drug and alcohol awareness - ehs international, inc1 drug and alcohol awareness supervisor training...

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Drug and Alcohol Drug and Alcohol AwarenessAwareness

Supervisor Training for an Supervisor Training for an AlcoholAlcohol-- and Drugand Drug--Free WorkplaceFree Workplace

www.ehsinternational.org1

Objectives of TrainingObjectives of Training

The different components of the DrugThe different components of the Drug FreeFree

At the end of the training, supervisors should understand:


The different components of the DrugThe different components of the Drug--Free Free Workplace PolicyWorkplace PolicyTheir role in maintaining a DrugTheir role in maintaining a Drug--Free WorkplaceFree WorkplaceBasic signs and symptoms associated with Basic signs and symptoms associated with alcohol/drug influencealcohol/drug influenceAbility to recognize basic paraphernalia related to Ability to recognize basic paraphernalia related to drug use drug use

Objectives of a DrugObjectives of a Drug--Free Free Workplace PolicyWorkplace Policy

Sends a clear message that use of alcoholSends a clear message that use of alcohol

The Drug-Free Workplace Policy accomplishes two major things:


Sends a clear message that use of alcohol Sends a clear message that use of alcohol and drugs in the workplace is prohibitedand drugs in the workplace is prohibitedEncourages employees who have problems Encourages employees who have problems with alcohol and other drugs to voluntarily with alcohol and other drugs to voluntarily seek helpseek help

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The Drug-Free Workplace Policy exists to:

Protect the health and safety of all employeesProtect the health and safety of all employees

Objectives of a DrugObjectives of a Drug--Free Free Workplace PolicyWorkplace Policy


Protect the health and safety of all employeesProtect the health and safety of all employeesSafeguard employer assets from theft and Safeguard employer assets from theft and destructiondestructionMaintain your company’s integrity and reputationMaintain your company’s integrity and reputationComply with the DrugComply with the Drug--Free Workplace Act of Free Workplace Act of 1988 or any other applicable laws1988 or any other applicable laws

The DrugThe Drug--Free Workplace Policy should Free Workplace Policy should answers the following questions:answers the following questions:

What is the purpose of the policy and program?What is the purpose of the policy and program?Who is covered by the policy?Who is covered by the policy?When does the policy apply?When does the policy apply?


What behavior is prohibited?What behavior is prohibited?Are employees required to notify supervisors of Are employees required to notify supervisors of drugdrug--related convictions?related convictions?Does the policy include searches?Does the policy include searches?Does the program include drug testing?Does the program include drug testing?

What are the consequences for violating the What are the consequences for violating the policy?policy?Are there ReturnAre there Return--toto--Work Agreements?Work Agreements?

The DrugThe Drug--Free Workplace Policy should Free Workplace Policy should answers the following questions:answers the following questions:


What type of assistance is available to What type of assistance is available to employees needing help?employees needing help?How is employee confidentiality protected?How is employee confidentiality protected?Who is responsible for enforcing the policy?Who is responsible for enforcing the policy?How is the policy communicated to employees?How is the policy communicated to employees?

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Supervisors’ ResponsibilitiesSupervisors’ Responsibilities

Maintain a safe, secure and productive Maintain a safe, secure and productive environment for employeesenvironment for employees

It is your responsibility, as a supervisor, to:


p yp yEvaluate and discuss performance with Evaluate and discuss performance with employeesemployeesTreat all employees fairlyTreat all employees fairlyAct in a manner that does not demean or Act in a manner that does not demean or label peoplelabel people

It is NOT your responsibility, as a supervisor, to:

Diagnose drug and alcohol problemsDiagnose drug and alcohol problems



Have all the answersHave all the answersProvide counseling or therapyProvide counseling or therapyBe a police officerBe a police officer

Legally sensitive areas:

Safeguard employee’s confidentialitySafeguard employee’s confidentialityEnsure the policy is clearly communicated Ensure the policy is clearly communicated E t bli h d t th hl i ti tE t bli h d t th hl i ti t



