A lot has happened since I published Version 3 of the DXM FAQ; some of it has been good, some not so good. I'd like to take a moment to address some of these changes and some of my concerns. I still do not regret having published the FAQ, and out of all the feedback I have received (including letters from physicians, scientists, parents, and just plain druggies), less than one percent has been negative. The reasons I gave for its publication still apply, but those of you familiar with v3.0 will notice that this version shows considerably less praise for DXM.

When I published the FAQ on Usenet (and then the World Wide Web), it was my expectation that it would be of interest primarily to psychonauts, experienced psychedelic users, and others who use drugs for self-exploration and spiritual purposes. I knew, of course, that not everyone who did DXM would use it with the intention of expanding the mind, but I reasoned that, given the relative unpleasantness of consuming cough syrup, and the "heaviness" of the DXM experience, most people would find casual, recreational use of DXM unlikely. Things didn't quite turn out how I expected.

Also at that time there was a severe shortage of information from former DXM users about adverse effects of long-term use. I had reasoned that long-term use was probably not a good idea, but probably not terribly dangerous. Of the people I had interviewed who had used DXM regularly, very few had any problem with it, and those who did recovered when they stopped using it.

Since then there has been a great increase in DXM use (or at least more people are talking about it). My concern that the FAQ had started a "DXM epidemic" turned out to be mostly baseless; the majority of new DXM users seem to hear about it the same way that DXM users have always learned about it: from their friends. Some do learn about it from the FAQ, but for the most part you have to know about DXM in the first place before finding or understanding the FAQ.

As I have spoken to more and more users of DXM, I have learned that more people have negative experiences with the drug than I had expected. Most of these are simply people who try it once, decide they don't like it, and never try it again. A few people, on the other hand, seem to be greatly susceptible to DXM addiction and some of these have suffered long-term health consequences. A very few may have suffered permanent brain damage from extremely heavy use of DXM (e.g., an 8oz bottle of Maximum Strength syrup every day). On the other hand, some people consume the same amount for years seemingly without consequence. And while some people can consume DXM regularly without psychological consequences, others suffer from severe depression and psychotic breaks, even leading to a few cases of suicide attempts.

This brings me to the most relevant new information about DXM: Olney's findings of NMDA Antagonist Neurotoxicity (NAN). There is great debate right now whether NAN is relevant at recreational doses or not. In animals, the dosage required to induce NAN is far in excess of the anaesthetic dose, and humans typically take sub-anaesthetic doses of dissociatives. On the other hand, there may be danger with long-term use at considerably lower dosages that the animal models do not show.

The data from human experiences are hard to interpret. Many heavy PCP users suffer obvious cognitive and motor impairment; however, PCP has neurotoxic effects (in particular in the cerebellum) not shared by other dissociatives including DXM or ketamine. Ketamine is probably a better approximation of DXM, but very few people have done large amounts of ketamine for long periods of time. A notable exception is John Lilly, who is a bit of a nut, but was probably a bit of a nut before doing ketamine, and (at least the last time I checked) he doesn't seem to suffer from cognitive impairment.

There are a few DXM users who have suffered long-term consequences. Out of approximately five hundred current and former DXM users I have heard from, three have suffered lasting cognitive impairment. Additionally, there is one published paper on cognitive impairment from chronic DXM use, although the author suggests an underlying temporal lobe seizure disorder. DXM has been shown to increase the frequency of complex partial seizures, and it's possible that it is the seizures, and not the DXM itself, which is causing problems. Unfortunately, it has also been suggested temporal lobe epileptics may also be more susceptible to dissociative addiction. Hopefully much of this will be resolved in the next few years.

Until then, my official recommendation is not to use DXM at all. Since I know this isn't likely to happen, my own personal belief is that DXM is probably pretty safe when used occasionally (e.g., once or twice a month) at the lower plateaus, and rarely (e.g., once or twice a year) at the higher plateaus. I have yet to hear from anyone who used DXM with this or less frequency who has suffered any impairment, temporary or permanent. Actually, to be technically correct, nobody using it once a week for less than six months has ever seemed to have problems, but it's always best to keep a wide safety margin.

Another thing to keep in mind is that DXM in the upper plateaus is a considerably different experience than the lower plateaus, and may be better suited to spiritual or ritual use. Even at the lower plateaus, DXM is not really well suited as a frequent recreational drug.

