DXM

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DXM is dextromethorphan. It is commonly found in OTC cough suppressants and sometimes used as an adulterant in "ecstasy" pills. Dextromethorphan is classified as a dissociative hallucinogenic drug, with visible effects that are similar to those of ketamine and phencyclidine (PCP)

From [BL FAQ] By Grugz with modifications to conform to Proposed Layouts

Contents

The Basics

Uses for drug

Dextromethorphan is a semisynthetic opiate derivative which is legally available over-the-counter in most countries in cough suppressants. The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), as well as those resulting from inhaled irritants.

At doses higher than medically recommended, DXM becomes a dissociative hallucinogenic drug, with visible effects that are similar to those of ketamine and phencyclidine (PCP), DXM can produce a disconnected, dreamlike trip. DXM is a dissociative, creating a sensation of separation from the body. It can also cause visual and auditory hallucinations, an elevated mood and an increased sensitivity to stimuli.

The effects of DXM are made more attractive to some people because in most countries, DXM is legal and can be bought over-the-counter.

DXM can sometimes be a adulterant in Esctasy tablets

Dosages

As with many psychoactive substances, dosages of DXM vary greatly, depending on the individual and the desired level of effects. Recreational doses range from 100 mg to 1200 mg or more.

  • DXM takes 20 minutes to 1 hour to take effect, with higher doses generally taking longer. Peak effects of recreational doses begin 1 1/2 to 3 hours after onset.
  • Effects of low doses generally last 4-6 hours, with large doses lasting 6 hours or more.

Effects

First plateau: At a dosage of 1.5 to 2.5mg/kg, effects include alertness, restlessness, increased heartbeat, increased body temperature, intensification of emotions, euphoria, loss of balance, and slight intoxication.

Second plateau: At 2.5 to 7.5mg/kg, effects are similar to the first plateau, but with heavier intoxication, choppy sensory input, a dreamlike state of consciousness, some detachment from outside world, and closed-eye hallucinations.

Third plateau: At 7.5 to 15.0mg/kg, effects include flanging of visual effects, difficulty recognizing people or objects, chaotic blindness, dreamlike vision, inability to comprehend language, abstract hallucinations, delayed reaction time, decision making impairment, feelings of peace and quiet, near complete loss of motor coordination, short-term memory impairment, and/or feelings of rebirth.

Fourth plateau: At 15.0mg/kg or more, an individual may experience a perceived loss of contact and control with their own body, changes in visual perception, out-of-body experiences, perceptions of contact with "superior" beings, other miscellaneous delusions, lack of movement or desire to move, rapid heart rate, complete blindness, increased hearing, and intensification of third plateau effects.

Plateau Sigma: 2.5-7.5mg/kg every three hours for 9–12 hours; occurs by prolonging dosage. Plateau sigma is marked by the presence of psychosis with visual and auditory hallucinations. Users have reported that inclinations manifest as auditory hallucinations; rather than simply feeling tired and sitting down, a user might hear a voice saying, "sit down now, you're tired," and feel inclined to obey. White says that of all the reports of Plateau Sigma experiences he received, over half were described as unpleasant.


Why is DXM sold as MDMA?

DXM is sometimes sold as MDMA for several reasons:

  • DXM is legal, inexpensive, and widely available. In most countries, DXM is available over the counter. The methods used to extract DXM from a source are not nearly as difficult or dangerous as the methods used to produce MDMA. Moreover, MDMA manufacture/possession is entirely illegal, and many of its precursors are very difficult to obtain.
  • At low doses, DXM can cause effects that a user unfimilar to MDMA may deem to be MDMA-like, resulting in them believing that they bought a good pill. In particular, the increased sensitivity to touch, etc. and mild visual hallucinations may cause a user to believe that they bought a good pill, and perhaps take more pills in order to boost the effects. This may lead to a very unpleasant experience, as a higher-dose DXM trip does not resemble the effects of MDMA.
  • DXM produces a reaction to the Marquis reagent that may be confused with an MDxx reaction. MDMA will cause the reagent to quickly go to purple/black, and DXM will first smoke a bit, then slowly go to grey/black. Not only is the end colour very similar, but test samples have been know to smoke a bit if the sample has a very high MDMA content. If the test is performed in poor or erratic lighting conditions (as may be the case at a party), the reactions are even easier to confuse.

From the perspective of a scamming manufacturer, DXM is basically the ultimate substitute for MDMA. It is a substance that allows them to have maximum deception and reward with relatively minimal risk.

Detecting DXM with Reagent test kits

Marquis – Smoke to dark grey/black, generally slower than an MDMA reaction (takes 5-10 seconds) Mecke – Yellow Mandelin – No reaction

Problems

Addiction Issues

  • Regular users experience tolerance and require increased dosages to achieve the same level of effects.
  • Regular or frequent DXM use can lead to craving the experience and to emotional dependence. Although not common, some people go on to use DXM daily and can find it difficult to quit.
  • It is not yet established whether regular use of DXM causes physical dependence (physical withdrawal symptoms upon stopping regular use). Some users report a 1-2 week "hangover" period after stopping use which could suggest mild physical withdrawal. There is no evidence of life-threatening health risks from withdrawal, but there is little data available on the subject.

Withdrawal Issues

  • Nausea, stomach cramps, and other unpleasant gastro-intestinal effects are common and may persist for days after use.
  • Itching and other skin reactions have been reported.
  • The large amount of glucose, thickeners, etc., present in many cough syrups may be hard on your kidneys and pancreas.

