This document was obtained from the Dextroverse (http://dex.port5.com) but originated from www.frognet.net/dxm (which is no longer available) and was written by William White. ---------------------------------------------------------------------------- THE DEXTROMETHORPHAN FAQ ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT DEXTROMETHORPHAN (DXM) William E. White Text Version 4.0 Copyright © 1997 All Rights Reserved Comments, questions, or feedback? Please take a moment to fill out the feedback form. New Section: Moron of the Moment Since first coming up with the FAQ I've received a grand total of four negative responses out of over eight hundred total. Recently I got one with no return address (funny, that); because of this, I can't respond to him/her directly. However, I can take the comments and deconstruct them (besides, s/he marked them public anyway). So, if you'd like to take a look at my first negative comment in over six months, and the response I'd give to it, go here. New Section on Quitting DXM If you find yourself psychologically addicted to DXM you may wish to consult the new section on quitting DXM (Section 6.8). Remember, I'm not a doctor and I'm not going to play one on the net either, so see a physician first and foremost and ask her or him about the suggestions I list from former DXM addicts. Introduction to the FAQ v4.0 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. William White March 15, 1997 Introduction to the FAQ v3.0 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! William White May 10, 1995 THE DEXTROMETHORPHAN FAQ ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT DEXTROMETHORPHAN (DXM) Table of Contents 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 1 Acknowledgements ACKNOWLEDGEMENTS First and foremost I would like to thank my wife, Nicole, for providing me with a seemingly endless supply of love and support, and for putting up with my idiosyncrasies. I doubt anyone else could have coped with being married to someone whose idea of fun is spending hours in a library researching tripping off of cough syrup. I would also like to thank Barbara Adeanna and Peter Zachariah Kramer who helped me proofread the FAQ and who took the time to tell me when I was confusing, unclear, or simply full of it. Additionally I would like to thank them for their support and encouragement throughout the writing process. I would like to acknowledge Schering-Plough, Richardson-Vicks, and other OTC pharmaceutical companies, for giving me something to write about. How about bringing back DXM-only pills, folks? The evolution of this document also owes a great deal to the participants of Usenet alt.drugs, alt.psychoactives, and rec.drugs.psychedelic, notably including P. L. and all the people who made hyperreal.com, the Lycaeum, and other drug websites what they are today. And to the hundred or so people who contributed their experiences to the FAQ, thank you; my understanding of DXM came about because of your assistance. I'd like to give a moment of thanks to the one and only person thus far who has given me truly critical and negative feedback. I showed her feedback (and the resulting exchange of email) to a friend of mine who is a neuroscience researcher and physician, and my friend reassured me that this person's objections, although numerous, were also baseless. Still, it has given me something to think about. As hard as it may be for some people to believe, a big part of why I wrote the FAQ in the first place was out of concern for people's physical, emotional, and spiritual well-being. Finally, thanks to my friend H., who taught me about DXM in the first place. 2 Preliminary Information 2.1 Restrictions and Disclaimer This text covers the recreational and medical uses of dextromethorphan, a cough suppressant in common use in over-the-counter (non-prescription) cough medicines. This is version 4.0-Y (text). 2.1.1 Distribution Restrictions 1. Distribution in electronic form is permitted, free of charge, except as otherwise specified below. 2. When distributed electronically, this document may be broken up into sections, provided all sections receive the same distribution and all are distributed within 1 day. (The exception is the Quick Reference Page, which may be distributed by itself). 3. When distributed by the author via Usenet, some sections may be omitted at the author's discretion. Automatic redistribution (i.e., Usenet news) may legally duplicate this pattern of omissions. 4. You are permitted to make a printed copy of the electronic document for personal use, and encouraged to pay the US$10.00 license fee when convenient. Any additional printed copies may be made at a license fee of US$10.00 per copy, sent to my address (see below). You may also purchase bound, printed copies of this text for US$25.00 (including shipping and handling); email or mail me for more information. 5. Sale of this document in any form (electronic or printed) by anyone other than the author without written permission is expressly forbidden. 6. When distribution in electronic form, this document must remain in the same format as received (e.g., ASCII, PostScriptTM, etc.). For information regarding specific formats, please contact me. 7. The HTML format hypertext files on my website may not be distributed without my approval; please use my site for them. You may, however, provide links to them. 8. Once a given version number has been released, no prior versions may be distributed without written permission. Please stick to this rule if you can; I try and keep the information in this document as up-to-date as possible. 9. This document may be cited as: White, William E. (1995) The Dextromethorphan FAQ: Answers to Frequently Asked Questions about Dextromethorphan, version 4.0. Published in HTML at http://www.frognet.net/dxm 10. As I do not wish my motives to be misrepresented, no citation or quotation of this document may be used so as to explicitly or implicitly suggest that I am in favor of the illegal use of any drug (legal or not), or any other illegal activity, subject to USA law. 11. No modified version of this document may be distributed in any form. 2.1.2 General Disclaimer This text discusses some rather controversial topics. Currently, there are laws in most places of the world that make it illegal to use certain drugs for recreational purposes. It doesn't take a genius to figure out that the medical nature of the drugs in question has nothing to do with their legal status (otherwise, alcohol would be illegal and we'd all be smoking dope). In particular, a lot of people are making a lot of money from the illegal drug trade. The distributors, manufacturers, and sellers of illegal drugs are among them, of course. So are the law enforcement agencies and politicians, and the manufacturers and distributors of legal drugs like nicotine and alcohol. In the past few years, many scientists, physicians, journalists, and others have suggested legalization as a way to reduce the harm associated with the drug trade. It is not my desire to address this topic in depth here. What is important is that, in response to these suggestions, the proponents of the War on Drugs (and its equivalents elsewhere) have become increasingly aggressive. One of their goals is to prevent the dissemination of information about recreational drugs (unless it's their own propaganda). As such, anyone even discussing drug use is walking on thin ice, and once you go about telling people how to do it, the ice becomes a lot thinner. I have no intention of being thrown into prison so that they are forced to release rapists, murderers, and child molesters in order to make room for me. I'm not planning to become a martyr any time soon; I'd much prefer for the Drug Peace to come without violence (legal or physical). However, I feel it is important to provide true information about drugs. J. S. Mill argued very eloquently that if an idea is true, then it can only become stronger when it is confronted with falsehood; to prevent debate in the hope of protecting the "truth" only leads to lies. I agree entirely, and quite frankly I think anyone even thinking of getting into politics should be familiar with (and hopefully agree with) Mill and his arguments. Honest and open discussion of drugs can only lead to better policy and less harm. In any case, like so many others, I am walking on somewhat thin ice here, and must take certain steps to protect myself. Thus the following rather verbose disclaimer, which may or may not be worth anything in an actual court of law: It is not my intention to influence anyone to commit an illegal act. I explicitly instruct all readers not to violate any international, national, state, regional, city, or other applicable laws governing any of the information presented in any document authored by me or made available by me through electronic or other publishing methods, including this document. Specifically, I hereby advise everyone not to ingest, inject, smoke, snort, shove up your ass, or otherwise administer any legal or illegal drug (except for legal drugs under order of a physician), or to engage in the manufacture, distribution, synthesis, analysis, or other processing of any legal or illegal drug, regardless of anything you may see in the aforementioned documents. I advise everyone not to follow any procedures listed. All information is presented for EDUCATIONAL PURPOSES ONLY! None of the information in this document is guaranteed to be accurate or valid in any way. Anyone attempting any such action or process takes full responsibility for any outcome resulting from such, and neither I, nor my access provider, nor any other subset of the Usenet/Internet or world community (except for the person or persons attempting the action) may be held responsible. By proceeding past this Disclaimer, you agree to assume all responsibility for any actions, legal or not, that you may take. If any part of this disclaimer is found to be invalid, then all rights to access and distribute this information are revoked. 2.1.3 How to Reach the Author Any questions or comments may be addressed to me: Email: bwhite@frognet.net PGP 2.6.2 block available by finger Encrypted mail preferred. US Mail: William White PO Box 536 Athens, OH 45701 USA PGP Key: -----BEGIN PGP PUBLIC KEY BLOCK----- Version: 2.6.2 mQCNAi1lhpkAAAEEALzR0vS+W7qdMjQJz0Lc+TQm86HMpHu1ZEGDtGHcZShBy/tB xoDueEe7vy0nPJpvrfoEUjp8KhR55/Eb1i27CCTP47+5IvJNlV+1D0xrnaX6gSWr OVPjz/rLOvi8BHQxu7XNQ1BfUaaV0CPs8McPSUyeEqzNNadKouCp8NBoN4HlAAUR tC5XaWxsaWFtIEUuIFdoaXRlIDxid2hpdGVAb3Vjc2FjZS5jcy5vaGlvdS5lZHU+ =qyt4 -----END PGP PUBLIC KEY BLOCK----- Please don't call me up, telling me I'm going to Hell or somesuch nonsense. I don't believe in it and I don't have the time or inclination to listen to that sort of drivel. Thus far I've gotten very few negative responses, and I thank everyone who has taken the time to email me, call me, or otherwise contact me. Testimonials and personal data are presented anonymously. I do not maintain copies of the sender's name, address, or personal information, either online or offline, and thus I cannot give information as to their identities. Any personal information, testimonials, or reports as to DXM's effects that were or are sent to me will be considered anecdotal and not specifically referring to the sender. I encourage anyone with applicable data to send it to me anonymously. Any data sent PGP encoded will be decoded on my private system (MS-DOS) which is offline. After decoding, all information regarding the sender's identity is overwritten (200 pass random pattern). Thus I cannot link testimonials or information to senders after this operation. Note that my system is NOT TEMPEST SECURE (not that I've noticed any strange vans near my house). 