Dextromethorphan, or DXM, the common active ingredient found in many over-the-counter cough suppressants, used as recreational and entheogenic drugs for their dissociative effects. It barely has psychoactive effects on medically recommended doses. Dextromethorphan possesses strong dissociative properties when administered in much higher doses that are considered therapeutic for cough suppression. The use of recreational DXM is sometimes referred to in slang form as "robo-tripping," which has a prefix originating from the brand name Robitussin, or Triple Cs, derived from the Coricidin brand. (The pill is printed with "CCC" for "Coricidin Cough and Cold.") However, this brand presents a danger when used at a recreational dose due to the presence of chlorpheniramine.
In over-the-counter formulations, DXM is often combined with acetaminophen (paracetamol, APAP) to relieve pain and to prevent recreational use; However, to achieve the dissociative effect of DXM, the maximum daily dose of APAP 4000mg therapy is often exceeded, potentially leading to acute or chronic liver failure, making subsequent abuse and tolerance of products containing potentially fatal DXM and APAP.
An online essay first published in 1995 titled "The DXM FAQ" explains the potential for dextromethorphan for recreational use, and classifies its effects into the plateau.
Due to usage and theft problems, many US retailers have removed products containing dextromethorphan behind the counter so people have to ask the pharmacist to accept it or become 18 years (19 in New York, California, and Alabama, 21 in Mississippi) or older to buy it. Some retailers also provide printed recommendations about potential misuse by purchasing products containing dextromethorphan.
Video Recreational use of dextromethorphan
Classification
At high doses, dextromethorphan is classified as a general dissociative and hallucinogenic anesthetic, similar to ketamine and phencyclidine-controlled substances (PCP). Also like drugs, dextromethorphan is a NMDA receptor antagonist. Dextromethorphan generally produces no symptoms of withdrawal of substance-dependent physical dependence, but there are some cases of psychological dependence. Because SSRI dextromethorphan (selective serotonin re-uptake inhibitor) -as an act, the sudden cessation of recreational doses in tolerant individuals can produce mental and physical withdrawal symptoms similar to withdrawal from SSRIs. This withdrawal effect can manifest as a psychological effect, including depression, irritability, cravings, and as a physical effect, including lethargy, body aches, and unpleasant tingling sensations, unlike a mild "electric shock".
Maps Recreational use of dextromethorphan
Effects
The Dextromethorphan effect has been divided into four plateau. The first plateau (1.5 to 2.5 mg per kg body weight) is described as having euphoria, hearing changes, and changes in the perception of gravity. The second plateau (2.5 to 7.5 mg/kg) causes intense euphoria, clear imagination, and closed-eyed hallucinations can occur. The third and fourth plateaus (7.5 mg/kg and more) caused major changes in consciousness, and users often reported out-of-body or temporary psychotic experiences. Flanging (accelerating or slowing down) sensory input is also a characteristic effect of recreational use.
There is also a striking difference between dextromethorphan hydrobromide, which is contained in most cough suppressing preparations, and dextromethorphan polistirex, contained in the Delsym brand preparation. Polystyrex is a polymer bound to dextromethorphan which requires more time for the stomach to digest it because it requires an ion-exchange reaction to take place before its dissolution into the blood. Therefore, dextromethorphan polystirex takes longer to absorb, resulting in a more gradual and longer lasting effect reminiscent of time release pills. As a cough suppressant, the polystylexe version lasts up to 12 hours. This duration also applies when used recreationally.
In 1981, a paper by Gosselin estimated that the lethal dose was between 50 and 500 mg/kg. Doses as high as 15-20 mg/kg taken by some recreational users. It is suggested by one case study that the antidote to dextromethorphan overdose is naloxone, administered intravenously.
In addition to producing mental effects such as PCP, high doses can lead to false-positive results for PCP and opiates in some drug tests.