Establish procedures to thoroughly investigate Establish procedures to thoroughly investigate alleged violationsalleged violationsProvide due process and ample opportunity for Provide due process and ample opportunity for response to allegationsresponse to allegationsIf testing is included, ensure proper procedures If testing is included, ensure proper procedures are followedare followedConform to union contracts, if applicableConform to union contracts, if applicable

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Identifying Performance Problems and Identifying Performance Problems and Handling Potential Crisis SituationsHandling Potential Crisis Situations

Distinguishing between a crisis situation and Distinguishing between a crisis situation and a performance problem a performance problem

Crisis situations are less common than


performance problems and can consist of:Dangerous behaviorThreatening behaviorObvious impairmentPossession of alcohol and other drugsIllegal activity

Recognizing ProblemsRecognizing Problems

The irresistible compulsion to use alcohol and other drugs despite adverse consequences. It is

Addiction:


g p qcharacterized by repeated failures to control use, increased tolerance and increased disruption in the family.

Recognizing ProblemsRecognizing ProblemsOngoing performance problems that do not respond to normal supervisory actions may be signs of addiction and other personal problems and may require more intervention. Examples of common performance problems that may be indicators of


Co-workers or customer complaintsPoor attendance - tardiness, unexplained absences, long lunchesMistakes and missed deadlines

performance problems that may be indicators of underlying addiction include:

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Intervention and ReferralIntervention and Referral

Document the performance problem Document the performance problem

Steps to take when you have identified a performance problem:


Get yourself readyGet yourself readySet the stageSet the stageUse constructive confrontationUse constructive confrontationReferences for assistanceReferences for assistanceFollow up on progress towards meeting Follow up on progress towards meeting performance goals 26performance goals 26

Constructive confrontation:

Tell employee you are concerned about Tell employee you are concerned about



p y yp y yhis/her performancehis/her performanceState problemState problemRefer to documentation of specific eventsRefer to documentation of specific eventsAvoid overAvoid over--generalizationsgeneralizationsAsk for an explanationAsk for an explanation

Avoid getting involved in discussions of Avoid getting involved in discussions of personal problemspersonal problemsTry to get employee to acknowledge what Try to get employee to acknowledge what you see as the problemyou see as the problem



y py pState what must be done to correct problemState what must be done to correct problemSet time frame for performance improvementSet time frame for performance improvementSpecify consequences if problem continuesSpecify consequences if problem continuesDo not allow the employee to redirect the Do not allow the employee to redirect the conversationconversation

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Protecting ConfidentialityProtecting Confidentiality

For a supervisor’s referral to be effective, an employee needs to know that:

Problems will not be made publicProblems will not be made public


Conversations with an Employee Assistance Conversations with an Employee Assistance Program (EAP) professional Program (EAP) professional -- or other referral or other referral agent agent -- are private and will be protectedare private and will be protectedAll information related to performance issues will All information related to performance issues will be maintained in his/her personnel filebe maintained in his/her personnel file

Information about referral to treatment, however, Information about referral to treatment, however, will be kept separatelywill be kept separately




will be kept separatelywill be kept separatelyInformation about treatment for addiction or mental Information about treatment for addiction or mental illness is not a matter of public record and cannot illness is not a matter of public record and cannot be shared without a signed release from the be shared without a signed release from the employeeemployeeIf an employee chooses to tell coworkers about If an employee chooses to tell coworkers about his/her private concerns, that is his/her decisionshis/her private concerns, that is his/her decisions



When an employee tells his/her supervisor


When an employee tells his/her supervisor something in confidence, supervisors are obligated to protect that disclosure

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If EAP services are available, employees are also assured that:

EAP records are separate from personnel records EAP records are separate from personnel records and can be accessed only with a signed releaseand can be accessed only with a signed release



and can be accessed only with a signed release and can be accessed only with a signed release from the employeefrom the employeeEAP professionals are bound by a code of ethics to EAP professionals are bound by a code of ethics to protect the confidentiality of the employees and protect the confidentiality of the employees and family members that they servefamily members that they serveThere are clear limits on when and what information There are clear limits on when and what information an EAP professional can share and with whoman EAP professional can share and with whom

