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Table of Contents

1. Introduction
2. Dosage
3. Physical Effects
4. Visual Effects
5. Hallucinatory States
6. Cognitive Effects
7. Toxicity and Harm Potential
8. Dependency and Abuse Potential
9. Overdose Risks and Interactions
10. Legal Status

Understanding Dextromethorphan (DXM) Abuse: A Closer Look

The Basics of DXM

Dextromethorphan (DXM), also known as robo, dex, DM, and DXM, belongs to the morphinan class of dissociative substances. Primarily found as the active ingredient in numerous over-the-counter (OTC) cold and cough medicines, DXM is known for its cough suppressant properties. However, when consumed in quantities exceeding approved doses, DXM can induce dissociative effects akin to those of ketamine and phencyclidine (PCP). Its mechanism of action involves acting as a noncompetitive NMDA receptor antagonist.

Historical Context and Regulation

DXM was first synthesized in 1953 and received approval for use as a cough suppressant in the United States in 1958. Initially marketed under the name Romilar, its widespread abuse prompted its voluntary removal from the OTC market as early as 1975. Subsequently, various refined DXM products were introduced, often containing additional ingredients intended to deter abuse, such as unpleasant taste additives.

Persistence of Recreational Use

Despite efforts to curtail its misuse, recreational consumption of DXM persists, particularly among teenagers attracted to its low cost and easy accessibility.

Subjective Effects and Variability

Users of DXM commonly report a range of subjective effects, including dissociation, time distortion, bodily hallucinations, immersion enhancement, loss of motor control, euphoria, and ego loss. The effects can vary widely, with lower doses often likened to alcohol intoxication, while higher doses mimic the effects of ketamine or PCP. Many users also experience a strong, uncomfortable body load accompanied by significant nausea. However, individual responses to DXM can differ greatly, with some finding the experience unpleasant or neutral, while others report profound psychedelic-like experiences.

Formulation Considerations

It's important to note that DXM in freebase form, such as that found in products like Robocough RoboTablets, is approximately 27-37% more potent than its hydrobromide form due to a higher concentration of DXM by weight. This discrepancy should be taken into account when calculating doses to avoid potential overdose.

Controversy Surrounding Toxicity

The toxicity of DXM in recreational doses remains unclear and is subject to ongoing controversy. Some evidence suggests that excessive use of NMDA antagonists like DXM may have neurotoxic effects. Numerous cases of DXM dependence and abuse have been documented, underscoring the importance of harm reduction practices for those who choose to use this substance.

In conclusion, while DXM may offer legitimate therapeutic benefits as a cough suppressant, its misuse and abuse present significant risks to individuals' health and well-being. Understanding its effects, dosage considerations, and potential dangers is crucial for promoting safe usage practices and mitigating harm associated with its recreational consumption.

Unraveling the History and Culture of Dextromethorphan (DXM)

Origins and Regulation

The parent compound of dextromethorphan, racemethorphan, was first documented in Swiss and US patent applications by Hoffmann-La Roche in 1946 and 1947, respectively. In 1950, a patent for racemethorphan was granted. Notably, DXM emerged from this as a successful cough suppressant during US Navy and CIA-funded research in 1954, aimed at finding nonaddictive alternatives to codeine.

DXM received FDA approval in 1958 as an over-the-counter antitussive, addressing concerns associated with the use of codeine phosphate, such as sedation and opiate dependence [5]. However, similar to dissociative anesthetics like phencyclidine and ketamine, DXM later became associated with nonmedical use.

Cultural Shifts and Mitigation Efforts

During the 1960s and 1970s, dextromethorphan became available in tablet form under the brand name Romilar. However, due to widespread misuse, Romilar tablets were withdrawn in 1973 and replaced with cough syrup to deter abuse.

The rise of internet accessibility in the 1990s facilitated rapid dissemination of DXM-related information, leading to the formation of online communities discussing its use and acquisition. By 1996, DXM HBr powder was readily available for bulk purchase from online retailers, allowing users to bypass syrup preparations. California enacted legislation in 2012 prohibiting DXM sales to minors without a doctor's prescription.

Understanding the Chemistry

Dextromethorphan belongs to the morphinan class, characterized by a phenanthrene core structure with one aromatic ring (benzene) bound to two saturated rings (cyclohexane). Additionally, it features a saturated piperidine ring attached to specific sites within the core structure. Substitutions include a methyl group at RN and a methoxy group at R3.

