Dextromethorphan or DXM, an active ingredient found in most cough suppressant cold medicines, is commonly used as a recreational drug. While having almost no psychotomimetic effects at medically-recommended doses, dextromethorphan has euphoric, hallucinogenic, and dissociative properties when administered in doses well above those which are considered therapeutic medically for cough suppression.
An online essay first published in 1995, entitled "The DXM FAQ", was possibly the first source of specific scientific details regarding dextromethorphan's potential for recreational use. This may have led to a number of "underground" websites in existence today, devoted to the topic of dextromethorphan as a recreational drug.
Due to abuse and theft concerns, many retailers in the US have moved dextromethorphan-containing products behind the counter so that one must ask a pharmacist to receive them or be 18 years (19 in NJ and AL) or older to purchase them. Some retailers also give out printed recommendations about the potential for abuse with the purchase of products containing dextromethorphan.
The sale of dextromethorphan in its pure powder form may incur penalties in the United States, although no explicit law exists prohibiting its sale. There have been cases of individuals incurring time in prison and other penalties for selling pure dextromethorphan in this form, due to the incidental breaking of related drug laws — such as resale of a medication without proper warning labels.
Dextromethorphan was excluded from the Controlled Substances Act (CSA) of 1970 and was specifically excluded from the Single Convention on Narcotic Drugs. Dextromethorphan is still excluded from the CSA (as of 2008), however officials have warned that it could still be added if increased abuse warrants its scheduling.
Dextromethorphan is generally available over the counter in most countries, with two exceptions being Hong Kong and Sweden.
There may also be a marked difference between dextromethorphan hydrobromide, contained in most cough suppressant preparations, and dextromethorphan polistirex, contained in the brand name preparation Delsym. Polistirex is an edible plastic surrounding the dextromethorphan molecule, allowing for timed release as the stomach acids break down the plastic. As a cough suppressant, the polistirex version lasts up to 12 hours, so this duration may also hold true when used recreationally.
In 1981, a paper by Gosselin estimated the lethal dose to be between 50 and 500 mg/kg. Doses as high as 15-20 mg/kg are taken by some recreational users. It is suggested by a single case study that the antidote to dextromethorphan overdose is naloxone, administered intravenously.
In addition to producing PCP-like behavioral effects, high doses may cause a false-positive result for PCP and opiates in some drug tests.
Combining dextromethorphan with other substances can compound risks. Stimulants such as amphetamine and/or cocaine can cause a dangerous rise in blood pressure and heart rate. CNS depressants such as ethanol (drinking alcohol) will have a combined depressant effect, which can cause a decreased respiratory rate. Combining dextromethorphan with other CYP2D6 substrates can also cause both drugs to build to dangerous levels in the bloodstream.
Just like all NMDA receptor antagonists, dextrorphan and dextromethorpan inhibit a neurotransmitter called glutamate from activating receptors in the brain. This can effectively slow or even shut down certain neural pathways, preventing areas of the brain from communicating with each other. This leaves the user feeling dissociated (disconnected) or "out-of-body".
Dextromethorphan's euphoric effects have sometimes been attributed to the triggering of an increase in dopamine levels, since such an increase generally correlates to a pleasurable response to a drug, as is observed with antidepressants. However the effect of dextrorphan and dextromethorphan on dopamine levels is a disputed subject. Studies show that some NMDA receptor antagonists, like ketamine and PCP, do raise dopamine levels. Other studies show that dizocilpine, another NMDA receptor antagonist, has no effect on dopamine levels. Some findings even suggest that dextromethorphan actually counters the dopamine increase caused by morphine. Due to these conflicting results, the actual effect of dextromethorphan on dopamine levels is yet to be determined.
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