2.2 Why a DXM FAQ? There is the philosophy among some in the USA (and probably the rest of the world) that the best way to prevent people from making mistakes is to withhold information from them. For example, this is particularly noticeable in the case of sex education, where some assert that teaching children about sex is equivalent to giving them permission to copulate, and that, since no sex is perfectly safe, and since teenagers especially have a tendency to take risks (e.g., no birth control), we ought not to teach sex education in the schools. One might just as easily say that teaching children about cars is equivalent to giving them permission to drive, and that, since no driving is perfectly safe, and since teenagers especially have a tendency to take risks (e.g., racing down Main St.), we ought not to teach driving education in schools. This misguided philosophy of "ignorance is strength" is just as often applied to information pertaining to drug use. In the case of drug use, however, good information is immediately useful towards preventing drug-related injuries. In the case of DXM, there are several possible mistakes people can make, and the chance for making a mistake is compounded by the fact that people hear "you can get high off cough syrup" as advertisement for DXM use. At best they are unprepared for the trip; at worst, they get hold of an acetaminophen-containing preparation and end up in the hospital or dead. Make no mistake; this information will probably encourage some to try, and continue to use, DXM. That is not my intention. A few of these people may end up addicted, or at least habituated to the point of trouble. That is certainly not my intention. My intention is to make sure that everyone out there knows what the risks and effects of DXM use are, so that s/he can make intelligent choices for herself or himself. An intelligent choice is not always right, but it is fair, and you always learn from it. This text sprung out of the Usenet newsgroups alt.drugsand alt.psychoactives, where about 1 or 2 questions a week about DXM would appear. After responding weekly, or in some cases daily, I decided to put together all the questions (and a few questions I thought would follow) and write a full explanation of DXM. Some of the material is fairly technical, but I thought it better to give too much information than not enough. It is distributed once a month (more or less) on the Usenet newsgroups rec.drugs.psychedelicand alt.drugs (until the latter disappears); please distribute it beyond Internet and Usenet (subject to the restrictions above). It is my sincere hope that this type of information may help the Internet fulfill its potential as an information source. Those of us who have the time and ability to provide good information should feel obligated to do so; if we set a standard of high signal and low noise, perhaps others will follow. 2.3 Keeping DXM Legal Right now, DXM is legal for over-the-counter use in most places. This seems to be for two reasons primarily. First, there is no substitute for DXM that does not also have abuse potential. Nor is there likely to ever be one; everywhere the cough reflex can be blocked involves some type of receptor associated with recreational drug effects. Second, pharmaceutical companies don't want to lose a major chunk of their income. DXM works as a cough suppressant, and it works well. Besides, nobody wants to have to go to the doctor to get a prescription every time they get a cold. However, it is possible that DXM-only preparations might disappear from the market. This would be unfortunate, both for recreational users and for the general public; the most likely additive - guaifenesin - makes some people vomit even at low doses. Another possibility would be the addition of something which would be harmless at regular doses but induce nausea (or other unpleasant effects) at recreational doses. ------------------------------------------------------------------------ The best answer is probably prevention, which unfortunately involves two conflicting goals. On the one hand, it is essential that DXM related deaths do not occur - this was my primary motivation in making this FAQ in the first place. Several DXM cough medicines can be dangerous if consumed recreationally, due to the presence of other ingredients. There is also the problem of drug interactions, e.g., DXM + SeldaneTM, which can be fatal. On the other hand, the spread of information to keep people from hurting themselves is also likely to inform people who didn't know about DXM, and will want to try it. DXM is still an unknown to many people (although not as big an unknown as most think - pockets of recreational DXM use have existed as long as DXM has). I've come to the conclusion that I'd rather have a bunch of people doing it safely than a few doing it dangerously - but then again, I'm also in favor of sex education. Thus, I encourage anyone who may want to try DXM or tell her or his friends to try it (which I again explicitly tell you not to do) to make sure and emphasize all the risks and dangers involved. Don't rush into high dosages. Don't trip alone, or without a designated sober person. Don't encourage people who are not psychologically mature to experiment with DXM. And please use common sense and be safe. In the event that DXM-only preparations do get pulled, the best answer is probably to have an isolation method that will separate the DXM from other ingredients. In my opinion, the most likely additive is guaifenesin (although people were using Robitussin DMTM long ago, and just toughing out the inevitable extreme nausea). I've been working on a way to separate the DXM from guaifenesin, using commonly available substances, and producing a pure, safe product. We don't want another "cat" (methcathinone) media-scare on our hands. Currently I offer a method for evaluation only; this method is not proven. I'm posting it with the FAQ so that other people can give it their consideration. ------------------------------------------------------------------------ In conclusion I'd like to remind everyone that we may be walking on thin ice here. I've tried my absolute hardest to make this FAQ as accurate and scholarly as possible, so that if anyone who matters ever does get a look at it, they'll get bored somewhere around the explanation of P450-2D6 polymorphism. Still, please use common sense. 2.4 How to Use This Document I have tried to make this document useful for a variety of audiences, and as such it can sometimes get fairly technical. If confused, consult the glossary; if still confused, check with a basic neuropharmacology text. I unfortunately do not have the time to answer general questions about neuropharmacology; I'm employed full time at a small ISP, trying to finish my education, and married. This document is broken up into chapters and sections by subject, with appendices, references, glossary, and index. At present, figures and diagrams are fairly minimal; I'm trying to improve that aspect. Also, sometimes I simplify things a bit. If you take exception to anything, email me with references and I'll consider modifying it. This document is distributed in three forms: ASCII text on Usenet; HTML on the World Wide web (http://www.frognet.net/dxm), and in printed form. I try to keep the HTML copy the most current, not an easy task considering the length of the document. I still haven't found an HTML editor that beats vi. The following additional formats will be made available as I have time to create them: Microsoft WordTM PostScriptTM and PDF. Email me for requests for any other format. Requests for oddball printer formats will be redirected to the bit bucket. Again, apologies; I just don't have much time anymore. If this is coming to you via Usenet, please note that the Usenet version is subdivided into sections; some news machines choke on very long files. I do not post the section on what you can synthesize from DXM, since it's mostly specialized information. Email me if you want it. Otherwise, posting is once a month, with the DXM Quick Reference being posted biweekly. If I'm eating up your bandwidth, I'm sorry; recently a lot of DXM use has been going on and I want to make sure everyone has the facts available. 3 DXM QuickFAQ This is a quick question-and-answer section about DXM which avoids most of the technical detail of the full FAQ sections. However, since DXM is a complex drug, you are advised to read the appropriate sections in the full FAQ. ------------------------------------------------------------------------ 3.1 What is DXM? DXM, or dextromethorphan, is a cough suppressant drug found in cough syrups and cough medicines. It can be used recreationally, but there are risks. ------------------------------------------------------------------------ 3.2 You Mean I Can Get High Off Cough Syrup? Yes, if you choose the right kind; if you pick the wrong kind, you can end up dead. And you may not like the "high" you get; some people love it, others hate it. ------------------------------------------------------------------------ 3.3 What Kinds of Cough Medicine are Safe? Basically, anything containing ONLY dextromethorphan hydrobromide (DXM HBr). Popular US brands include Robitussin Maximum Strength Cough (and generic equivalents), Drixoral Cough Liquid Caps (the red kind), and generic equivalents. ------------------------------------------------------------------------ 3.4 What Happens if I Drink the Wrong Cough Syrup? If it has gauifenesin (Robitussin DM and generic "DM" syrups have this drug), you'll probably puke your guts up. If it has acetaminophen (paracetamol), you stand a good chance of a painful, prolonged death. Anything else, you're likely to ruin the trip and may end up in the hospital. ------------------------------------------------------------------------ 3.5 I'm Taking Other Drugs -- Can I Take DXM? Quick answer: it depends. Don't take DXM if you are taking any of the following other drugs: * Antidepressants of any kind. MAOIs (monoamine oxidase inhibitors) are the worst; DXM + a MAOI will kill you. DXM with other antidepressants can cause serotonin syndrome, an unpleasant and occasionally fatal condition. * Diet drugs like phentermine, fenfluramine (Redux), or phen-fen. Again, a risk of serotonin syndrome. * Non-drowsy antihistamines (allergy medicines) like Allegra, Seldane, or Hisminal. ------------------------------------------------------------------------ 3.6 What's the DXM Trip Like? Well, that depends on how much you take. There are four different kinds of experiences, based on the dosage; these are called plateaus. The first plateau is a mild stimulant effect with a little bit of a buzz, and has been compared to MDA. The second plateau is more intoxicating and has been compared to being drunk and stoned at the same time. The third plateau is dissociative, like a lower dose of ketamine. The fourth plateau is fully dissociative like a higher dose of ketamine. You should not attempt higher plateau doses unless you have someone with you who can take care of you in case you get sick or freak out. It happens on DXM. Many things can happen unexpectedly on upper plateaus, such as spontaneous memory recall, complex delusions, hallucinations, out-of-body experiences, near-death experiences, and perceived contact with spiritual or alien entities. You need to be pretty stable and grounded before you can handle these things. ------------------------------------------------------------------------ 3.7 How Much DXM Do I Take? See the full FAQ; it's complicated and depends on your body weight; furthermore, some people can't handle DXM due to a genetic mutation in an important enzyme. So you always want to do a low dose on your first trip, and then increase gradually with each new trip. ------------------------------------------------------------------------ 3.8 Is DXM Like Acid? No. It's more like ketamine or PCP, but not much like them either. ------------------------------------------------------------------------ 3.9 Is DXM Fun? Some people think so; others point out that while the lower two dosage plateaus are more recreational or fun, the upper two seem to be more suited for self-exploration and shamanic work. ------------------------------------------------------------------------ 3.10 Is DXM Dangerous? Yes, especially if you take too much. Some of the more important dangers you might want to know about are: * Nausea, diarrhea, vomiting, and allergic reactions (often from the cough syrup itself) * Hot flashes, dizziness, and bad trips * Psychotic breaks (generally from high dose use) * Psychological addiction and depression (generally from regular use) * Irreversible brain damage (from chronic use at high doses) The last -- brain damage -- is fairly rare, occurring in less than 1% of the regular users I've interviewed. They all used DXM very frequently. If you do DXM twice a month or less, you'll probably be OK. But remember there's always the risk of something going wrong. ------------------------------------------------------------------------ 3.11 If DXM is Dangerous, Why Do It? That's up to you. Most people in our culture seem to shun the idea of taking real risks, whether it be through drugs or high-risk sports such as mountain climbing and hang gliding. On the other hand, when someone goes and climbs a mountain without adequate equipment and training, and then falls to her death, nobody goes and blames the mountain. There are many people who believe that the risks of DXM (or other drugs) are worth the rewards. If you are a legal adult and are willing to take responsibility for your actions, in my opinion you should be permitted to experiment with psychedelics to your heart's content. 