Risks associated with usage
Dextromethorphan has not been shown to cause vacuolization in animals, also known as Olney lesions, although initial speculation is possible, due to similarities to phencyclidine (PCP). In mice, oral administration of dextromethorphan does not cause vacuolization in laboratory tests. Oral administration of dextromethorphan repeatedly during adolescence, however, has been shown to interfere with learning in mice during adulthood. The occurrence of an Olney lesion in humans, however, has not been proven or proven. William E. White, author of "DXM FAQ," has compiled informal studies of correspondence with dextromethorphan users indicating that severe abuse can lead to various deficits associated with brain areas affected by the Olney lesion; this includes loss of episodic memory, decreased ability to learn, abnormalities in some aspects of visual processing, and deficits of abstract language understanding. In 2004, however, White retracted the article in which he made this claim.
An official survey of dextromethorphan users showed that more than half of users reported experience from individual withdrawal symptoms for the first week after long-term/addictive dextromethorphan use: fatigue, apathy, flashback, and constipation. More than a quarter reported insomnia, nightmares, anhedonia, memory impairment, attention deficit, and decreased libido. Less common side effects include panic attacks, learning disorders, tremors, jaundice, urticaria (itching) and myalgia. DXM has also been "known to increase the frequency of complex partial seizures in epilepsy by 25% compared with placebo." The frequent and long-term use of high doses can lead to toxic psychosis and other permanent psychological problems. It is important to note that the use of medical DXM has not been proven to cause the above problems.
Drug abuse of multi-symptomatic drugs, rather than using a cough suppressant whose only active ingredient is dextromethorphan, carries a significant risk of serious fatalities or illness. Multi-symptomatic cold medicines contain other active ingredients, such as paracetamol (acetaminophen), chlorpheniramine, and phenylephrine, any of which can cause permanent body damage such as kidney failure, or even death, when taken at generally acceptable dextromethorphan dose scales.. Sorbitol, an artificial sweetener found in many cough syrups containing dextromethorphan, can also have negative side effects including diarrhea and nausea when taken with recreational doses of dextromethorphan. Guaifenesin, the usual expectorant accompanying dextromethorphan in cough preparation, can cause unpleasant symptoms including vomiting, nausea, kidney stones, and headaches.
Combining dextromethorphan with other substances can add to the risk. Central nervous system stimulation such as amphetamines and/or cocaine can lead to increased blood pressure and a dangerous heartbeat. CNS depression such as ethanol (drinking alcohol) will have a combined depression effect, which can lead to decreased respiratory rate. Combining dextromethorphan with other CYP2D6 substrates can cause both drugs to build up to dangerous levels in the bloodstream.
Combining dextromethorphan with other serotonergic drugs may lead to serotonin toxicity, an excess of serotonergic activity in the central nervous system (CNS) and peripheral nervous system (PNS).
Pharmacology
The hallucinogenic and dissociative effects of Dextromethorphan can be attributed in large part to dextrorphan (DXO), the metabolites produced when dextromethorphan is metabolized by the body. Dextrorphan and dextromethorphan are NMDA receptor antagonists, such as dissociative hallucinogenic ketogenic drugs and phencyclidine (PCP), although dextrorphan is more potent than dextromethorphan "molecular elders".
As a NMDA receptor antagonist, dextrorphan and dextromethorphan inhibit the excitatory amino acids and glutamate neurotransmitters in the brain. This can effectively slow down, or even shut down certain neural pathways, preventing areas of the brain communicating with each other. This makes the user feel separated or disconnected, experiencing brain fog or derealization.
The euphoria effect of Dextromethorphan is sometimes associated with increased levels of dopamine, since such improvement is generally correlated with a favorable response to the drug, as observed with some clinical antidepressants, as well as some recreational drugs. However, the effects of dextrorphan and dextromethorphan, and other NMDA receptor antagonists, at dopamine levels are a subject of debate. Studies show that NMDA receptor antagonists ketamine and PCP indeed increase dopamine levels, although other studies have shown that other NMDA antagonists of dizocilpine have no effect on dopamine levels. Some findings even suggest that dextromethorphan can actually resist the dopamine-enhancing effect caused by morphine. Because of this conflicting result, the actual effects of dextromethorphan at dopamine levels remain undetermined.