However, confidentiality limits may require:Disclosure of child abuse, elder abuse and Disclosure of child abuse, elder abuse and serious threats of homicide or suicide as dictated serious threats of homicide or suicide as dictated



by state lawby state lawReporting participation in an EAP to the referring Reporting participation in an EAP to the referring supervisorsupervisorReporting the results of assessment and Reporting the results of assessment and evaluation following a positive drug testevaluation following a positive drug test

However, confidentiality limits may require:

Verifying medical information to authorize Verifying medical information to authorize release time or satisfy fitnessrelease time or satisfy fitness--forfor--duty concernsduty concerns



release time or satisfy fitnessrelease time or satisfy fitness forfor duty concerns duty concerns as specified in company policyas specified in company policyRevealing medical information to the insurance Revealing medical information to the insurance company in order to qualify for coverage under a company in order to qualify for coverage under a benefits planbenefits plan

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EnablingEnabling

Enabling: Action that you take that protects the employee from the consequences of his/her actions and actually helps the employee to NOT deal with the problem.


Covering UpRationalizing

BlamingWithdrawing/Avoiding

Examples of enabling:

Supervisor TrapsSupervisor Traps

SympathySympathyExcusesExcusesA lA l

InnocenceInnocenceAngerAngerTT


ApologyApology

DiversionsDiversions

TearsTears

Pity Pity

Dos for SupervisorsDos for SupervisorsDODO emphasize that you only are concerned with work emphasize that you only are concerned with work performance or conductperformance or conductDODO have documentation or performance in front of you have documentation or performance in front of you when you talk with the employeewhen you talk with the employeeDODO remember that many problems get worse without remember that many problems get worse without

i ti t


assistanceassistanceDODO emphasize that conversations with an EAP, if emphasize that conversations with an EAP, if applicable, are confidentialapplicable, are confidentialDODO explain that an EAP, if applicable, is voluntary and explain that an EAP, if applicable, is voluntary and exists to help the employeeexists to help the employeeDODO call an EAP, if applicable, to discuss how to make call an EAP, if applicable, to discuss how to make a referrala referral

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Don’ts for SupervisorsDon’ts for Supervisors

DON’TDON’T try to diagnose the problemtry to diagnose the problemDON’T DON’T moralize. Limit comments to job moralize. Limit comments to job performance and conduct issues onlyperformance and conduct issues onlyDON’TDON’T discuss alcohol and drug usediscuss alcohol and drug use


DON T DON T discuss alcohol and drug usediscuss alcohol and drug useDON’TDON’T be misled by sympathybe misled by sympathy--evoking tacticsevoking tacticsDON’T DON’T cover up. If you protect people, it cover up. If you protect people, it enables them to stay the sameenables them to stay the sameDON’T DON’T make threats that you do not intend to make threats that you do not intend to carry outcarry out

77% of all Drug77% of all Drug--Users are Employed! Users are Employed!

Only about 23% of our Nation's Only about 23% of our Nation's drugdrug--abusersabusers are sitting around in theare sitting around in the abandonedabandoned

Did You KnowDid You Know


abusersabusers are sitting around in the are sitting around in the abandoned abandoned buildings and back alleys of our buildings and back alleys of our cities cities 'shooting up' heroin, 'snorting' coke, 'shooting up' heroin, 'snorting' coke, 'taking a hit' of grass, or smoking some 'taking a hit' of grass, or smoking some meth...meth...

Do any of those 77% work for you?Do any of those 77% work for you?

The average meth user costs their The average meth user costs their employer (if they have one) $47,500 a year employer (if they have one) $47,500 a year in lost productivity, theft, absenteeism,in lost productivity, theft, absenteeism,



in lost productivity, theft, absenteeism, in lost productivity, theft, absenteeism, increased health care costs and worker’s increased health care costs and worker’s comp. claims.comp. claims.