Pharmacological Insights

The precise pharmacology of DXM remains incompletely understood. In vitro studies suggest its primary mechanism of action is NMDA receptor blockade, akin to ketamine and PCP. However, DXM serves as a prodrug for its more potent metabolite, dextrorphan, which mediates its dissociative effects.

Additional pharmacological actions include serotonin reuptake inhibition, alpha-3 beta-4 nicotinic receptor antagonism, and sigma-1 receptor agonism. High doses of DXM can elevate blood pressure and heart rate, as well as increase plasma levels of adrenocorticotropic hormone (ACTH) and corticosterone.

Metabolic Pathways and Variability

DXM undergoes O-demethylation into dextrorphan via the CYP2D6 enzyme, with additional N-demethylation into 3-methoxymorphinan by CYP3A4. Variations in metabolic pathways significantly impact the nature of the DXM experience, with poor metabolizers exhibiting altered ratios of DXM to active metabolites and heightened potency and duration.

Role of Metabolites

Dextrorphan, a metabolite of DXM, contributes to its psychoactive effects and acts as a potent NMDA receptor antagonist. Conversely, 3-methoxymorphinan, another metabolite, exhibits local anesthetic effects. 3-Hydroxymorphinan, derived from both dextrorphan and 3-methoxymorphinan, demonstrates neuroprotective and neurotrophic properties.

Subjective Experiences

The headspace induced by DXM is often described as hallucinogenic, impairing, and disorienting, compared to substances like MXE and ketamine. However, individual responses vary, and higher doses increase the likelihood of experiencing the full spectrum of effects, including adverse outcomes like addiction or severe injury.

Understanding the intricate history, chemistry, pharmacology, and subjective effects of DXM is crucial for promoting informed decision-making and mitigating potential harms associated with its use in various contexts.

Navigating Dextromethorphan (DXM) Dosages

Understanding Thresholds and Intensity

When it comes to consuming dextromethorphan (DXM), understanding dosage thresholds is crucial for managing its effects safely. Below are the dosage ranges categorized by their respective intensities:

Threshold Dosage: 75 mg

At this level, users may begin to perceive subtle effects of DXM, signaling the onset of its activity. While not significantly psychoactive, individuals may notice slight alterations in perception or sensation.

Light Dosage: 100 - 200 mg

In the light dosage range, users typically experience mild effects of DXM. This may include a slight elevation in mood, subtle changes in perception, or a mild sense of dissociation. Overall, the experience remains relatively manageable and non-intense.

Common Dosage: 200 - 400 mg

This dosage range is where many users begin to encounter more pronounced effects of DXM. Common experiences may include heightened dissociation, perceptual distortions, time dilation, and alterations in sensory perception. Users may also notice increased euphoria and a deeper sense of introspection.

Strong Dosage: 400 - 700 mg

At the strong dosage level, DXM effects become significantly potent and immersive. Users may experience intense dissociation, profound alterations in consciousness, vivid hallucinations, and a profound sense of detachment from reality. Motor coordination may be severely impaired, and navigating the environment can become challenging.

Heavy Dosage: 700 mg and above

Entering into the heavy dosage territory, DXM effects can become overwhelming and potentially dangerous. Individuals may experience extreme dissociation, intense hallucinations, and a complete loss of connection with the external world. Motor control is severely impaired, and individuals may find it difficult to move or communicate coherently. Such high doses pose significant risks and may lead to adverse reactions, including medical emergencies.

Exploring the Physical Effects of Dextromethorphan (DXM)

Understanding Physical Sensations

DXM induces a range of physical effects that can vary depending on dosage and individual response. These effects encompass both stimulatory and sedative properties, impacting bodily sensations and functions.

• Stimulation & Sedation: At lower doses, DXM tends to be stimulating, but as dosage increases, it can transition to a more sedating state, potentially leading to lethargy or immobility.

• Perception of Bodily Lightness: Users may experience a sensation of weightlessness, making movement feel effortless and encouraging physical activities.

• Bodily Control Enhancement: While some users may notice improved bodily control at lower doses, higher doses can result in motor control loss, altered gait, and spatial disorientation.

• Spontaneous Bodily Sensations: DXM can induce tingling sensations, known as the "body high," which range from pleasurable warmth to heavy body load.

• Physical Euphoria: Feelings of physical pleasure or bliss can occur, ranging from mild to intense.