Legality
Antitussive preparations containing legal dextromethorphan to be purchased from pharmacies in most countries, with a few exceptions are UAE, Sweden, Estonia and Latvia.
In Russia, dextromethorphan (commonly sold under the brand name Tussin and Glycodin) is a Schedule III controlled substance and is placed on the same list as benzodiazepines and the majority of barbiturates.
United States
There is no legal difference today in the United States between use, sale, or medical and recreational purchases. Some state and chain stores have implemented restrictions, such as requiring a signature for DXM sales, limiting the amount allowed for purchase, and requiring buyers to be above the majority in their country.
The sale of dextromethorphan in pure form can be subject to punishment, although there is no explicit law prohibiting its sale or ownership, other than in the state of Illinois. There are individual cases sentenced to imprisonment and other penalties for selling pure dextromethorphan in this form, due to the more common legal incidental infringement for the sale of legitimate drugs - such as resale of drugs without proper warning labels..
Dextromethorphan was excluded from the Controlled Substances Act (CSA) in 1970 and was specifically excluded from the Single Convention on Narcotics Drugs. In 2010, Dextromethorphan was still excluded from scheduling controlled substances in the US; However, officials have warned that it could still be added if increased torture guarantees its scheduling. The motivation behind the exclusion of CSAs is that, under CSA, all the optical isomers of Schedule II opiates are automatically listed as Schedule II substances. Since dextromethorphan is an optical isomer of the Schedule II levomethorphan opiate (but does not act like opiates), an exception is required to keep the substance uncontrolled. The Federal Analog Act does not apply to dextromethorphan because a new drug application has been filed for it.
Indonesia
Having previously been available outside the table, the National Agency for Drug and Food Control of the Republic of Indonesia (BPOM-RI) prohibits the sale of a single component drug dextromethorphan with or without a prescription. Indonesia is the only country in the world that makes dextromethorphan an illegal component even with recipes and offenders can be prosecuted by law. The National Narcotics Bureau of Indonesia (BNN RI) even threatens to revoke pharmacy and drugstore licenses if they still have dextromethorphan stock, and will notify the police for criminal prosecution. As a result of this regulation, 130 drugs have been withdrawn from the market, but drugs containing multicomponent dextromethorphan can be sold on the table. In its official press release, BPOM-RI also stated that dextromethorphan is often used as a substitute for marijuana, amphetamines, and heroin by drug users, and its use as an antitusive is less useful today.
Director of Narcotics, Psychotropic, and Addictive Substance Control (Drugs) BPOM-RI, Dr. Danardi Sosrosumihardjo, SpKJ, explains that dextromethorphan, morphine, and heroin come from the same tree, and declare the dextromethorphan effect to be equivalent to 1/100 of morphine and heroin injections. In contrast, Deputy Product Therapy and Drug Control BPOM-RI, Dra. Antonia Retno Tyas Utami, Apt. MEpid., States that dextromethorphan, which is chemically similar to morphine, has a far more dangerous and direct effect to the central nervous system, thus causing a mental breakdown in the user. He also claims, without citing previous scientific studies or reviews, that unlike morphine users, dextrometorphan users can not be rehabilitated. These claims contradict various scientific studies showing that naloxone alone offers effective treatment and promising therapeutic results in treating dextromethorphan addiction and poisoning. Dra. Antonia Retno Tyas Utami also claims a high rate of abuse of dextromethorphan, including death, in Indonesia and for further questioning suggests that codeine, though a physically addictive antigenative class, is available as an alternative to dextromethorphan.
See also
- Dissociative medicine
- Dextrorphan
- Dextromethorphan
- Ketamine
- Nitrous oxide
- Phencyclidine (PCP)
- Hallucinogen
- NMDA receptor antagonist
- Psychedelic drugs
- Purple drink
- Sigma Agonis
References
External links
- Dextroverse
- Fatigue Cough Fatigue Test by Jim Hogshire from Harper's
- Erowid Dextromethorphan Vault
Source of the article : Wikipedia
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