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Someone in Your Workplace May Have Someone in Your Workplace May Have an Alcohol or Other Drug Abuse an Alcohol or Other Drug Abuse ProblemProblem



The patterns listed may be signs that a The patterns listed may be signs that a coworker has a problem with alcohol or other coworker has a problem with alcohol or other drugs. Do you see someone you know?drugs. Do you see someone you know?

Work HabitsWork HabitsDan used to be a very organized worker. His work was Dan used to be a very organized worker. His work was always neat and on time. Lately, Dan’s desk is a mess, always neat and on time. Lately, Dan’s desk is a mess, his work is sloppy and he misses deadlineshis work is sloppy and he misses deadlines



his work is sloppy, and he misses deadlines.his work is sloppy, and he misses deadlines.AbsenteeismAbsenteeism

Julie was always an employee you could count on Julie was always an employee you could count on ----always there and on time. For the past month, she’s always there and on time. For the past month, she’s been coming in late more often and she’s missed a lot been coming in late more often and she’s missed a lot of days.of days.

AccidentsAccidentsFrank used to have a good safety record. Over the past Frank used to have a good safety record. Over the past 2 months, he’s had three industrial injuries, and his 2 months, he’s had three industrial injuries, and his supervisor has reported him for safety violations.supervisor has reported him for safety violations.

C l i tC l i t



ComplaintsComplaintsLinda and her husband own a small but growing Linda and her husband own a small but growing landscape company, and they’ve had to hire a lot of new landscape company, and they’ve had to hire a lot of new people. Lately, customers have complained about two people. Lately, customers have complained about two new employees who go off at lunch and don’t seem to new employees who go off at lunch and don’t seem to do much in the afternoon. Everyone else is picking up do much in the afternoon. Everyone else is picking up the slackthe slack..

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ProductivityProductivityGeorge used to be a good salesman. Over the past George used to be a good salesman. Over the past year his sales have gone way down and he has missed year his sales have gone way down and he has missed meetings.meetings.

MoodMood



Anna is a bank teller who was always well liked by her Anna is a bank teller who was always well liked by her coworkers and customers, but lately she’s become coworkers and customers, but lately she’s become more and more moody and hard to work with.more and more moody and hard to work with.

CrimeCrimeMarty owns a small machine shop. This past weekend Marty owns a small machine shop. This past weekend the shop was broken into and tools and equipment were the shop was broken into and tools and equipment were taken. Two of Marty’s employees were arrested. They taken. Two of Marty’s employees were arrested. They had drugs on them at the time of the arrest.had drugs on them at the time of the arrest.

Drug IdentificationDrug Identification

www.ehsinternational.org


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Look At The Eyes!


The size of a person’s pupils can tell you a lot about drug use.

Dil t d il ll

Look At The Eyes!


Dilated pupils are generally associated with Cannabis, Hallucinogens & Stimulants.

Constricted pupils are generally associated with only an Opiate.

The Window to Their SoulThe Window to Their Soul

The Human Eyes


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Pupil DilationPupil Dilation

• CNS Stimulants

The Human Eyes


• Cocaine / Meth

• Hallucinogens

• LSD / MDMA

• Marijuana

• Hash / Hash Oil


The Human Eyes



The Human Eyes


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Constricted PupilsConstricted Pupils

The Human Eyes

• OpiatesOpiates


•• HeroinHeroin

•• CodeineCodeine

•• OxycodoneOxycodone

•• DilaudidDilaudid


Pupils are Pupils are

The Human Eyes


ppconsidered considered constricted constricted when they when they

measure less measure less than 3.0 mmthan 3.0 mm


The Human Eyes


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The Human Eyes


ALCOHOL DURATION OF EFFECTS: 4 to 8+ Hours (Dependant alcohol level)

GENERAL INDICATORS: Disoriented, droopy eye lids, drowsiness, slurred speech, impaired coordination,

f f


impaired divided attention, odor of alcohol, loss of inhibitions, and drunken behavior.

CNS Depressants

DefinitionDefinition

Those drugs that slow down operation of the


Those drugs that slow down operation of the Central Nervous SystemAs the dose increases, it affects the body’s automatic process

Heartbeat

Respiration…. etc.

