but is far from safe in excessive usage. Studies indicate that DXM probably isn’t addictive but it is not known for certain if it is possible to get addicted to DXM or not. That being said, if a person is having trouble quitting dextromethorphan, even though they’ve been trying, some professional help may be required. Symptoms of DXM withdrawal are not deadly but are very uncomfortable. They are:
- Bone or muscle aches
- Cold flashes
- Diarrhea and vomiting
There are no medications approved specifically to treat DXM addiction. Behavioral therapies, such as cognitive-behavioral therapy (CBT) and contingency management may be helpful. CBT helps modify the patient’s drug-use expectations and behaviors, and effectively manage triggers and stress. Contingency management provides vouchers or small cash rewards for positive behaviors such as staying drug-free.
As we continue to watch celebrities such as Justin Bieber abuse Sizzurp and other drugs, it is critical to stay educated about the many different ways that both teens and adults are getting high so that preventative measures can be taken, and negative consequences such as jail time, relationship problems, and health effects do not occur.
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