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.

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