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BarbituratesBarbiturates

CNS Depressants


Medical Use: Tranquilizers, Anti-seizure

Abuse Potential: High

Examples: Seconal, Phenobarbital,

Nembutal, etc.

NonNon--BarbituratesBarbiturates

CNS Depressants


Medical Use: Tranquilizers, Anti-seizure


Examples: Benadryl, Doriden, Soma,

Lunesta, Ambien, Sonata, etc.

AntiAnti--DepressantsDepressants

CNS Depressants


Medical Use: Depression

Abuse Potential: Low

Examples: Prozac, Paxil, Zoloft,

Elavil, Nardil*, Marplan*, Wellbutrin, Sinequan

*MAO Inhibitors

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AntiAnti--Anxiety TranquilizersAnxiety Tranquilizers

CNS Depressants


Medical Use: “Minor” Tranquilizers


Examples: Xanax, Dilantin, Valium,

Klonopin, Ativan, Rohypnol*

Librium, Miltown*No medical use

AntiAnti--Anxiety Tranquilizers Anxiety Tranquilizers (Benzodiazepines)(Benzodiazepines)

This type of drug is still considered a Minor Tranquilizer and also has a

CNS Depressants


yp g qhigh potential for abuse. Some examples of Benzodiazepines are:

Alprazolam – Xanax Lorazepam – Ativan Clonazepam – Klonipin Oxazepam - Serax Diazepam – Valium Quazepam - DoralEstazolam – ProSom Temazepam - Restoril Flurazepam - Dalmane Triazolam – Halcion

Antipsychotic TranquilizersAntipsychotic Tranquilizers

CNS Depressants


Medical Use: Seizures, Psychiatric Patients

Abuse Potential: Low

Examples: Haldol, Thorazine, Innovar, Lithium

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General IndicatorsGeneral Indicators

CNS Depressants


Disoriented

Droopy Eyelids

Drowsiness

Drunk-like Behavior

Thick, Slurred Speech

Uncoordinated

Lack of Coordination

Slow, Sluggish Reactions

If it looks like a drunk, walks like a drunk and acts like a drunk, it just might be pills!

Cannabis


Flowering TopsFlowering Tops

Cannabis


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Methods of IngestionMethods of Ingestion

Cannabis


Smoked

Oral


Cannabis


MARIJUANA PIPES


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Cannabis



Cannabis


Body and Eye Tremors

Disorientation

Dilated Pupils

Impaired Perception of Time & Distance

Marked Reddening of the Eyes

Relaxed Inhibitions

Issues of Memory

Impaired Divided Attention

Li i & D i H d & F t

CNS Stimulants


Living & Dying Harder & Faster

in the

Night of the Living Dead

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DefinitionDefinition

CNS Stimulants


Those drugs that speedup the operation of theCentral Nervous System

CocaineCocaine OthersOthers

Types of CNS StimulantsTypes of CNS Stimulants

CNS Stimulants


AmphetaminesAmphetaminesMethamphetamineMethamphetamineAmphetamineAmphetamineBiphetamineBiphetamineDesoxynDesoxynMethcathinoneMethcathinone

RitalinRitalinPreludinPreludinCylertCylertCaffeine Caffeine Khat Khat AdderallAdderall

MethamphetamineMethamphetaminePowder

Tan, brown, white, pink, Glass appearance

CNS Stimulants


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MethamphetamineMethamphetamine

Crystal MethamphetamineIce

CNS Stimulants


Crystal Methamphetamine (Ice)Crystal Methamphetamine (Ice)

CNS Stimulants



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A Simple Hiding PlaceA Simple Hiding Place

CNS Stimulants


Just a Simple Coke Can?Just a Simple Coke Can?