4 General Information About DXM This section covers general information about dextromethorphan, herein referred to as DXM. IUPAC chemical names are in a sans serif font, in square brackets. PLEASE NOTE that the UK (and European?) name of acetaminophen is paracetamol. It is also known as APAP. They all refer to the same substance. ------------------------------------------------------------------------ If you get nothing else out of this FAQ, let it be this: Remember that DXM is a powerful psychedelic which can be used safely, but must be used with care and respect for your own body and mind. DXM is not a safe drug, and it has not been well studied at recreational levels; whenever you use it you are taking a risk, possibly a big one. Please read and follow these basic guidelines: [*] Not everyone likes DXM, and your experiences with it may be very unpleasant. A very few have had such intense side effects from DXM that their first trip lands them in the hospital. DXM is not a quick and easy buzz, and getting good results with it can be hard, sometimes unpleasant work. [*] Do not use DXM on a constant or frequent basis! Like alcohol (and unlike marijuana), constant or frequent (more than once or twice a week) use may be dangerous. Although not everyone seems susceptible, a very few daily high-dose users may have seriously and permanently fried their brains. [*] Do not use DXM if you have a any of the following medical conditions: mental illness, epilepsy, seizures, liver or kidney disorders, hypertension, heart problems, or ulcers. [*] Do not use DXM if you are pregnant or nursing. All dissociatives adversely affect fetal development, and may lead to birth defects and mental retardation. [*] Because some people can have severely adverse reactions to DXM, never rush into a high dose. Instead, take no more than twice your last dose, and wait at least one week between doses. Yes, it may take you a month before you get to interesting territory, but that's better than ending up in the hospital. Yes it can happen to you! [*] Never exceed 20mg/kg (or 2000mg, whichever is lower) of DXM under any circumstances, and never exceed 15mg/kg (or 1500mg) unless you have a trip-sitter who is experienced and capable in the event of a medical emergency. [*] Because of the potential for allergic or other adverse reactions to inert ingredients, always try a low dose first when taking a DXM product (syrup, gelcap, capsule, whatever) you haven't taken before. [*] Never experiment with hallucinogens without a sober person around to help you in case you get into trouble. This goes doubly for DXM, which is much more likely to induce abnormal and dangerous behaviour than LSD. [*] NEVER, EVER, EVER drive under the influence of any intoxicating drug including DXM! [*] Never use a product containing acetaminophen (also called paracetamol or APAP, and known by the brand name TylenolTM). Large doses of acetaminophen can cause liver damage or death. Many cough syrups contain acetaminophen so always read the label. [*] Never take DXM with yohimbine (YoconTM)! To do so may be risking permanent brain damage! [*] Never take DXM if you are taking a monoamine oxidase inhibitor (MAOI). This also applies for one week before and two weeks after taking a MAOI. MAOIs include some (rarely used) prescription drugs for depression and Parkinson's disease, a few recreational ethnobotanicals (harmine and harmaline), and yohimbe bark. Mixing DXM and a MAOI has regularly been fatal. [*] Do not take DXM with phentermine, fenfluramine, or the combination (phen-fen), all of which are used as prescription diet pills. This combination can cause serotonin syndrome. [*] Never take DXM if you are taking, will take, or have taken within six weeks, the prescription antihistamine terfenadine (SeldaneTM), or any other prescription, non-drowsy antihistamine (e.g., ClaritinTM or HisminalTM). [*] Never take DXM with the SSRI antidepressants Desyrel (trazodone) or Serzone (nefazodone); these combinations have resulted in liver damage. [*] Be very careful combining DXM with SSRI and tricyclic antidepressants (i.e., those in common use), and never use DXM when taking more than one drug at a time for depression, due to the potential for serotonin syndrome. [*] Avoid all products containing DXM and other active ingredients. [*] Avoid BenylinTM brand products which seem to cause severe nausea. Avoid any product with castor oil. Avoid Coricidin Cough and ColdTM at upper plateau doses due to the potentially dangerous effects of antihistamine overdose. [*] Remember that DXM can sometimes trigger panic attacks in susceptible individuals, especially those inexperienced with DXM. This is a major cause (if not the major cause) of tachycardia (high heart rate) from DXM. All the more reason not to rush in to anything. [*] Always remember: recreational use of DXM is still a great unknown. The brain you are risking is your own. 4.1 DXM Quick Reference Page Dextromethorphan (decks-tro-meth-OR-fan), or DXM, is a cough suppressant found in over-the-counter medications. It has also been used recreationally for at least 30 years, without much harm or publicity. Although chemically related to opiates, its effects are closest to ketamine's. In addition to suppressing coughs, DXM is used medically for diagnostic purposes, and may be useful for a variety of conditions from seizures to heroin addiction. In the brain, DXM blocks the dopamine reuptake site, activates the sigma receptor, and blocks the open NMDA channel. (None of these effects are permanent). Occasional recreational use of DXM is probably safe, though side effects and risks have been noted (I hereby tell you not to use any recreational drug including DXM). Many cough medicines contain ingredients other than DXM; some, like acetaminophen (paracetamol) can be fatal when an overdose is taken. The commercial preparations which can be used recreationally are those containing DXM only In the USA this includes mostly "Maximum Strength" cough formulas and Drixoral Cough Liquid CapsTM, and generic equivalents. All should list ONLY dextromethorphan hydrobromide under active ingredients. Avoid Benylin DMTM. The above cough syrups have 3mg/ml (15mg per teaspoon), for 360mg per 4oz bottle and 720mg per 8oz bottle; the cough gelcaps have 30mg each. Preparations like Robitussin DMTM contain guaifenesin and may cause vomiting. Never take DXM with, or up to two weeks before or six weeks after, the prescription "non-drowsy" antihistamines (allergy medications) SeldaneTM, ClaritinTM, or HisminalTM. Never take DXM with, or up to two weeks before or three weeks after, a MAOI (Monoamine Oxidase Inhibitor) - certain drugs for depression; you will probably be told by your doctor if your drug is a MAOI (ProzacTM isn't). Never drive under the influence of DXM. Don't take DXM more than once or twice a week. Don't take DXM if you have a history of mental illness, panic attacks, seizures, liver, kidney, or heart disease. Some people react very badly to DXM; others don't experience anything at all, partly from inherited lack of an enzyme. ProzacTM blocks this enzyme and may lengthen or change the DXM trip. Recreational DXM use may be illegal. DXM may cause false positives on drug tests. DXM trips vary depending on dosage, and can be lumped into four very different plateaus, or types of trips, depending on the amount taken. Dosages are given in milligrams per kilogram, so multiply the figure by your mass in kg (or pounds divided by 2.2). The first plateau, 1.5 to 2.5 mg/kg, is like a slightly intoxicating stimulant; music and movement are often pleasurable. The second plateau, 2.5 to 7.5 mg/kg, is intoxicating, with a "stoning" a bit like that of nitrous oxide or marijuana; sounds and sights seem to be on strobe-effect ("flanging"), short-term memory is somewhat disrupted, and there are occasional mild hallucinations. The third plateau, at 7.5 to 15mg/kg, consists of strong intoxication, hallucinations, and overall disturbances in thinking, senses, and memory; third plateau trips can be unpleasant. The fourth plateau, above 15mg/kg, is similar to a sub-anesthetic dose of ketamine, with dissociation of the mind from the body, and may be dangerous physically and psychologically. Most recreational use of DXM happens at the first and second plateau. DXM starts to become toxic around 20 to 30mg/kg. While occasional recreational use of DXM is probably safe, some people react very badly to dissociatives, especially at high doses, and may panic. Frequent DXM use, like frequent alcohol use, is probably dangerous and should be avoided. Please be safe, sensible, and use your brain; it's the only one you'll ever have. From The Dextromethorphan FAQ: Answers to Frequently Asked Questions about DXM, v4.0, by William White (bwhite@frognet.net). Available on Usenet rec.drugs.psychedelic and on the World Wide Web at http://www.frognet.net/dxm.html. This section may be freely printed or photocopied separately provided it is kept intact, on one page. 4.2 What is Dextromethorphan Hydrobromide (DXM)? Dextromethorphan hydrobromide is the water-soluble salt of dextromethorphan (DXM) and hydrobromic acid (that is, DXM hydrobromide is what you get when you react pure DXM with hydrobromic acid). DXM is a synthetic morphine analog, similar to levorphanol, but does not have any opiate-like effects. DXM has been in use in the USA for approximately 30 years, and has replaced codeine as an OTC cough suppressant (1-3). DXM has been popular as an "underground" recreational drug for at least 30 years (3). It is probably one of the few OTC medicines with any serious recreational use potential (ephedrine might also qualify). It is both extremely safe and very effective as a cough suppressant. DXM's IUPAC name is [(+)-cis-1,3,4,9,10,10a-hexahydro-6-methoxy- 11-methyl-2H-10,4a-iminoethanophenanthrene], and is also (and more commonly) known as 3-methoxy-17-methyl-(9alpha,13alpha,14alpha)-morphinan; CAS-125-71-3 (1). Note: the 3-methoxy and 17-methyl groups are pointed out for later notes. (Oh, just as a side note, I'm proud to say that for once I actually got the IUPAC name right all by myself - the Merck Index lists the same thing). The recreational use potential of DXM has not, in general, been well known, either by drug users or by physicians. Not too long ago, many physicians denied that dextromethorphan was psychoactive at all; whether this was out of ignorance or a desire to prevent recreational use, I do not know (probably the latter). At present, there is an increasing body of knowledge about DXM's potential for recreational use (and abuse) available in medical journals (3-7,132,136,139-141). DXM is unique among recreational drugs for several reasons. First, it is pharmacologically unlike most other recreational drugs (PCP and ketamine being its nearest relatives). Second, its effects can vary considerably from individual to individual. Finally, it can cause quite different effects at different dosage levels, ranging from mild euphoria to full dissociation. 4.3 What is Dextromethorphan Polistirex? Dextromethorphan Polistirex is a time-release formulation of DXM; the "polistirex" refers to a sulfonated styrene-divinylbenzene copolymer complex -- basically, an edible plastic (1-2). It is occasionally spelled polystirex or polystyrex. Unlike the HBr salt, which is absorbed fairly quickly, this compound is intended for longer duration cough suppression. Most, but not all, people who use DXM recreationally tend to prefer the HBr form (which is also much more readily available). The polistirex preparation will probably increase the ratio of DXM to DXO (see next section). Dextromethorphan polistirex may be more toxic than the hydrobromide version, possibly due to buildup of DXM in the bloodstream (143). 