So what do you do then if you find yourself in that particularly human condition of ennui (for which psychedelics are a most effective medicine)? Well, ideally I'd suggest you hop on a plane to Amsterdam (or somewhere else where 2CB and marijuana are legal). Unfortunately this isn't an ideal world, and flying across the Atlantic is outside the means of most of us (including me). A more reasonable suggestion would be to do your part to change the laws in this country so that psychedelics can regain their rightful place as tools for mental, emotional, and spiritual exploration and growth. Remember, the laws aren't going to change unless we work to change them.

In summary, I'm not nearly as convinced that DXM is a benevolent psychedelic as I used to be. It is in many ways considerably more powerful (and certainly more dangerous) than LSD or mushrooms. Like all psychedelics it can profoundly change you; unlike others, these changes are not necessarily under your control, especially if you are not very familiar with yourself. DXM can be a great tool for spiritual rebirth, but it can also turn you into a paranoid, antisocial asshole. I still believe that DXM has a place among psychedelics, but do understand that it is not a replacement for LSD, mushrooms, 2CB, or even ketamine. It is a unique and uniquely powerful mind-altering drug, and one which I think most people would do best to avoid.

This document is a FAQ ("fack"), i.e., a series of questions and answers. The term comes from Usenet, and stands for Frequently Asked Questions. These are the sorts of questions that people new to Usenet tend to ask frequently. When these questions become frequent enough, the question and its answer may be placed into the FAQ for the newsgroup (or for a topic within the newsgroup). A few people use the term AFAQ (Answers to Frequently Asked Questions), but most use FAQ to refer both to a frequent question and to the document

This FAQ covers dextromethorphan (decks-tro-meth-OR-fan), the cough suppressant commonly found in cough medicines available over-the-counter in the USA and other parts of the world. Of course, dextromethorphan (DXM) does more than suppress coughs; otherwise, there wouldn't be so much discussion about it on Usenet. The bizarre truth about DXM is that it is a very potent psychoactive drug when taken in sufficient quantities. So if you've ever heard about people drinking cough syrup for fun, well, now you know why.

The trouble, however, is that most cough medicines have other ingredients which can make you uncomfortable, sick, or dead, depending on the ingredient and how much you take. Furthermore, even when pure, chronic or heavy use of DXM may cause health problems. This document is intended to combat potentially dangerous misinformation about the recreational use of DXM, and to allow you to make an intelligent and informed decision about DXM.

My own interest in DXM came quite by accident; once, while sick with the flu, I misread the instructions on a bottle of cough syrup and drank two shots from the included shotglass instead of two teaspoons. Soon after I noticed that music and motion had become very satisfying experiences. This left me puzzled, and my reaction was to go to the library and research DXM through Medline, medical journals, and books.

Of course at that point I was hooked - not on DXM, but on neuropharmacology. I decided to learn as much as I could about DXM, and found it to be one of the most unique and interesting of all recreational drugs in terms of how it works on the brain.

About this time I noticed a number of incorrect and potentially dangerous posts (articles) about DXM appearing on alt.drugs. So, I decided to gather the information I had and write a FAQ. It eventually became much more than a FAQ, giving explanations and information in addition to answers, but by then the name had stuck. The FAQ took me over 150 hours to complete - I figured if I'm going to do it, I'd better do it right.

After publishing the DXM FAQ, the reports of DXM use started coming in. People who had been using DXM but were uncomfortable talking about "getting high off cough syrup" shared their stories with me. Some were good, some were bad, some indifferent. I've been trying my best to get all of these personal reports together into a coherent whole, but this FAQ is written in my free time and I don't get paid for it (although donations are acceptable :^).

Please note that it is not my intention to get a bunch of people hooked on cough syrup (actually addiction is very rare, but you get my point). It is my intention for people to know the truth so they don't make bad decisions for lack of knowledge. DXM is not safe and harmless; nothing is. Nor is it universally enjoyable; in fact, some find high-dose DXM experiences terrifying. But I believe that people can only make good decisions, or learn from bad decisions, if information is available. So please, use your head!