CNS Stimulants


Method of IngestionMethod of Ingestion

Smoking Pipes Gas Torches

CNS Stimulants


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CNS Stimulants



Methamphetamine “Foiling or Chasing the Dragon”

CNS Stimulants


Methamphetamine can be smoked on a small piece of aluminum foil

g g g

Signs & SymptomsSigns & Symptoms

CNS Stimulants


RestlessnessAnxiety HyperactiveIrritable

BruxismTremorsDilated PupilsMisperceived Time

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Opiates


PRESCRIBED OPIATE DERIVATIVES

OXYCONTIN MORPHINE


TYLENOLW/CODEINE

DEMEROL

DILAUDID

PERCOCET

PERCODAN

VICODIN

Abused PharmaceuticalsAbused Pharmaceuticals(Opiates)(Opiates)

C d i (#2 3 & 4) H d h (Dil did)

Opiates


Codeine (#2, 3 & 4) Hydromorphone (Dilaudid)Meperidine (Demerol) Propoxyphene (Darvocet,Darvon)

Morphine (MS Contin) Methadone (Dolophine)

Oxycodone (OxyContin, Percocet, Percodan, Tylox)

Hydrocodone (Vicodin, Lorcet, Lortab, Norco)

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Methods of UseMethods of Use

Opiates


Injection

F h t d i

Opiates

Injection Mark LocationsInjection Mark Locations


Fresh puncture wound is generally characterized as raised dot that is located over a vein

Recent puncture wound

Opiates

Injection Mark LocationsInjection Mark Locations


Recent puncture wound

Note the slight scabs starting to develop

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Opiates

Injections Gone Wrong!Injections Gone Wrong!


Pain relief Droopy eyelids

Opiates

Common Opiate ImpairmentCommon Opiate Impairment


Pain relief Droopy eyelids

Slow speech Slow reflexes

“On the nod” Relaxed muscles

Itchy Constipation

Track marks Facial itching

Opiates



On the nod Dry mouth

Droopy eyelids Euphoria

Slowed reflexes Nausea

Slow raspy voice Constricted pupils

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“Huffing”“Huffing”

Inhalants


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Volatile SolventsVolatile Solvents

Plastic cement (Toluene)

Petroleum products

Inhalants


Petroleum products

Lighter fluid

Fingernail polish remover

Thinners

Paints (Toluene)

AerosolsAerosols

Inhalants


Hair spray

Photo/computer dusters

Deodorants

Frying pan lubricants

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Traffic Collisions and deaths from inhaling

Inhalants

“Dusting”“Dusting”


Traffic Collisions and deaths from inhaling Dust Off have occurred through-out the State.Some officers investigating the traffic collisions have discovered at the scene of the collision that the driver was under the influence of Dust Off.Most drivers involved in these incidents have been teenagers.

Dust Off is being done mostly by

Inhalants

“Dusting”“Dusting”


Dust Off is being done mostly by kids ages 9 through 18.

They call it “dusting”, a take off from the Dust Off name.

It gives them a slight high for about 10 seconds. It makes them dizzy.

Dust-Off is the chemical 1,1-Difluoroethane, a fluorinated hydrocarbon, also known as fluorocarbons or Freons. They are used as propellants, refrigerants and cleaning agents.

According to the National Institute of Drug Abuse (NIDA), “Inhaled chemicals travel rapidly from

Inhalants


Abuse (NIDA), Inhaled chemicals travel rapidly from the lungs through the blood to the brain and other organs. In minutes, the user feels alcohol- like effects such as slurred speech, clumsymovements, dizziness and euphoria.

Other effects might include lightheadedness, hallucinations, delusions, and, after heavy use of inhalants, drowsiness and a lingering headache.

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NIDA believes that the most serious hazard for an inhalant abuser is a syndrome called “sudden sniffing death.”

A single, prolonged session of inhalant use can d id d i l h t h th

Inhalants


produce rapid and irregular heart rhythms, heart failure and death. It can happen within minutes and can strike an otherwise healthy young person.

But inhalant abuse can cause death in other ways, too - asphyxiation, suffocation, or choking.”

Dust OffDifluoroethane Warning Label


Sources of Nitrous OxideSources of Nitrous Oxide

Inhalants


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Nitrous Oxide Nitrous Oxide -- TanksTanks

Inhalants


Glass chillers (NOS)

Whipped cream fillers (NOS)

Inhalants

Nitrous Oxide is


Nitrous Oxide is also a commonly used anesthetic gas.