4.4 What is Dextrorphan (DXO)? Dextrorphan is a metabolite of DXM (i.e., the body converts DXM to dextrorphan). The conversion from DXM to DXO occurs via removal of the methyl group at position 6, a process called "O-demethylation". DXO is very similar chemically to DXM, and reacts with the same receptors in the body, but with a very different spectrum. Whereas DXM is strongest at the PCP2 and sigma receptors, DXO primarily targets the NMDA receptor (see Section 10). The practical upshot is that the dissociative and intoxicating or "stoning" effects are stronger with DXO, whereas the stimulation, cognitive alterations, delusions, and psychotomimetic (literally, "psychosis-like") effects are stronger with DXM. Most DXM users find some balance between the two to be the most pleasurable. Too much sigma activity is usually regarded as dysphoric (strongly unpleasant) and disturbing, and if prolonged, may be dangerous (101,135). Fortunately, you don't have to worry about converting DXM to DXO; the body does it for you via an enzyme called P450-2D6 or CYP2D6 (also called debrisoquine 4-hydroxylase). However, between 5 to 10% of the Caucasian population lacks this enzyme (12-15), and in the rest of us it can vary. Many drugs can temporarily block P450-2D6 from working (10-11) and thus alter the balance between DXM and DXO. For a list of these drugs, see Section 15.1. One of DXM's metabolites, 3-methoxymorphinan, can itself block P450-2D6. As a consequence, taking a second dose some time after the first dose of DXM will probably increase the ratio of DXM to DXO in the bloodstream. Taking the dose all at once, on the other hand, will probably increase the relative amount of DXO. Generally, then, the quicker the dosing, the more DXO and less DXM, and the more NMDA blockade (like ketamine) and the less sigma and PCP2 activity. Subcutaneous injection leads to very little conversion from DXM to DXO. When discussing effects, this text usually uses "DXM" to refer to both dextromethorphan and its metabolite, DXO. A few people have used DXO specifically; one indicated that it did in fact have fewer cognitive effects than DXM. 4.5 Is DXM Enjoyable as a Recreational Drug? It depends on what you consider "enjoyable". Roughly one third of the people who try DXM like it enough to ever repeat the experience; one third hates it, and one third doesn't enjoy it enough to drink cough syrup. Among those who do enjoy it, most report that their more "profound" DXM experiences were in many ways also very unpleasant, challening, and have a strong dysphoric undertone. Experienced psychedelic users seem to enjoy DXM more than the inexperienced. Generally speaking, enjoyable DXM experiences require putting a lot of emotional and psychological energy into the experience. DXM does not provide a simple high like marijuana, and it is not a substitute for other psychedelics. Many people will not enjoy it; before considering DXM, remember that you may hate the experience. If you are looking for a cheap buzz or a gentle ride, you probably won't like DXM. 4.6 Is DXM an Opiate? No, it isn't. Sometimes people get confused because DXM's stereoisomer (basically, the mirror image molecule), called levomethorphan, is an opiate. In two dimensions the molecules look identical, but in three dimensions, they are mirror images of each other. DXM no more fits into opiate receptors than a left-hand threaded screw will fit into a right-hand threaded nut. In fact, DXM doesn't bind at any opiate receptors, doesn't have opiate painkilling effects, and isn't cross-tolerant with opiates. It is only out of sheer chance that when DXM was invented, its origins were among the opiates; DXM's cough suppressant effects are completely different in mechanism from the cough suppressant effects of opiates. 4.7 Does Everyone Like DXM? No, in fact from speaking with many people who have tried it, only about one third of the people who try it ever take it again. One third seem to absolutely hate it, and the last third couldn't care less. Among the third who do like it, the majority (around 80% of those who like DXM) take it once a month or less. Part of the problem is that not everyone gets the interesting sets of effects (see Section 5). To some, the DXM trip is just a moderate buzzing sensation and a feeling of being slightly drunk. So your mileage may vary. A few people really enjoy DXM, and use it weekly; a very few (less than 5% of those who like DXM) use it more than twice a week. Keep in mind that I have not assessed the error margin on these figures, and that they reflect a biased sample of the population. I hope to have more accurate figures after completing a survey of DXM users. 4.8 How Does One Obtain and Use DXM? DXM is available at drugstores throughout the world, chemical suppliers, and (very rarely) as a street drug. Generally, however, I wouldn't trust anyone saying he or she had DXM on the street; it's probably ketamine, PCP, or something totally unrelated. DXM is most commonly available in cough syrups, though some syrups contain other ingredients which can make you sick (or dead) if you take too much of them. It is also available in gelcaps and in some places in capsules, either alone or in combination with other ingredients. DXM can also be extracted from cough medicines, and the extract can be taken orally, injected subcutaneously, intraperitoneally, intramuscuarly, or intravenously. It can probably also be snorted or used rectally (though why one would want to I don't know). Smoking the free base is very difficult if not impossible. DXO (not DXM) free base can be smoked at 190 C (pers. comm.). Some drugstores keep track of people who frequently buy DXM-containing cough preparations, especially if they buy multiple bottles at once or tend not to buy other things at the same time. This is less common in larger supermarket/drug stores. In some cities where DXM use has become popular (and come to public attention), sales have been restricted to adults. In Utah in the 1980's, DXM was placed behind the counter due to recreational use. Finally, DXM is available from chemical suppliers, very few of which will sell to individuals. Hopefully I'll soon be finished with the "Find the DXM" page, which allows people to find out which DXM preparations are available in their areas. Don't hold your breath, though; I'm a sysadmin at a small ISP and that doesn't leave me with a lot of time. 4.8.1 Cough Syrups DXM is widely available in cough syrups, both brand-name (such as RobitussinTM or Vicks Formula 44TM) and store brands. Most DXM-containing cough syrups also contain one or more of the following other active ingredients: nasal decongestants, antihistamines, acetaminophen, or guaifenesin (see Section 4.11). As a rule, you want to avoid all of them. Generally speaking, DXM cough syrups all taste nasty. This is for two reasons: to cover up the (even nastier) taste of DXM itself, and to prevent recreational use. The generics tend to be less thick, and thus more drinkable, than the brand names. Some people prefer to mix the DXM with sodas; others find this only makes an already unpleasant task even more unpleasant. Your Mileage May Vary. Most people who have used DXM cough syrups recreationally seem to prefer to take it on a mostly empty stomach, possibly with crackers or some other source of carbohydrates. I generally feel that you should avoid slamming your kidneys and pancreas with a lot of glucose at once; thus I think some crackers or chips beforehand would be advisable. Greasy food should be avoided both before and after taking DXM. Most people report that if carbonated drinks are ingested, they should be clear (e.g., 7-UpTM). The German company "Dr Rentschler" makes a cough syrup called "tuss hustenstiller saft". 4.8.2 Gelcaps There are "gelcaps" (liquid or gel filled capsules) available that contain DXM, but they tend to be brand-name only. The most frequent (if not only) brand in the US is Drixoral Cough Liquid CapsTM. They come in boxes of 10 or 20 gel capsules, each containing 30mg of DXM. The gel capsule itself is red colored; the liquid inside is actually clear (and tastes very, very bad). The capsules are somewhat large, and difficult if not impossible to take without liquid to wash them down. This brand also comes with a $0.50 or $1.00 manufacturer's coupon inside, which some have taken to calling DrixoralTM Dollars (after Camel BucksTM, a fake currency coupon in CamelTM cigarettes which could be collected and "spent" on various stuff, unfortunately not including iron lungs and chemotherapy). Note that Drixoral also makes several other liquid and capsule products, all of which contain undesirable active ingredients besides DXM. Recently, Drixoral Cough Liquid Caps have been getting harder and harder to find. The usual story from the drugstores is that they aren't very popular; my suspicion is that they are too popular. Look around, and you will probably be able to find them. There is a rumor going around that the "new" gelcaps have something in the coating that induces nausea, but I have found no evidence for this whatsoever. The ingredient list hasn't changed, and changing ingredients without making it public is strictly Absorption from the gelcaps takes some time, and can be sped up somewhat by cracking open each gelcap in your mouth before it is swallowed. Note, however, that the liquid inside is apt to spurt out, and it tastes bad. Really, really bad - sour and bitter and cloying all at once with a stickiness that won't go away. However, if you can stand it, you can become used to it after the first few gelcaps. You can also crack open the gelcaps and try to collect the liquid, but it tends to go everywhere. Some people have claimed that gelcap DXM "feels" different from cough syrup DXM. This may be pure placebo effect, or it may be a result of the slower absorption (and thus more DXM vs. DXO) of gelcaps. It is also possible that the "inactive" ingredients in cough syrup may affect the experience by altering blood glucose levels. Most seem to prefer the gelcap "feel". 4.8.3 Tablets and Capsules (including Coricidin) A variety of DXM-only pill brands are available throughout the world; unfortunately, none are available in the US. Some of the brands include: * Contac CoughCaps (Canada) * Romilar (southeast Asia and others) * Dr. Rentschler tuss hustenstiller retard kapseln (Germany) * Everest (Taipei and others) Please let me know if you learn of any others. DXM pills typically contain 15 or 30 mg of DXM, but some (such as the Dr. Rentschler brand, tuss Hustenstiller retard Kapseln) contain 60mg of DXM. In the US, a new tablet brand, Coricidin Cough & Cold, is available. Containing 30mg DXM and 4mg chlorpheniramine maleate (an antihistame), these have become popular for lower plateau dosing, but can have extremely unpleasant anticholinergic side effects (drymouth, blurred vision, confusion, etc.) with higher doses. One person had to be hospitalized for vomiting blood and entering respiratory arrest after taking a high dose of Coricidin tablets. Even low doses often have unpleasant side effects and may be very confusing. At the lower plateaus, the chlorpheniramine does seem to alleviate the "Robo Itch" (see Section 6.1.3). The box is marked "suitable for people with high blood pressure" (Coricidin has other tablets available which are unsuitable for recreational use). Furthermore, many Coricidin seem to report that frequent use leads to increasingly severe nausea triggered by taking, or even looking at, the pills. Some people have been known to puke in the drugstore from seeing the box (one user reported that 30+ people he knows suffer from this). I have no idea why this would happen. Again, remember that the antihistamine in these tablets will change the character of the DXM trip (not necessarily in a good way), potentially increasing the degree confusion. Do not use this product except at first and second plateau dosage! An overdose of antihistamine, while not typically fatal, can be extremely unpleasant and has been reported to be a frequent cause of "bad trips" from Coricidin. Most DXM users have recommended not taking more than eight Coricidin tablets; some say not to use this product at all. 4.8.4 Lozenges There are a few brands of cough drops/lozenges which contain DXM without other active ingredients. One such brand is SucretsTM (not the kind that come in the tin; these come in a bag and are labelled as containing DXM). Each lozenge contains 15mg DXM, as well as a number of inert ingredients (primarily sucrose, flavoring, coloring, magnesium silicate). Some people report the sucrets contain menthol; others don't (I suspect there may be different versions available). Other lozenges available contain from 7.5mg DXM (a South African brand) to 30mg DXM. Revco carries a DXM lozenge containing 5mg DXM each called HoldTM, which supposedly taste better than Sucrets but are fairly expensive (and contain less DXM). Since the inert ingredients present in these lozenges may cause nausea, some people have managed to get rid of most of them by placing the lozenges in a container of water and microwaving until fully dissolved, then filtering through a coffee filter, discarding the precipitate (solid), and drinking the liquid. Longer boiling seems to drive off the flavoring and menthol without affecting the DXM. Interesting side note: recently, in South Africa, cough lozenges containing an abnormally high amount of DXM were illegally diverted from disposal and resold, causing "moderately severe" toxicity in 24% of primary school pupils using these lozenges (369). 