Medical Consequences of Addictive Disorder

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DXM (Dextromethorphan)

 

Medical Consequences of Addictive Disorder

http://www.oasas.state.ny.us/AdMed/drugs/dmx.htm

 

Many have noted that over-the-counter (OTC) preparations are

increasing in popularity with teenagers, possibly due to a belief

that they are safe and because they are easy to procure and many

Internet sites report on their ability to induce a " high. "

 

Abuse of cough medications is not a new phenomenon. Information

about this abuse dates back to the 1950's when cough preparations

contained codeine or similar compounds. In 1990, the FDA's Drug

Advisory Committee held a hearing concerning the abuse of cough

syrups with dextromethorphan (DXM).

 

DXM is a synthetically produced substance, the methylated

dextrorotary analogue of levorphanol, a substance related to

codeine. The cough suppressant ability of the opiates act on the

cough center located in the medulla oblongata and raises the

threshold of the cough reflex. It does not have other opiate effects

such as analgesia, sedation, or constipation. DXM is found in over

75 OTC medications.

 

Recent research is examining DXM as an anti-epileptic,

neuroprotector and anti-parkinson agent. However, DXM's antagonism

of the N-methyl-D-aspartate receptor (NMDA) by way of its immediate

metabolite dextrorthan leads to its potential as a substance of

abuse when used in greater than recommended dosages. Dextrorthan's

effect can last 3 - 6 hours and cause a PCP intoxication - like

syndrome. Thus, DXM has been classified as an dissociative agent,

much like PCP and Ketamine. With DXM intoxication, one can see

hyperexcitability, lethargy, ataxia, slurred speech, hypertension,

elevated heart rate, nystagmus and hallucinations. It is also

thought that DXM can cause the release of serotonin.

 

If used with an antidepressant of the SSRI class (Prozac, Paxil,

etc.), it can cause a potentially fatal condition know as the

Serotonin Excess Syndrome.

 

Information from Internet sites advise and instruct the potential

user on how to " trip " using DXM (called " roboing " or " robo-copping, "

a slang term derived from Robitussin) which is contained in

Robitussin Maximum Strength, Vicks 44 and Drixoral Cough.

 

The Internet sites also provide access for the purchase of purified

pharmaceutical - grade powdered DXM through the mail. Instruction is

given in mixing the powder with juice to avoid its bitter taste or

how to obtain gelatin capsules that can be filled with the powder.

 

One site teaches the uninitiated how to dose DXM - called plateaus,

being aware that a 4 ounce bottle of DXM cough syrup contains 354 mg

DXM. The first plateau, 100-250 mg of DXM consumed, leads to

euphoria. Plateau 2 is 250 - 450 mg and the user sees increased

euphoria, and a decrease in the sense of time and surroundings.

 

The 3rd plateau is 450 - 800 mg and includes plateau 1 and 2

reactions plus visual hallucinations. Even the Internet sites

caution the user of the 4th (800-1800mg) and the 5th (over 1800mg)

plateaus as being very dangerous with profuse sweats, extreme nausea

and blackouts.

 

Other problems with DXM use is that many of the OTC preparations are

not pure DXM and may contain acetaminophen, antihistamines or

stimulants that can cause a severe side effect if taken in excess.

 

Also, DXM can be found in the form of a bromide salt which can lead

to bromide poisoning if large quantities are taken. Bromide

poisoning is manifested by: behavior changes, headaches, apathy,

irritation, slurred speech, psychosis, tremors, ataxia,

hallucinations, weight loss, acne like rash, and coma.

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