1	Acknowledgements
2	Preliminary Information
2.1	Restrictions and Disclaimer
	Distribution Restrictions
	General Disclaimer
	How to Reach the Author
2.2	Why a DXM FAQ?
2.3	Keeping DXM Legal
2.4	How to Use This Document
3	DXM QuickFAQ
3.1	What is DXM?
3.2	You Mean I Can Get High Off Cough Syrup?
3.3	What Kinds of Cough Medicine are Safe?
3.4	What Happens if I Drink the Wrong Cough Syrup?
3.5	I'm Taking Other Drugs -- Can I Take DXM?
3.6	What's the DXM Trip Like?
3.7	How Much DXM Do I Take?
3.8	Is DXM Like Acid?
3.9	Is DXM Fun?
3.10	Is DXM Dangerous?
3.11	If DXM is Dangerous, Why Do It?
4	General Information About DXM
4.1	DXM Quick Reference Page
4.2	What is Dextromethorphan Hydrobromide (DXM)?
4.3	What is Dextromethorphan Polistirex?
4.4	What is Dextrorphan (DXO)?
4.5	Is DXM Enjoyable as a Recreational Drug?
4.6	Is DXM an Opiate?
4.7	Does Everyone Like DXM?
4.8	How Does One Obtain and Use DXM?
	Cough Syrups
	Gelcaps
	Tablets and Capsules (including Coricidin)
	Lozenges
	Pharmaceutical and Chemical Suppliers
	Extracted DXM
	Injection and Other Routes
4.9	What are Some Typical DXM-Containing Preparations?
4.10	How am I Supposed to Drink Cough Syrup?
4.11	What Should I Know About Other Drug Ingredients?
	Decongestants
	Antihistamines
	Guaifenesin
	Analgesics, Acetaminophen/Paracetamol
	Alcohol
	Food Coloring and Dyes
	Bromide Ions
	Other "Inactive" Ingredients
4.12	Why are So Many DXM Preparations in Liquid Form?
4.13	Is Recreational Use of DXM Illegal?
4.14	If DXM is Legal Why Isn't Everyone Doing It?
4.15	New Medical Uses for DXM
	Diagnostic Uses
	Neuroprotectant Uses
	DXM for Chronic Pain
	DXM for Drug Addiction
	DXM for Disease and Miscellaneous Conditions
4.16	Drug Interactions
	Fatal or Dangerous Interactions
	Beneficial Drug Interactions
	Recreational Drug Interactions
4.17	General Warnings
4.18	What About Other Cough Suppressants?
	Noscapine
	Opiates
	Topical Anaesthetics
	Can DXM be Detected on Drug Tests?
5	The DXM Experience
5.1	What is the General Character of the DXM Experience?
5.2	Overview of the Lower Plateaus
5.3	The First Plateau
	Sensory Effects
	Cognitive/Emotional Effects
	Motor Effects
	Memory Effects
5.4	The Second Plateau
	Sensory Effects
	Cognitive/Emotional Effects
	Motor Effects
	Memory Effects
5.5	The Transitional Phase
5.6	The Upper Plateaus
5.7	The Third Plateau
	Sensory Effects
	Cognitive/Emotional Effects
	Motor Effects
	Memory Effects
5.8	The Fourth Plateau
5.9	Plateau Sigma
5.10	Is There Anything Beyond the Fourth Plateau?
5.11	What is the "DXM Third Eye Camera"?
5.12	Tussin Space, Tussin Consciousness
5.13	What is the "Tussin Euphoria" and What Makes it Unique?
5.14	What Can Happen with Long-term or Regular Use?
5.15	Why does DXM Affect Different People So Differently?
5.16	How Does DXM Compare With Other Dissociatives?
6	DXM Side Effects and Other Things to Avoid
6.1	What are Some Minor Risks of Occasional Use?
	Nausea and Other Gastric Disturbances
	Dizziness
	Mild Allergic Reactions and Histamine Release
	Sexual Dysfunction
	Diaphoresis (sweating)
	Impaired Judgement and Mental Performance
	Hangovers
	Tachycardia (Increased Heart Rate)
	Pupil Dilation or Constriction
	Hot and Cold Flashes
	Facial Edema
	Mild Hypertension (High Blood Pressure)
	Mild Hyperthermia (Increased Temperature)
	Overexertion
	Urticaria (skin rash/wheal)
	Increased Bile Secretion
	Inappropriate Behaviour
	Miscellaneous