4.8.5 Pharmaceutical and Chemical Suppliers DXM is not DEA scheduled in the USA (or most other parts of the world), and consequently should be available via pharmaceutical chemical suppliers. For example, Sigma Chemical Company (1-800-325-3010) lists DXM hydrobromide (product D2531) for US $18.20 for 5 grams, US $128.45 for 50 grams. Note that I have no affiliation with Sigma in any way; I just happened to have a copy of their catalog handy when writing this. In theory, it would be fantastically cheap and easy to order DXM this way; in practice, it's possibly difficult, and probably a Very Bad Idea. First off, most chemical companies are wary about selling to individuals (and if you're not a legal adult, forget it). Secondly, there's a significant chance that your order will be reported to the DEA, and although it's not technically illegal, if enough people do this, that may change very quickly. Still, though, if you have the (possibly foolish) courage to try, there's no reason why this shouldn't be a reasonable source. Just use your head. And don't mention the FAQ. Recently, a few chemical resale companies have popped up, relying upon the fact that many potentially useful chemicals can be sold legally to researchers (for which there doesn't seem to be a legal definition). Please remember that it is your responsibility to make sure that ordering and using DXM from a chemical supplier is legal in your area. Also, to my knowledge no chemical supplier (at least, none you're likely to run across) warrants its product for human consumption. Buyer beware! Currently I know of two companies selling DXM (other than Sigma and the like, which won't sell to individuals): Chemical Resale of Santa Barbara and WANMAN Enterprises. 4.8.5.1 Chemical Resale of Santa Barbara Chemical Resale of Santa Barbara (CRSB) offers a variety of chemicals to independent researchers. CRSB explicitly forbids the use of these chemicals for pharmaceutical use, illegal drug manufacture, explosives production, or human consumption. They have a webpage at http://www.sb.net/wirehead. Orders over US$100 must be made by company or personal check; orders under US$100 may be made by money order (i.e., no paper trail). These aren't CRSB's rules of choice, they're California law, so don't complain the CRSB about it. I A short disclaimer here: I have had no dealings with CRSB, and cannot guarantee anything about them. Nobody on the Usenet drugs newsgroups who has dealt with them has ever said anything negative about them (other than their prices, which are understandable given the amount of legal paperwork CRSB evidently goes through to be able to sell to researchers not associated with established institutions). My personal belief is that they are legit, and that in the case of ordering DXM it probably doesn't matter anyway, since DXM is neither scheduled nor prescription. Just remember that this is for research purposes only. Prices on DXM HBr have been decreasing, and CRSB runs specials, so check their website for current pricing. The last time I checked, the prices were 10g for $92, 100g for $310. These prices are a bit stiff, but CRSB goes through tremendous legal hassles to make numerous useful chemicals available. All prices are US dollars. Their address: Chemical Resale of Santa Barbara 6 Harbor Way Suite #171 Santa Barbara, CA 93109-2353 Email: wirehead@sb.net WWW: http://www.sb.net/wirehead 4.8.5.2 WANMAN Enterprises Another company which offers USP grade DXM is WANMAN Enterprises. I know next to nothing about them except they gave me their address and prices for inclusion in the FAQ. Current prices are 10g for $50, 100g for $300, and 1kg for $1000 (US dollars). Orders are shipped via private carrier (UPS, FedEx, etc). They have a special of 50g for $100 to readers of the FAQ (mention you saw them there). Certified check or money order should be made out to WANMAN Enterprises. Their address: WANMAN Enterprises 7620 Vance Rd. Kernersville NC 27284 winfrey@ssasoutheast.com 4.8.5.3 Other I have also heard of a company in Texas that sells small quantities of DXM (again, for research purposes I suppose), but do not know anything else about them. 4.8.6 Extracted DXM DXM can be extracted (see Section 11) and the extracted DXM can be taken orally, either as free base or as salt (the free base should convert to the hydrochloride salt in your stomach). DXM is commercially available as the hydrobromide salt (as well as polistirex), but DXM extraction typically results in DXM citrate (see Section 11.1.3). The free base tends to be somewhat alkaline and should be avoided unless combined with food and/or juice (or other acidic beverage). When taken on a mostly empty stomach, the extract is generally (but not always) absorbed faster than cough syrups, gelcaps, or capsules. Some extraction processes may convert some or all of the DXM into dextrorphan (DXO). Extracted DXM, unlike cough syrups and gelcaps, has no bromide toxicity (see Section 4.11.7). 4.8.7 Injection and Other Routes DXM hydrobromide is reasonably soluble in saline, and I see no reason why other acid salts shouldn't be - though their long-term stability may be doubtful. However, injection is a very dangerous way of using recreational drugs, especially if the substance in question is not prepared specifically to be injected. Some of the potential risks include: sterile abscesses, torn or collapsed veins, bruising, muscle fiber damage, histamine release, infection (hepatitis B, HIV, etc.), embolism (and possible resulting stroke or cardiac arrest), increased chance of addiction, overdose, and people mistaking you for a junky. True, most of these are unlikely, and if done correctly injection is generally very safe. However, the key word is correctly. If you're still interested, consult a medical text; I'm not going to teach you how to shoot up. A few notes for those brave or stupid enough to still be interested. Intravenous (IV) and intramuscular (IM) injection both seem to produce similar results in animals, and IM injection is almost always safer. DXM can also be injected intraperitoneally (IP), but that evidently requires some skill. Subcutaneous (SC) injection ("skin popping") leads to slower absorption and a great increase in the amount of DXM relative to DXO. All injected drugs should be completely pure, dissolved in the appropriate physiological saline. In the case of SC (and possibly IM) injection, injecting too large a volume of material can lead to a sterile abscess. DXM can also theoretically be snorted although I don't generally think this is a very smart route; the nasal lining is very tender. DXM free base is probably too alkaline to try this with. It can also probably be used rectally, but somehow the thought of a cough syrup enema doesn't thrill me. Smoking DXM free base has been attempted several times by various people without much success. DXM itself seems to vaporize at a fairly high temperature, and is extremely harsh. To make matters worse, in typical DXM extractions, some of the flavoring agents end up surviving the extraction and they lend a definite unpleasant taste to the smoke. I have received one report of a successful DXM freebasing experiment. The person said that while it was nice to know it was possible, it was just too much trouble to be worth it. Another person reported making the attempt and suffering from a severe burning sensation in his lungs which ended up as an asthma attack. 4.9 What are Some Typical DXM-Containing Preparations? OK, I finally gave up on even trying to list commercial DXM preparations because there are too many (not to mention they differ from place to place even within the US). Instead, I list here the typical DXM formulas and preparations you are likely to encounter. * Pediatric Syrups (1-1.5mg/ml DXM) There are several brands and generics of "Pediatric" formulation DXM preparations. Intended for children, they contain very little DXM; on the other hand, they usually taste better. In general though it's a waste of money and time to try and use pediatric DXM formulas for recreational purposes. * Regular Strength Syrups (2mg/ml DXM) Many "regular strength" cough syrups contain 2mg/ml DXM. In the US, the most notable example is Vicks Formula 44TM (which formerly contained 3mg/ml). These are of course quite usable for recreational purposes, although 3mg/ml syrups are preferred. * "DM" Cough Syrups (2mg/ml DXM) Most of the "DM" cough syrups (of which the notable brand is Robitussin DMTM) contain 2mg/ml DXM as well as gauifenesin. During the 1980's, many of these syrups contained 3mg/ml DXM but were reduced in strength in response to recreational use. These syrups can also be used recreationally, but note that the guaifenesin can cause nausea or vomiting (see Section 4.11.3). * Maximum Strength Cough Syrups (3mg/ml DXM) The strongest syrups regularly available in the US are 3mg/ml and are typically marked "Maximum Strength Cough" (of which RobitussinTM is the most notable example). The generics are almost always called "Tussin Maximum Strength Cough". These are the most commonly used syrups for recreational purposes. * Concentrate Syrups (6mg/ml DXM) There are a very few brands of "concentrate" syrups, which are intended for institutions (or large families) who buy the concentrate and dilute it, possibly adding flavoring. The only brand I've ever heard of is PinexTM. Good luck trying to find these. * Gelcaps (30mg DXM) Drixoral Cough Liquid CapsTM are available in the US (and possibly other places), and contain 30mg DXM in a gel capsule. These are sporadically available; if you can't find them in your area, try elsewhere. * Lozenges (7.5mg - 30mg DXM) A few lozenges are available which contain DXM. In the US, the only brand I'm aware of is SucretsTM, which contain 15mg of DXM (see above notes on Section 4.8.4). Another brand containing 7.5mg DXM is available in South Africa. * Capsules and Tablets (15mg - 60mg DXM) Various capsules and tablets are available throughout the world containing only DXM (to my knowledge, none are available in the US). These range from 15mg to 60mg per pill, with 15mg and 30mg being the most common. * DXM + Chlorpheniramine Capsules (30mg DXM) Coricidin Cough and ColdTM tablets are available in the US with 30mg DXM and 4mg chlorpheniramine maleate (an antihistamine). These are suitable only for first and second plateau dosing (generally, ten pills or less) due to the adverse effects (possibly dangerous) of antihistamines at high doses. Be advised that some people react very poorly to antihistamines. On the other hand, the antihistamine evidently can prevent the dreaded "Robo Itch" (see Section 6.1.3). Coricidin has other formulas which contain undesirable or dangerous ingredients; the correct one is marked "suitable for people with high blood pressure". * Miscellaneous I have heard rumors of DXM available on the street in 240mg, 300mg, and 600mg doses, but I cannot verify these rumors. The "DXM" may actually be PCP, ketamine, or anything for that matter (but is probably just extracted or purchaed DXM). "Agent Lemon" (see Section 11.1.3) has also been made available in some locations. Again, be advised that you are relying upon someone else's chemistry skills. 4.10 How am I Supposed to Drink Cough Syrup? Good question. Part of the reason DXM isn't terribly popular is that drinking cough syrup is, well, disgusting. However, here is a suggested method courtesy of "JR": Materials: * 2 glasses * A sink with COLD water * cough syrup * toothpaste Procedure: 1. Fill one glass with water, the other with Robo. Keep the water running (it makes the sensation less gross for some reason). Do not allow Robo to be smelled under any circumstances! 2. Pinch nose shut with one hand 3. Sip water 4. Take 5-6 deep hyperventilative breaths 5. Slam the entire 8oz bottle of Robo at one time. 6. While still holding nose, drink remainder of water 7. Refill glass with water and drink the entire glass of water. 8. Repeat again, for a third glass of water. 9. Still holding your nose, spread toothpaste in your mouth, thoroughly coating the inside of your mouth. 10. Release your nose, and exhale through both nose and mouth. Minty fresh! 4.11 What Should I Know About Other Drug Ingredients? There are five main classes of active ingredients that are present in OTC DXM-containing products: decongestants, antihistamines, guaifenesin, analgesics, and alcohol. Each will be discussed in turn, followed by "inactive" ingredients. With the possible exception of alcohol, all should be avoided, although for differing reasons. Some of these other active ingredients will make your experience unpleasant; others can kill you. Additionally, some of the dyes and other "inactive" ingredients may cause some people trouble. 