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Dextromethorphan (DXM) Abuse and Addiction

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.

Medications Containing Dextromethorphan

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 brands.

Effects of Dextromethorphan

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 Abuse

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.

Dextromethorphan Overdose

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 DXM

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 Treatment

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.
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