6.2	What are Some Major Risks of Occasional Use?
	Panic Attacks
	Psychotic Breaks
	Impaired Judgement in Critical Situations
	Depression
	Serious Hyperthermia (High Temperature)
	Serious Hypertension (High Blood Pressure)
	Rhabdomyolysis
	Respiratory Depression
	Serotonin Syndrome
	Major Allergic Reactions and Histamine Release
	Miscellaneous
6.3	What Are the Risks of Regular Use and Binges?
	NMDA Antagonist Neurotoxicity (Olney's Lesions)
	Cerebral Hemorrhage and Stroke
	Other Neurotoxicity Mechanisms
	Mania
	Depression
	Violent Ideations, Antisocial Behaviour, and Paranoia
	Memory Impairment
	Language Impairment
	Weight Loss
	Loss of Muscle Control
	Habituation and Psychological Addiction
	Tolerance and Physical Addiction
	Psychosis
	Liver, Kidney, and Pancreas Damage
	Bromide Poisoning
	Miscellaneous
	Summary: Regular Use Considered
6.4	DXM and Pregnancy
6.5	What is NMDA Antagonist Neurotoxicity and How do I Prevent It?
	Overview and Mechanism of Olney's Lesions
	Dosages at Which NAN Occurs
	Balancing the Risks: Is Olney's Research Relevant to DXM Use?
	A Look at the Areas Involved
	Preventing and Limiting NMDA Antagonist Neurotoxicity
6.6	Is DXM Addictive?
6.7	Is DXM Withdrawal Dangerous?
6.8	Kicking the DXM Habit: What to Do If You are Addicted
	Preparing to Quit
	Quitting "Cold Turkey"
	Build-Down
	After Quitting: When Can I Use DXM Again?
6.9	DXM Hangovers -- Avoiding and Alleviating
6.10	How Toxic is DXM, and What is the Lethal Dose?
6.11	Do You Recommend DXM for Recreational Use?
6.12	Help! What do I do if ...
	Itching (the "Robo Itch")
	Fast Heartbeat
	Panic Attacks
	Irregular or Skipped Heartbeats
	Nausea, Vomiting, Gas, and Diarrhea
	Unconsciousness
	Overdose
	High Temperature / Fever
	Shortness of Breath / Breathing Problems
	Choking On Your Tongue
	Nosebleeds
	Feeling "dead" / losing one's body
	Hangovers (lethargy and feeling "not all there")
	Prolonged Dissociation From the Real World
	Serotonin Syndrome
	Bad Trips
	Psychotic Breaks
6.13	How to Know When You've Done Too Much DXM
7	Getting the Most Out of DXM
7.1	General Tips on Enjoying the DXM Experience
7.2	What are Some Fun or Interesting Things to Do on DXM?
	Listen to Music
7.3	Watch a Movie
	Make Music
	Dance
	Swimming (First Plateau Only!)
	Group Tripping
	Paranormal/Spiritual Exploration
	Observe People
7.4	What Tools Can Enhance the DXM Experience?
	Sensory Deprivation
	Ganzfeld
	Light and Sound (Brainwave) Machines
	Hemisphere Synch Audio Tapes
	Trip Programs
	Trip Toys
7.5	What are Some Things to Avoid on DXM?
	Heavy Exercise
	Driving
	Going to Class, School, or Work on DXM
	Dose "Boosting" and Re-dosing
	Stressful Environments
7.6	What is the "50 Trip Limit" and How Can I Avoid It?
7.7	Why Can't I Hallucinate on DXM?
8	Altered States and Paranormal Experiences
8.1	Preliminary Information and Discussion
8.2	What Paranormal and Altered State Experiences Occur on DXM?
	The Dissociative Spiral
	Deja Vu and Other Memory Mishaps
	Out-of-Body Experiences (OOBEs)
	Near-Death and Rebirth Experiences
	Contact with Alien and Spiritual Beings
	Clairvoyance, ESP, and Other Psi Phenomena
	Memory Loops and Prescient Sensations
	Dissociative Thought Patterns
8.3	Cosmic Coincidence Central and the Alien Conspiracy
8.4	Are These Experiences Dangerous?
8.5	How Can These Be Explained
	Temporal Anomalies
	Complex Partial Seizures
	Influence of the Unseen Environment