4.11.1 Decongestants There are three nasal decongestants that are used in OTC cough formulas in the USA: PPA, pseudoephedrine, and phenyleprine (the latter is almost always found with antihistamines). PPA is also known as phenylpropanolamine (from which the acronym PPA is derived), norephedrine, and the IUPAC name [alpha-(1-aminoethyl)benzyl alcohol]. Pseudoephedrine, known as the brand name SudafedTM, has the IUPAC name [(+)alpha-(1-methylamino)benzyl alcohol]. Phenyleprine is [(-)-3-hydroxy-alpha-(methylaminomethyl)benzyl alcohol] (1-2). These decongestants belong to a class of chemicals known as the phenethylamines; this class also includes methamphetamine, MDMA (ecstasy), MDA, etc., and tend to be DEA scheduled. Decongestants are not scheduled by the DEA (this is USA laws) because they do not have significant psychostimulant activity. Ephedrine, which is similar to pseudoephedrine, and is (or was, depending on your state) available throughout truck stops and mail-order pharmaceutical companies in the USA, does have mild stimulant properties; thus its popularity as a form of "legal speed". All of these drugs stimulate the sympathetic nervous system (the "fight or flight" system) and are thus called sympathomimetics. What nasal decongestants do share with the more potent amphetamines is the peripheral activity common to sympathomimetics, such as vasoconstriction (constriction of blood vessels) and decreased nasal secretions (the good side), and - with larger doses - insomnia, hypertension, heart rhythm abnormalities, hemorrhaging, stroke, or death (the bad side) (8). Note that these are extreme reactions, and that individual tolerance to sympathomimetics tends to vary considerably. Tolerance can build quickly, and a fatal dose for one person may have only a mild effect on another person. Because of the potential danger of hypertension, exceeding the recommended dose of DXM and decongestant containing preparations may be asking for trouble. Most people can probably handle it in smaller recreational doses, but the peripheral "speediness" can be distinctly unpleasant. Anyone with high blood pressure or the like has no business taking large quantities of decongestants. Finally, more recent research suggests that many of DXM's potentially disturbing side effects (see Section 6) might be potentiated by any stimulant. Panic attacks, hyperthermia, hypertensive crisis, and the like are notable examples. In extreme cases, stroke or brain hemorrhage may be possible. Conclusion: Possibly suitable for first plateau use only; otherwise avoid these drugs! 4.11.2 Antihistamines The antihistamines operate by blocking histamine receptors (see Section 10.1 for an explanation of receptors). Peripherally, this has the effect of reducing the symptoms of histamine activity (stuffy and runny nose, itchy eyes, hives, rashes, etc.) associated with infections and allergies. In the brain, histamine is partially responsible for wakefulness, and antihistamines that cross the blood-brain barrier will cause sleepiness. In fact, most OTC "sleeping pills" in the USA are really just antihistamines (although melatonin is making inroads as an alternative). There are antihistamines that do not cross the blood-brain barrier (e.g., SeldaneTM) but these are prescription in the USA. High doses of antihistamines can result in dizziness, impairment of concentration, extreme sedation (or, paradoxically, insomnia), headache, heart palpitations, dry mouth, gastric discomfort, delusions, and abnormally high blood pressure. Doses of 30-60mg/kg have been fatal in very young children; most adults, however, are very unlikely to overdose on antihistamines. Death, when it does occur, is from cardiovascular collapse or respiratory arrest (8). High doses of prescription antihistamines are much more dangerous; do not mix DXM with prescription antihistamines! The danger of an antihistamine overdose is very low when using a DXM-containing product recreationally. However, you will most likely experience some unpleasant symptoms, such as sleepiness, dry mouth, heart palpitations, etc. These side effects increase as the dosage increases. A very small amount of antihistamines might be useful in preventing DXM-induced histamine release. Conclusion: Traditional antihistamines may be suitable for first and second plateau dosage levels, but should not be used at the upper plateaus. NEVER use DXM with prescription, non-drowsy antihistamines! 4.11.3 Guaifenesin Guaifenesin (gwye-FEN-a-sin) [3-(2-methoxyphenoxy)-1,2-propanediol] is an expectorant; it increases the production of respiratory tract fluids, thus making phlegm less viscous and easier to cough up. Guaifenesin has been shown effective as an expectorant, but is of no use as a cough suppressant. It is often combined with dextromethorphan. Guaifenesin should not be used for chronic coughs or coughs accompanied by excessive phlegm (1-2). High doses of guaifenesin tend to induce emesis (i.e., you puke). Other effects from high guaifenesin doses are not well known, but probably not serious. Some suggest that guaifenesin may act as a muscle relaxant at high doses (an effect for which it is used in veterinary medicine). Conclusion: as most people do not enjoy vomiting, I would recommend avoiding guaifenesin-containing products. 4.11.4 Analgesics, Acetaminophen/Paracetamol Acetaminophen, also known as paracetamol and APAP, is the most common analgesic (painkiller) present in cough suppressant formulas. It is closely related to the NSAIDs (non-steroidal anti-inflammatory drugs) of which aspirin and ibuprofen are the two most common examples. Unlike the OTC NSAIDs, however, acetaminophen/paracetamol does not tend to irritate the stomach, and thus its inclusion in cough syrups. An acetaminophen overdose is very dangerous. Normally, acetaminophen is metabolized (broken down) in the body by two separate pathways, both of which lead to harmless metabolites. However, these two pathways can only handle so much before saturating. At that point, the remaining acetaminophen is metabolized by a cytochrome P450 liver enzyme. The metabolite via the P450 pathway is toxic to the liver (2,8). Furthermore, this doesn't happen right away; it can take 16 hours before any signs of liver damage show up. This delayed toxic effect has been responsible for the rather painful deaths of some people who (accidentally or not) overdose on acetaminophen, and then think they are fine when no immediate problems occur. There is an antidote (acetylcystine), but it must be administered within the first 12 to 16 hours. The toxic dose of acetaminophen can be as low as 50mg/kg; for a 60kg person this is only six acetaminophen tablets. This is unlikely but possible. DO NOT UNDER ANY CIRCUMSTANCES USE RECREATIONALLY ANY DXM PRODUCT WHICH ALSO CONTAINS ACETAMINOPHEN / PARACETAMOL! As for aspirin and ibuprofen, the other two most common OTC painkillers, both tend to irritate the stomach at high doses. I recommend against them, especially if you have an irritable stomach. Never take large doses of aspirin or ibuprofen if you have an ulcer. Conclusion: avoid any product containing an analgeisc. 4.11.5 Alcohol Most cough syrups contain some alcohol, to help dissolve the DXM (and other drugs) and to numb the throat. With a few exceptions (such as NyquilTM), the amount of alcohol is not usually very great. While alcohol does not, in general, mix well with DXM as a recreational drug, the amount in cough syrups should not cause trouble unless you are specifically sensitive to, or attempting to avoid, alcohol. There are alcohol-free preparations available; gelcaps and tablets are alcohol-free. 4.11.6 Food Coloring and Dyes Some of the dyes used in cough formulas may give some people allergic reactions. Most notable among these is tartrazine (FD&C Yellow #5). Generally, these dyes are not a problem unless you take a lot of them (which recreational DXM use may involve). If you think you may be allergic to a dye, switch to a different brand (or more accurately, a different color). It is also a good idea to keep an antihistamine (not a prescription or non-drowsy one!) nearby in case an allergic reaction does occur. 4.11.7 Bromide Ions DXM is usually ingested as a hydrobromide salt. Large amounts of bromide ions can cause sedation and eventually lead to bromism (bromide poisoning), which affects (among other things) the skin and nervous system (see Section 6.3.15. I don't think this is terribly relevant for users of DXM (recreational or not); however it is one more reason to avoid prolonged high-dose use. You can avoid bromide ions by converting the DXM to free base and/or hydrochloride salt (see Section 11.1). Some physicians do believe that prolonged heavy use of DXM may lead to bromism (144). 4.11.8 Other "Inactive" Ingredients Cough syrups tend to contain several thickening and sweetening agents. Glucose, sucrose, invert sugar, and fructose are all commonly used as sweetening agents. Obviously, a person with blood sugar problems (diabetes or hypoglycemia) should not take large amounts of these syrups. "Diabetic" syrups are available. Thickening agents don't generally cause problems other than nausea. Occasionally people will look on cough syrup labels and see propylene glycol or polyethylene glycol, and (thinking about ethylene glycol, i.e., antifreeze) worry about toxicity. Propylene glycol is not toxic, even though ethylene glycol is. The same goes for polyethylene glycol (PEG) - it's also nontoxic. About the worst you will get from any of these is an upset stomach. One general note - keep in mind that your body does eventually have to use or excrete whatever you eat and drink. Drinking huge amounts of sugars and thickening agents can put a fair amount of load on the pancreas and kidneys and should definitely be avoided if you have kidney problems already. There is anecdotal evidence that regular high-dose use of DXM cough syrups (without eating much) has led to kidney damage due to the glucose load (though I suspect rhabdoymolysis may be the cause -- see Section 6.2.7. I cannot confirm this but I can't disprove it either. I've also heard of people having blood sugar problems after repeated use of DXM cough syrups, but again I can't verify this. 4.12 Why are So Many DXM Preparations in Liquid Form? Cough preparations are in liquid form for two reasons. First and foremost, most people have the (mistaken) belief that in order for a cough suppressant formula to work, it must coat the throat. While this may be true for local anaesthetics, in the case of DXM (or codeine for that matter), it's complete bunk. If consumers were a bit smarter, maybe we wouldn't have to gag down cough syrup. There are, in fact, gel-capsule cough suppressants on the market, and I expect that tablet or capsule dextromethorphan will eventually be more common. Second, tablet-form DXM preparations have been kept from the market in an attempt to prevent their recreational use. RomilarTM tablets used to be available in the US, but were removed from the market due to concerns about their abuse. Other DXM formulas have been reduced in strength, or combined with other ingredients, in an attempt to prevent or reduce recreational use potential. 4.13 Is Recreational Use of DXM Illegal? Possibly. There may be laws making it a crime to use OTC medicines in any way other than directed on the label. Not that this stops people from using ephedrine (a bronchodilator) as a stimulant. Nor are you likely to get caught and/or prosecuted; the authorities are much too busy infringing upon our civil rights looking for the illegal drugs. But, remember - I SPECIFICALLY instruct you NOT to use any medicine in a manner inconsistent with its labeling. Furthermore, suggesting to someone that they use DXM as a recreational drug could also be violating a law - against prescribing drugs as a layperson. Again, it's not likely to happen, but it is possible. DXM is a prescription drug in Sweden (9). It is prescription and scheduled in Australia unless combined with other active ingredients. It may become prescription in other countries. In drug stores in some areas it is kept behind the counter, must be requested, and is only sold to adults. 