Inhalants

Step 1

Step 2

www.ehsinternational.orgStep 3

Step 4

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Stimulation Hallucinogen Sedative

Inhalants



gTremors Disorientation SleepySweating Confusion Watery eyesHyper Hallucinations DrowsyAntagonistic Altered colors Inebriation

NauseaMucous

Hallucinogens



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Dextromethorphan (DXM)

Dextromethorphan ProductsDextromethorphan Products


It is a cough suppressantMore than 125 OTC medications contain Dextromethorphan (DXM)Most OTC medications containing DXM contain approximately 10-30 Milligrams of DXM



pp y gWhen used as directed, it has very little side effectsTriggers a wide arrange of effects when used at high levelsEffects give way to disorientation and thought disturbances, along with vivid hallucinations

Light 100 - 200 mg

Common 200 - 400 mg

Oral DXM Dosages


Strong 300 - 600 mg

Heavy 600 - 1500 mg

Risk of Death 2,500 - 20,000 mg

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300mg DXM = light buzz, similar to 50 to 100ug LSD

600mg DXM = A stronger high,

Dextromethorphan Dosage


6 mg DXM r ng r g ,similar to 100 to 250ug LSD

900mg DXM = A very strong, full spectrum of hallucinations equivalent to 300 to 600ug LSD DXM

Per 5ml (8 oz/237ml)30mg DXM

15mg DXM



30mg DXM Per 5ml (4 oz/118ml)15mg DXM

DXM is synthetically produced and is chemically related to codeine, though it is not a Narcotic Analgesic.

DXM is used as a hallucinogen

It is legal to possess and is available over the counter (OTC) at grocery and drug stores



(OTC) at grocery and drug stores

Easy and cheap way to get high

It’s any drug that is named with a DM or contains the word “Tuss”

Robitussin, Delsym, Pertussin, Drixoral, Vicks Formula 44, Nyquil, Dayquil, Dimetapp DM

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It is mostly abusedby teenagers and

Who Abuses DXM


by teenagers and young adultsIt is believed that 1in 11 teens have abused DXM

Many OTC cough medication contain the cough suppressant Dextromethorphan, or DXM.

When abused in excessive doses, DXM may cause euphoria, auditory and visual hallucinations and a loss of coordination



Contains 15 mg. per teaspoon

hallucinations, and a loss of coordination.

Many abusers describe the effects of high doses of DXM as being similar to that of LSD.

Side effects can include panic, vomiting, diarrhea, brain damage, and death.

Sometimes referred to as TRIPLE and



Common cold medicinesPrimarily abused by teensEasy accessibility (Shoplifting)

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Chlorpheniramine Maleate (4mg)Dextromethorphan Hydrobromide (30mg)



RoboSkittlingDexing

Street Names For DXM Abuse


DexingRobotrippingRobodosingSyrup head

C-C-CTriple CCandyD

RoboRojoSkittlesT i

Street Names For DXM


DexDextroDMDrexRed Devils

TussinTussGelVelvetVitamin D

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First Plateau – Mild inebriationSecond Plateau – An effect similar to alcohol intoxication,

and occasionally mild hallucinations. The abuser’s speech becomes slurred and short term memory may become temporarily impaired.

The Four Plateaus of DXM


p y pThird Plateau – An altered state of consciousness. The

abuser’s senses, particularly vision, can become impairedFourth Plateau - Mind and body dissociation or an “out of

body” experience. The abuser can lose some or all contact with his or her senses. The effects can be described as similar to the effects caused by Ketamine or PCP

Flushing, sweatingNausea, vomitingDiarrhea, abdominal painSeizuresConfusion, hallucinationsHigh blood pressure (headache facial redness

Short Term Effects of DXM


High blood pressure (headache, facial redness, blurred vision)Irregular heartbeatNumbness of fingers or toesHyperactivityExcitability and impaired coordination Brain damage, death (in large doses)


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Thank You


Questions?

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