	Spiritual Explanations
8.6	How do I Maximize Altered States and Paranormal Experiences?
	Theta Stimulation
	Hemisphere Synch Tapes
	Magnetic Stimulation
	Sensory Deprivation and Ganzfeld
	Predosing
	Meditation
8.7	Factors Affecting Susceptibility to Paranormal Experiences
8.8	A Warning About "Spiritual Shortcuts"
8.9	A Warning About Temporal Lobe Epilepsy
9	Physiological Effects of DXM
9.1	How Does DXM Inhibit the Cough Reflex?
9.2	How Does DXM Cause its Psychoactive Effects?
	General Information
	Contribution of the PCP2 Binding Site
	Contribution of the Sigma Binding Sites
	Contribution of the NMDA Receptor
	Temporal Lobe Involvement
	Contributions of Indirect Activity
	Flanging
	Hyper-Abstraction
	Delusions and Memory Problems
9.3	Why Does DXM Exhibit Plateaus?
	Plateaus 1-3: Multiple Receptors
	The Fourth Plateau: Sensory Shutdown
9.4	Why is This So Complicated?
9.5	Pharmacokinetics: How DXM is Metabolized
	Factors Affecting Metabolism of DXM
10	Neuropharmacology of DXM
10.1	What is a Receptor, Anyway? (Basic Neuropharmacology)
	The Structure of a Nerve Cell
	Neurotransmission
10.2	What are Sigma Receptors?
	Sigma 1 Receptors and General Sigma Information
	Sigma 2 Receptors
	Sigma 3 Receptors
10.3	What Are NMDA Receptors?
	NMDA and Other Glutamate Receptors
	NMDA Receptor Structure and Function
	NMDA Receptors and Excitotoxicity
10.4	What are PCP2 Receptors?
10.5	What are Na+ and Ca2+ Channels?
10.6	How Does DXM Compare to Other Dissociatives at These Receptors?
10.7	Endopsychosin and the Big Picture
11	DXM Chemistry and Extraction
11.1	How Can I Extract DXM From Cough Syrups and Gelcaps?
	Theory of Acid-Base Extractions
	Single-Phase Acid-Base Extraction of DXM
	Agent Lemon: Dual-Phase Acid-Base Extraction of DXM
	Precipitation Method
11.2	How Can I Get Rid of Other Drug Ingredients?
	Acetaminophen
	Guaifenesin
	Antihistamines and Decongestants
11.3	How Can I Test for Acetaminophen?
11.4	How do I Use Free Base DXM?
11.5	How Can I Synthesize DXM?
11.6	What Can I Synthesize From DXM?
	Dextrorphan
	Levorphanol / Levomethorphan
	3-Substituted Analogs
12	DXM Drug Culture
12.1	Is There, or Was There, a DXM Drug Culture?
	DXM in the 1960's
	DXM in the 1970's
	DXM in the 1980's
	DXM in the 1990's
	The Future of DXM Use
12.2	Why Haven't I Heard About DXM Drug Culture?
12.3	DXM "Drug Slang"
	Non-American DXM Drug Slang
12.4	How do I Tell My Friends I'm Getting High off Cough Syrup?
13	Mixing DXM and Other Drugs
13.1	Alcohol
13.2	Barbiturates and Benzodiazepines
13.3	Amphetamines and Other Psychostimulants
13.4	Cannabis (Marijuana)
13.5	LSD, Psilocybin (Shrooms), and Other 5HT Hallucinogens
13.6	Opiates
13.7	PCP and Ketamine
13.8	Nicotine
13.9	Phenethylamines (MDMA, MDA, 2CB, etc)
13.10	Nootropics (Smart Drugs)
13.11	Miscellaneous Other Drugs
14	DXM Experiences and Personal Reports
14.1	First and Second Plateau Experiences
	Positive Experiences
	Negative Experiences
14.2	Third and Fourth Plateau Experiences
	Positive Experiences
	Negative Experiences
14.3	Long Term Use Experiences
	Positive Experiences
	Negative Experiences
14.4	Multiple Drug Experiences
	DXM + Cannabis + Alcohol + Opium
	DXM + Cyclazine
	DXM + Mushrooms + LSD + Cannabis + Nitrous Oxide
15	Appendices
15.1	Appendix 1: P450 Inhibiting Drugs
15.2	Appendix 2: Neuropharmacology of Recreational Drugs
15.3	Appendix 3: Other Sigma and NMDA Ligands
16	Glossary
17	References