4.14 If DXM is Legal Why Isn't Everyone Doing It? A lot of reasons, actually. Beyond the obvious one that not everyone knows about it are a number of reasons which may be more relevant. First and foremost, DXM doesn't appeal to everyone; in fact, it seems to follow a "rule of thirds". One third of people who try DXM like it, one third hate it, and one third could care less. Secondly, doing DXM is either disgusting or a time-consuming process for most people. Cough syrup tastes bad, and is unpleasant to drink; even the gelcaps become unpleasant to take after a few times due to their rather large size. DXM can of course be extracted, but it is a time-consuming process that requires enough effort to discourage those only casually interested. Third, DXM is to a certain extent "anti-addictive", at least when used occasionally. Because DXM blocks NMDA receptors (see Section 9 and Section 10.3), it prevents associating any pleasant effects of the drug with the taking of the drug. Instead, the memories of taking the drug are associated with sensations before the DXM kicks in, e.g., nausea. Fourth, DXM trips can be extremely confusing, especially if the user doesn't have experience with psychedelics. The DXM trip is so unlike an LSD or mushroom trip that people who take it expecting the latter are often discouraged and do not repeat the experience. Finally, DXM has a reputation as a "loser drug", something people take when nothing else is available. While it's true that DXM is legal, and thus can in fact be taken when nothing else is available, this doesn't make it any less powerful (or any safer) than illegal drugs. 4.15 New Medical Uses for DXM In the past five years, research, especially research centered on NMDA receptors, has uncovered more and more medical uses for DXM. Some of these include: 4.15.1 Diagnostic Uses Cytochrome P450-2D6, also known as CYP2D6 or debrisoquine hydroxylase, is a liver enyme which is extensively involved in metabolizing drugs. Many drugs are metabolized by P450-2D6, and many drugs also inhibit it. Some people are genetically lacking in the normal P450-2D6 variant, and physicians will use DXM to determine which variant of P450-2D6 a patient has (10-11). About 5-10% of Caucasians and 0.5% of Asians seem to lack P450-2D6 entirely, or have a very inactive mutation (12-15). In remaining individuals, its activity can vary significantly due to genetic factors (15-18). Between 0.5% and 2% of the population has multiple copies of the P450-2D6 gene and will metabolize 2D6-dependent drugs much more quickly than most people (155). Since many drugs become toxic at high doses, it is important to give the proper amount to those people who will metabolize it differently than the normal population. DXM is used to test metabolism by CYP2D6. The patient is given a specific amount of DXM, and then the relative concentrations of DXM and its metabolites are determined. Some recent research suggests that susceptibility to lung cancer may be related to P450 variant, and DXM may be an effective diagnostic tool for predicting lung cancer susceptibility (376). 4.15.2 Neuroprotectant Uses One area in which DXM (as well as other NMDA blockers; see Section 10.3) shows great promise is in the prevention of brain damage resulting from excitotoxicity (over-stimulation of nerve cells to the point of cell death) and other types of nerve cell damage (19). DXM may reduce or eliminate the brain damage resulting from conditions such as fever, hypoxia (lack of oxygen) (20), ischemia (cutoff of blood to brain cells) (21-22), physical injury (23), infection (such as poliomyelitis, encephalitis, and meningitis), stroke, seizure, drug toxicity (24-25), electrical shock (231), hypoglycaemia (243), and withdrawal from long-term dependence upon certain drugs (notably alcohol, barbiturates, and benzodiazepines such as ValiumTM) (26-29). In the case of infection (and in particular poliomyelitis), it has been demonstrated that the damage to the CNS often occurs not from the infection, but from the body's own defenses, and notably from a chemical called quinolinic acid (a metabolite of tryptophan) (30,31). Quinolinic acid is a very potent agonist (activator) at excitatory amino acid receptors, of which NMDA is one type; DXM prevents quinolinic acid from activating NMDA receptors. (Incidentally, the function of quinolinic acid - if it has any - is not currently known; it may be involved in the immune response). As for physical trauma, hypoxia, seizure, stroke, etc., there are several experiments which indicate that the majority of the damage again comes from excitotoxicity at excitatory amino acid receptors. While DXM has shown somewhat less success there (possibly due to other factors being involved), it still has potential. DXM is currently being evaluated as an anticonvulsant (32,33). The animal data are somewhat conflicting, but the most accurate model of epileptic seizures (called kindling) responds well to DXM. Preliminary studies in humans indicates that even very low levels of DXM may help prevent seizures. This effect is not, as was originally thought, due to NMDA receptors; instead, it is probably due to sigma receptors or voltage-gated ion channels (32). Interestingly, DXM produces different side-effects in kindled (seizure-susceptible) animals than in non-kindled animals (this may be due to uncoupling of NMDA receptors). It is possible that humans susceptible to seizure may experience different effects from recreational DXM use. 4.15.3 DXM for Chronic Pain DXM seems to enhance the painkilling ability of opiates without adding to the side effects, and in practice the patient can lower the dose of opiates while maintaining analgesic effect (37). As an added bonus, DXM seems to prevent opiate tolerance (see next section). DXM by itself has only marginal analgesic effect if any (373,375). 4.15.4 DXM for Drug Addiction DXM, as well as other dissociatives, seems to prevent and even reverse tolerance to (and thus physical addiction to) many drugs. In the case of opiates, DXM has been used to treat withdrawal symptoms (169). DXM plus diazepam (ValiumTM) was tested and found to be more effective at combating the symptoms of heroin withdrawal (goose flesh, tremors, pupil dilation, joint pains, etc.) than chlorpromazine (ThorazineTM) plus diazepam (34). A further study verified this and found that adding tizanidine (an alpha-2 adrenergic agonist) to the DXM+diazepam cocktail was even more effective (133). Dissociatives have also been found to reverse or prevent tolerance to cocaine (247), nicotine (249), and alcohol (232), and some researchers have suggested that DXM (and other NMDA antagonists) may be universally useful in most if not all drug addictions. 4.15.5 DXM for Disease and Miscellaneous Conditions DXM is being investigated as a treatment for various diseases due mostly to its NMDA antagonist effects. The most promising results have been in treating shingles, a disease which primarily affects the elderly wherein a dormant viral infection flares up and attacks peripheral nerves. DXM can block the (often excruciating) pain from this flareup, and may prevent peripheral nerve damage (370). It may also be effective at treating herpes pain (368). Some chronic neurodegenerative diseases may be treatable with DXM. Notable among these include ALS (Lou Gehrig's Disease) (168), although more recent research seems to show that DXM may not be a useful treatment for ALS (363). Even "Mad Cow" disease (and other prion diseases) may respond to treatment with DXM (362). DXM has also been used to treat mental retardation (35), and Parkinson's disease (36). DXM may even have be useful in treating lung and other cancers (38) and preventing tissue rejection in transplants (263) due to the (poorly understood) effects of sigma ligands on tumor cells and the immune system (see Section 10.2). Some papers have suggested that dissociatives have antidepressant effects (208,212,223,245,250), while others dispute this (225,229). Finally, the dissociative qualities of DXM may be of use; ketamine has been used to calm children in order to perform genital exam in cases of suspected sexual abuse (184-186). 4.16 Drug Interactions Please read through this section if you are taking (or have or will be taking) other drugs in addition to DXM. 4.16.1 Fatal or Dangerous Interactions DXM should not be used (either recreationally or at normal dosage levels) by people who are taking a monoamine oxidase inhibitor (MAOI, rhymes with "wowee") - either a prescription MAOI or a recreational one such as harmaline. Note that there is considerable confusion among drug users about what is and isn't a MAOI. MAOIs include a few drugs prescribed for depression and Parkinson's disease, and a few rare recreational drugs derived from exotic plant sources (harmine and harmaline, from Syrian Rue and Yagé, for example). ProzacTM, MDMA, cheese, beer, SeldaneTM, etc., are not MAOIs - they are things to avoid when taking a MAOI. If you are taking a prescription MAOI you will almost certainly know, as your physician will have (hopefully!) told you to avoid eating aged cheeses. Combining DXM and a MAOI has been fatal (3)! Fluoxetine (ProzacTM) is a cytochrome P450-2D6 inhibitor (39) and will change the characteristics of a DXM trip somewhat, increasing the ratio of DXM to DXO. Other P450-2D6 inhibiting drugs, which include many antidepressants, will probably do the same; see Section 15.1. The duration of the trip may be greatly extended by P450-2D6 inhibitors; some users have reported effects lasting 12 to 24 hours past the normal duration. The potency of DXM may also be enhanced via other mechanisms by fluoxetine (40). Combining DXM with the antidepressants Desyrel (trazodone) or Serzone (nefazodone) has been reported to cause liver damage! One user reported that combining DXM with bupropion (Wellbutrin[tm]) resulted in a prolonged (3+ day) hangover and an increase in adverse side effects. Fluoxetine and other SSRI antidepressants, as well as tricyclics and lithium (and of course MAOIs) may interact with DXM to cause serotonin syndrome (see Section 6.2.9). This condition, although rarely fatal, is not terribly pleasant. Vascular disease may increase the chance for serotonin syndrome with DXM + antidepressants (364), and other disease conditions may do so as well. Some DXM users who have taken DXM while on antidepressants have reported unpleasant reactions that sound a lot like serotonin syndrome, so you might want to watch out. Some of the symptoms of serotonin syndrome include muscle rigidity, confusion, diarrhea, incoordination, low-grade fever, sweating, muscle tremor, mania, agitation, exaggerated reflexes, and nausea. Do not take DXM with the diet drugs phentermine, fenfluramine, or phen-fen; this combination can also cause serotonin syndrome. DXM should not be taken (recreationally or at normal dosage levels) with the prescription antihistamine terfenadine (SeldaneTM). This combination has been fatal (41). Terfenadine has been implicated in other drug interactions, incidentally. The reason for this interaction seems to be that terfenadine, which is normally metabolized by a P450 enzyme, induces heart irregularities when it builds up. DXM may saturate the P450 enzymes that normally metabolize terfenadine. Incidentally, this probably applies to other non-drowsy antihistamines, such as ClaritinTM and HisminalTM as well; avoid combining them with DXM. Some people find that nicotine (cigarettes) causes severe nausea when combined with DXM. Others have noticed a general increase in physical discomfort and "bad trips" from combining the two. Some research has suggested that cigarette smoke inhibits monoamine oxidase (378,379) in which case cigarettes could greatly increase the chance of unpleasant side effects. 4.16.2 Beneficial Drug Interactions Both opiates and dissociatives have strong side effects which can limit their usefulness in pain treatment. When the two are combined, however, a synergistic effect occurs, and patients can lower the dose of both drugs to the point where side effects are minimalized (236,267,278). Dissociatives prevent tolerance to opiates (248) and can alleviate opiate withdrawal (254). On the other hand, combining the two may increase the chance for respiratory depression and fatal overdose. 