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Dextromethorphan (DXM) Abuse and
Dextromethorphan (DXM) is a cough suppressant that is widely available
over-the-counter. It is a synthetic substance related to codeine, but without
the sedating, constipating, or analgesic side-effects. The primary use of
DXM is as a cough suppressant, which used for this purpose is both safe and
effective. When taken far above its standard medical dosage, dextromethorphan
is classified as a dissociative drug, like ketamine and phencyclidine (PCP).
Slang terms for dextromethorphan vary by product, but some of the more common
names are tussin, robo, dex, triple C, skittles, dex, robo, syrup, rome,
cherries, ccc, and candy coated chaos.
Dextromethorphan is one of the few OTC medications with any serious
abuse potential. There are over 100 medications that contain DXM, either
as the only active ingredient or in combination with other active ingredients.
Some of the more common products containing DXM include: Coricidin HBP Cough
and Cold, Triaminic, Dimetapp DM, Robitussin, Sudafed, Vicks NyQuil LiquiCaps,
Alka-Seltzer Plus Cold & Cough Medicine, Dayquil LiquiCaps, Vicks Formula
44, Benylin DM, Pertussin, and Tylenol Cold, and various other store
When consumed in small recreational amounts, DXM is often noted to
have a psychedelic effect related to the combination of alcohol, marijuana,
and opiates. With a greater dose users may experience intense euphoria, vivid
imagination, and closed-eye hallucinations. With an even greater dose, intense
changes in consciousness have been noticed, along with out-of-body experiences
or even psychosis. Many people find such large doses to be extremely unpleasant
and do not want to repeat them.
It is rather typical for individuals to inadvertently overdose on
a multi-symptom cold medication, instead of using a cough suppressant whose
only active ingredient is DXM. This is very unsafe and would generally produce
a very negative experience. Most cold suppressants contain multiple active
ingredients which can cause permanent bodily damage, or even death when taken
at the same recreational dose as DXM. Reactions to dextromethorphan when
used recreationally change greatly depending on the individual user. Some
people will discover the effects of the drug to be very pleasant, while other
users will find that it causes panic, dread, or dysphoria.
The dissociative effects of a recreational dose of dextromethorphan
usually last as long as normal medical doses. Taking a recreational dose
of a four hour cough suppressant will have effects that last four hours.
The length of time that the drug has effect depends on the tolerance of the
user, along with the type of DXM consumed. The size of the dose itself has
very little impact on how long the dissociative effects last, using a large
dose of DXM will cause the user to have a greater effect, but will usually
not increase the length of the effect. DXM usually produces a calming afterglow
when the effect wears off, it can last up to 14 hours or more.
Negative Side-Effects of DXM
Users have reported to have various side effects from recreational
use of dextromethorphan such as itching, vomiting, blurred vision, dilated
pupils, sweating, fever, disassociation, nausea, drowsiness, confusion,
excitation, hypertension, shallow respiration, slurred speech, urinary retention,
and increases in heart rate. Dextromethorphan can also cause the user to
have a psychological dependence because of its potential for recreational
abuse, but it does not cause a physical addiction. When DXM is taken
recreationally, users describe several different plateaus variating from
small distortions of color and sound to visual hallucinations, loss of motor
control, and out-of-body sensations.
Death due to dextromethorphan overdoses are pretty uncommon because
most abusers ingest products that have other active ingredients that cause
the user to vomit the DXM from their stomach. Deaths related to DXM abuse
are generally caused by ingesting the drug in conjunction with other drugs.
Naloxone is considered to be the antidote to DXM overdose. It should also
be noted that DXM related deaths are also likely to occur from mental and
physical impairment, which can lead to accidents.
Olney's Lesions and
There is a controversy over the association between dextromethorphan
(when used in large doses) and Olney's lesions. Chronic, heavy abuse of
dextromethorphan or other dissociatives may cause Olney's Lesions to form
on the brain. This causes brain damage that affects cognitive ability, emotional
behavior, and memory. While some research suggests that ceasing the heavy
abuse of dissociatives will allow for minor damage to be repaired, their
have also been more serious cases where the user's deterioration continues
regardless, which normally ends in epilepsy or permanent psychosis.
Dextromethorphan Addiction and
Dextromethorphan normally will not have withdrawal symptoms like
physically addictive substances, but it is completely possible for a user
to suffer psychological addiction. Not very much is certain with respect
to chronic use and addiction. Keep in mind that any substance can be addictive,
to some degree, depending on the individual user. If an individual is having
mental problems from long-term dextromethorphan use, it is imperative that
they stop using it. If their medical condition does not improve after several
months, they should seek medical help.