Contraindications and Overdose

Combining DXM and MDMA can be extremely dangerous. Both DXM and MDMA rely on the same enzyme for metabolism (breakdown in the liver), and if you combine these two drugs, then they compete for the enzyme. As a result, either one or both of the drugs isn't broken down quickly enough, and a toxic build-up of that drug/those drugs occurs. In this particular case, the build-up of DXM/MDMA can lead to serotonin syndrome, a very unpleasant set of symptoms than can be fatal. (Kreth K, Kovar K, Schwab M, Zanger UM. Identification of the human cytochromes P450 involved in the oxidative metabolism of "Ecstasy"-related designer drugs. Biochem Pharmacol. 2000 Jun 15;59(12):1563-71.)

In addition, DXM causes an increase in body temperature and when combined with MDMA it can lead to dangerous overheating. Furthermore, DXM contributes to diarrhoea and vomiting. This gastrointestinal purging can be a major contributing factor to hyponatremia. Both overheating and hyponatremia can be fatal. The dissociative effects of DXM might possibly cause a user to be less aware of the fact that bad things are happening to their body.

Avoid this combination by not taking multiple pills unless you have tested them and know the contents of those pills. Also, DXM is an ingredient in many OTC cold medications - check the list of ingredients. DXM will remain active in the body for 4-8 hours. If you have taken cough syrup earlier in the day, be wary of dosing MDMA until the DXM has left your body.

  • Products containing any active ingredients other than 'DXM' or 'Dextromethorphan' should not be used:
    • High doses of Guaifenesin can cause severe nausea and vomiting.
    • High doses of Acetaminophen can cause liver-damage and may be fatal. Some brands of DXM containing cough-syrups, including Drixoral Cough and Fever contain acetaminophen.
    • High doses of Chlorpheniramine Maleate can cause severe and life-threatening symptoms including seizures, loss of consciousness, bleeding from skin, mouth, rectum, and vagina, and possibly death. Some brands, including Coricidin Cough and Cold contain Chlorpheniramine maleate.
  • Do not take DXM if you are using, or have used an MAO Inhibitor within the last 2 weeks.
    • MAOI's include harmine & harmaline, as well as many anti-depressants. Check with a doctor if you're unsure whether you medication contains MAOI's.
    • When combined with MAOI's, DXM can cause "serotonin syndrome" with fever, hypertension, and arrhythmias.
  • Do not take DXM if you are using, or have used an SSRIs within the last 2 weeks.
    • SSRIs include many anti-depressants, including Fluoxetine (Prozac), Citalopram (Celexa, Lexapro), Paroxetine (Paxil), and others. Check with a doctor if you're unsure whether you medication is an SSRI.
    • When combined with SSRIs, DXM may cause "serotonin syndrome" with fever, hypertension, arrhythmias, etc.

References: Bowdle TA. "Adverse effects of opioid agonists and agonist-antagonists in anaesthesia." Drug Saf. 19(3):173-189. 1998 Sep; Bernard SA, Bruera E. "Drug interactions in palliative care." J Clin Oncol. 2000 Apr;18(8):1780-99.;

Warnings

WARNING:

  • Do not operate heavy machinery.
  • Do Not Drive.
  • Avoid using DXM in combination with alcohol.
  • Do not take DXM if you have recently taken an MAOI. MAOIs are most commonly found in the prescription anti-depressants Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), Eldepryl (l-deprenyl), and Aurorex or Manerix (moclobemide). Ayahuasca also contains MAOIs (harmine and harmaline). DXM and MAOIs are a potentially dangerous combination.
  • Do not take DXM if you have recently taken an SSRI such as fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft).
  • DXM use in combination with other OTC cold remedies can increase risk of adverse reaction.

What is DXM’s legal status

Generally if it is in commercial packaged state it is legal. There is a grey area with it being in powder form, so check with local laws if unsure.

  • Australia – Uncontrolled
  • Canada – Uncontrolled
  • UK – Controlled, prescription only
  • US – Uncontrolled

What are the dangerous effects of DXM?

Dangerous side effects include loss of motor control, hyperthermia, nausea, psychosis, and (sometimes) death.

Bear in mind that what some perceive to be positive effects (disconnected feeling, loss of motor control, visuals, etc) may be very unpleasant if you are not expecting them (as would be the case with a bunk pill).

Erowid notes that there are only a handful of known deaths that occurred as a result of DXM alone; and that several more deaths (no exact figure is given) have resulted from the use of DXM in combination.

What else should I know before consuming DXM?

This section will not go into great detail, but will just touch on some dangerous possibilities and interactions.

  • DXM is often included in cough syrups that contain other active ingredients. In order to get an active dose of DXM, one usually needs to consume a lot of cough syrup. In consuming the requisite dose, it is entirely possibly to consume a dangerously high dose of another ingredient.
  • DXM may inundate the enzyme (P450) that metabolises many non-drowsy antihistamines. When taken in combination, this interaction can cause heart problems.
  • The combination of DXM with MAOIs, SSRIs, MDMA, or other serotonin agents may cause serotonin syndrome.
  • Nausea, stomach cramps, and other unpleasant gastro-intestinal effects are common and may persist for days after use.
  • Itching and other skin reactions have been reported.
  • The large amount of glucose, thickeners, etc., present in many cough syrups may be hard on your kidneys and pancreas.
  • Olney's Lesions: The theory that DXM may cause this type of brain lesioning is based on extrapolation from other NMDA antagonist actions and is not considered definitive.

Background and Chemistry

History of drug

Description of drug

Mechanism of Action

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