4.16.3 Recreational Drug Interactions Marijauna and DXM is a frequently used combination, albeit one which has seen little research. Competitive NMDA blockade enhances marijuana catalepsy (210), and conceivably noncompetitive blockade would as well. Dizocilpine, a dissociative used in research, decreases the analgesic effects of marijuana (214), and causes downregulation of anandamide receptors (THC receptors) (218). Dissociatives may block the depletion of 5HT (serotonin) caused by MDMA (ecstasy) (241). However, there is also the potential for hypertensive problems, so I wouldn't advise this combination. Methamphetamine produces vacuolation of neuron terminals due to a collapsed vesicular proton gradient (181) (translated into English, this means that speed damages brain cells by breaking open the little bubbles of neurotransmitters inside the cells). However, dizocilpine (and presumably other dissociatives) may prevent this (219). It also seems to block methamphetamine induced 5HT depletion (241). Antidepressants and dissociatives seem to interact as well, not necessarily in a good way. Both desipramine and dissociatives increase prefrontal lobe dopamine activity; the combination is highly synergistic (277). Even worse, dissociatives may actually reverse the antidepressant effect (229). Dizocilpine reduces 5HT2 receptor density (212), and increases 5HT binding in the hippocampus and striatum (252). On the other hand, one paper found that dizocilpine helped antidepressants in some tests (245,250). Finally, dissociatives block tolerance to many drugs, including alcohol (232), cocaine (247), nicotine (249), and morphine (248). 4.17 General Warnings Probably the most important warning about DXM is that, like other dissociatives, it may cause brain damage when used to excess (see Section 6.3.1. What exactly constitutes "excess" is anyone's guess, although in animal models, Olney's lesions (the type of brain damage caused by dissociatives) only occur at many times the anaesthetic dose, which is itself higher than the recreational dose. Of the people I've interviewed who have used DXM regularly, about 1% have reported long-term cognitive impairment (although some of these people were continuing to use DXM when they reported it, so it may have been due to chronic intoxication rather than any permanent damage). Everyone who did report impairment were very heavy users, i.e., * 720mg or more (upper plateau doses) * twice per week or more often * extended use over at least one year On the other hand, many people seem to be able to use DXM very heavily for years without adverse effects, though. So in any case, be careful!. Like other psychoactive drugs, DXM should not be used by people who are mentally or emotionally unstable. I tend to believe that NO recreational drug (legal or not) should be used unless the user is in a calm, rational mood, free from anxiety or negative emotions, and is in a controlled setting where s/he will not have to drive. Speaking of which, as DXM is an intoxicating drug, don't drive under the influence. Ever. But I shouldn't have to tell you that, right? High doses of DXM can be very dissociative. While this is not necessarily bad, you should know what you are getting into first. A high-dose DXM trip is not like an LSD trip; it more closely resembles ketamine. You will most likely encounter experiences that you didn't expect, and possibly didn't want. While this is OK for the more committed psychonaut, casual users of hallucinogens might want to think twice before taking a high dose. Prolonged use of DXM, or extended doses of DXM (including the polistirex formulation), may cause problems due to the buildup of DXM (as opposed to DXO), and the resulting activity at sigma receptors (see Section 10.2). Sigma receptors seem to have a potent modulatory role on neurons, possibly inducing permanent or semi-permanent changes when they are activated for long periods of time (most studies so far indicate over 3 days of high DXM concentrations are required before such changes occur). Furthermore, sigma activity seems to be correlated with delusional thinking, which should probably be avoided, especially in the inexperienced. Some people are allergic to tartrazine (FD&C Yellow #5), which is present in several cough syrups. Sensitivity to tartrazine is rare, but is frequent in people sensitive to aspirin. Avoid tartrazine if you are, or think you might be, allergic to it or to aspirin. Note that, based on anecdotal evidence, I believe that sensitivity to other dyes may develop from chronic use. The large amount of glycerine, glucose syrup, and sugars present in cough syrups can give some people problems ranging from stomach ache to sugar shock. Obviously anyone with diabetes or a family history of blood sugar problems should avoid cough syrups. 4.18 What About Other Cough Suppressants? There are other cough suppressants available, of course, but none of them are likely to take the place of DXM. 4.18.1 Noscapine Noscapine is a natural ingredient in opium, and is related to papaverine. It doesn't seem to have any opiate-like effects (other than cough suppression) and is not constipating. It may be a NMDA/sigma ligand like DXM. Adverse effects and effects of overdose include drowsiness, dizziness, headache, nausea, allergic rhinitis, conjunctivitis, and skin rashes. I have no idea whether it has recreational effects at high doses, but I wouldn't advise finding out. Oral adult dose is 25mg-50mg 3-4 times daily. 4.18.2 Opiates Opiates are of course still used as cough suppressants; the most common is codeine, which is still used for severe coughs (although some research suggests it is no better than DXM). Other opiates have been used for severe cough. As an interesting bit of trivia, heroin was first marketed for cough suppression. The recreational effects of opiates are fairly well known, and are in any case beyond the scope of the DXM FAQ. 4.18.3 Topical Anaesthetics A variety of substances have been used as topical anaesthetics to numb the throat, including phenol and methol. These have no recreational use potential (and in general are highly toxic in overdoses). 4.18.4 Can DXM be Detected on Drug Tests? As DXM itself, probably not; nobody bothers to look for it. There has been some anecdotal evidence that DXM can cause false positives for opiate tests, but one paper (374) disputes this. There may be more reliable evidence that DXM can cause false positives for PCP and possibly cocaine. So keep this in mind before using DXM if you have to take a drug test. If worse comes to worse, you can always claim you had a bad cold, and ask them to do a test which will discriminate between opiates and DXM. Good luck! 5 The DXM Experience This section discusses some of the effects you might expect to feel if you were to use DXM recreationally (which I recommend against, of course). The effects listed are generally positive, and reflect the results of people who have positive experiences with DXM. Some people have negative experiences with DXM! For these people, the DXM "trip" may just be several hours of dizziness, nausea, hot flashes, and confusion, with several days of hangover. This is the main reason why most DXM users suggest starting with a first plateau dose. ------------------------------------------------------------------------ 5.1 What is the General Character of the DXM Experience? This is a difficult question to answer, because DXM's effects tend to vary widely depending on the person, their set and setting, other drugs, their physiology, and so on. DXM, probably more than most drugs, tends to exert its (recreational) effects in separate stages or "plateaus", rather than being linearly dose-dependent. Within a given plateau, a given set of effects will occur (at a roughly dose-dependent strength). On the other hand, once the next plateau is reached, the feeling may change entirely. A reasonable analogy is water - it exists in three states (solid, liquid, and gas) which all can exist at varying temperatures (e.g., hot water and cold water), but which have different characteristics. DXM and its metabolite, dextrorphan (DXO), produce different sets of effects. Normally, DXM is converted mostly or entirely into DXO, but with recreational doses, the conversion enzyme (P450-2D6) may saturate, leaving a mixture of DXM and DXO. Furthermore, another of DXM's metabolites - 3-methoxymorphinan - can also block this enzyme, so that taking divided doses leads to more DXM and less DXO than taking a combined dose of the same amount. DXM's effects are in some ways much more subtle than DXO's. Whereas DXO produces a heavy "stoning" or intoxicating effect, DXM by itself is only lightly intoxicating. DXM, however, can alter the thought processes, leading to highly abnormal, psychosis-like mental states. It is possible that DXM, via sigma activation, may induce a mental state similar to that of schizophrenia. Whether or not this is fun to you is, of course, up to you. DXM seems to exhibit at least four definable plateaus based solely on dosage, and an additional plateau is notable from a specific dosing regimen (see below, Section 5.9). I previously listed three plateaus; then four; now I'm listing five (although "Plateau Sigma" doesn't occur at dosages higher than the fourth plateau). Evidently, dosages above the fourth plateau lead to full anaesthesia, psychosis, coma, and/or death. Not everyone notes distinction between the first and second plateaus, or between the third and fourth plateaus. Others suggest that each effect of DXM has a dosage level at which it starts, and (in some cases) a dosage level at which its effects are no longer noticeable (being overpowered by other effects). Some people will disagree with this classification method, but I think this is the best way to represent DXM's effects. Both the third and fourth plateaus have significant dissociative characteristics, much like ketamine. The most important thing to keep in mind is that the effects in different plateaus are often very different. For example, on the first plateau, DXM tends to have a stimulant effect. Upon reaching the second plateau, however, the stimulant effect may no longer be present. The beginning of the comedown off of a DXM trip can come abruptly. Often, the user will know when it's starting to end by noticing the return of normal sensory processing. Coming down from there may take a significant amount of time. A second DXM trip too soon after coming down is not a good idea due to the potential for side effects and psychotic episodes (227). Wait at least three days and preferrably two weeks between each DXM trip. The following table can be used as a general guideline for the plateaus. For convenience I give example dosages in gelcaps and 3mg/ml syrup for 75kg and 150lb adults; adjust up or down by the amounts indicated per 10kg or 25lb. Calculating with the mg/kg is more accurate, but it's easy to make mistakes when using non-metric measures. These dosages are as DXM hydrobromide. Dosage will vary considerably from person to person, by as much as 5 times! Also, these mg/kg figures should evidently be adjusted down for higher mass (e.g., maybe 6mg/kg to 13mg/kg third plateau for a 150kg adult). Note that kg = pounds * 0.45. I have included a new category in this table: "Usenet Suggestions". This is a combination of suggested dosage guidelines from Usenet, and may more accurately represent the plateau dosage of DXM in regular users (the original plateau levels were based mostly on occasional users). Table 1: DXM Plateaus and Dosages Plateau First Second Third Fourth Dosage Range (mg/kg) 1.5-2.5 mg/kg 2.5-7.5 mg/kg 7.5-15 mg/kg >15mg/kg Usenet Suggestions (mg/kg) 2.7 mg/kg 6.4 mg/kg 9.4 mg/kg 18mg/kg Gelcaps (30mg) for 4 to 6 6 to 18 18 to 37 75kg adult gelcaps gelcaps gelcaps >37 gelcaps Adjust per 10kg 1/2 to 1 1 to 2.5 2.5 to 5 5 gelcaps gelcap gelcaps gelcaps Gelcaps (30mg) for 3 to 5 5 to 17 17 to 34 150lb adult gelcaps gelcaps gelcaps >34 gelcaps Adjust per 25lb 1/2 to 1 1 to 2.5 2.5 to 5.5 5.5 gelcaps gelcaps gelcaps gelcaps Syrup (3mg/ml) for 75kg adult 37 to 62 ml 62 to 187 ml 187 to 375 ml >375 ml Adjust per 10kg 5 to 8 ml 8 to 25 ml 25 to 50 ml 50 ml Syrup (3mg/ml) for 2 tbsp to 2 2 oz to 5.5 5.5 oz to 11 150lb adult oz (1/4 cup) oz (2/3 cup) oz (1 1/3 cup) >11oz Adjust per 25lb 1 tsp to 2 2 tsp to 1 oz 2 tbsp to 2oz 2 oz tsp (1/8 cup) (1/4 cup) The specific effects at each plateau will be listed according to the following categories: Sensory, Cognitive/Emotional, Motor, and Memory. Additionally, the lower two plateaus are considered together, as are the upper two plateaus. ------------------------------------------------------------------------ 5.2 Overview of the Lower Plateaus The four dosage plateaus can be divided into two groups based on a certain degree of similarity: the lower plateaus and the upper plateaus. The lower two plateaus share many features and some of these will be considered here. A generalization would be that the lower two plateaus are more "recreational" than the upper plateaus. Specifically, they have considerably less hangover, do not generally involve serious disruption or breakdown of sensory processing, and are more similar to other intoxicants. DXM in the lower two plateaus has been compared to a cross between MDA and alcohol. It tends to intensify emotional responses and feelings of meaning from external events. At the lower plateaus there is usually enough motor control to be able t