• Appetite Suppression: DXM often suppresses appetite, which may persist into the following day.

• Changes in Felt Bodily Form: Users may perceive alterations in their bodily form, particularly at moderate to high doses.

• Nausea: DXM can induce nausea and vomiting, especially during the onset phase, potentially exacerbated by the medium in which DXM is consumed.

• Temperature Regulation: DXM can affect body temperature, leading to increased blood pressure, heart rate, and perspiration.

• Muscle Spasms: Users may experience involuntary muscle contractions or spasms.

• Orgasm Suppression and Decreased Libido: DXM can diminish sexual desire and inhibit orgasm.

• Difficulty Urinating: Higher doses may result in urinary retention or difficulty urinating.

• Itchiness: Some users may experience histamine-induced itchiness, colloquially known as "robo-itch."

• Cough Suppression and Pain Relief: DXM, as a cough suppressant, can alleviate coughing and provide mild pain relief.

• Muscle Relaxation: While inconsistent, DXM may induce muscle relaxation or alternately, muscle twitching.

• Optical Sliding and Dizziness: Visual distortions and dizziness can occur, especially at higher doses.

• Gustatory Hallucinations: Users may experience alterations in taste perception.

• Physical Autonomy: Very high doses may lead to waking up in unfamiliar locations with no recollection of events, actions, or surroundings.

• Tactile Suppression and Pupil Dilation: DXM can numb tactile sensations and cause pupil dilation, particularly at moderate to high doses.

• Gait Alteration and Visual Disorientation: Known as "robo-walking," altered gait and visual disorientation are common DXM effects.

Exploring Visual Effects

DXM can induce a range of visual alterations, enhancing, suppressing, or distorting perception:

• Enhancements: DXM may intensify colors, magnify perceptions, enhance peripheral vision, and increase frame rate.

• Suppressions: Visual suppressions like double vision, pattern recognition, and frame rate can occur, making tasks like reading difficult.

• Distortions: Users may experience drifting, depth perception changes, or environmental distortions.

• Geometry: Visual geometry on DXM is described as bright, colorful, and intricate, with elements of motion and transformation.

• Hallucinatory States: At high doses, DXM can induce external and internal hallucinations, though less consistently than other psychedelics.

Plateaus and Dosage Ranges

DXM experiences are often categorized into five "plateaus," each characterized by distinct effects:

• First Plateau: Mild effects including cognitive euphoria and music appreciation.

• Second Plateau: Considered the most recreational, featuring sedation, euphoria, and enhanced music appreciation.

• Third Plateau: More intense dissociative effects, euphoria, and hallucinations.

• Fourth Plateau: Extreme dissociation, external hallucinations, and memory loss. Highly dangerous and advised against.

• Fifth Plateau (Plateau Sigma): An unpleasant and unpredictable experience involving delirious hallucinations, dysphoria, and anxiety. Strongly advised against due to high risk of harm.

Understanding Toxicity and Harm Potential of Dextromethorphan (DXM)

Lack of Scientific Research

The toxicity and long-term health effects of recreational DXM use in humans have not been extensively studied in scientific contexts. Consequently, the exact toxic dosage remains unknown. Anecdotal evidence suggests that low to moderate doses of DXM used sparingly may not lead to negative health effects. However, caution is warranted, as chronic usage, especially at high doses, can potentially lead to severe organ damage.

Potential Health Risks

While early speculation raised concerns about neurotoxicity and the development of Olney's lesions, animal studies have not confirmed these effects. Nevertheless, chronic users often report issues with memory, attention, and mood that persist for months after cessation of DXM usage. Furthermore, repeated oral administration of DXM during adolescence has been shown to impair learning in rats during adulthood.

Harm Reduction Practices

Given the uncertainties surrounding DXM's toxicity, it is strongly advised to adhere to harm reduction practices when using this substance. Users should consider spacing out their usage to allow their bodies time to filter out potentially harmful chemicals. Additionally, conducting independent research on substance combinations and adhering to safe consumption practices are essential for minimizing risks.

Dependency and Abuse Potential

Development of Dependence

Similar to other dissociatives, DXM can lead to dependence with chronic use and possesses moderate abuse potential. Users may experience cravings and withdrawal symptoms upon discontinuation of usage.

Withdrawal Symptoms

A survey of DXM users revealed various withdrawal symptoms, including fatigue, apathy, flashbacks, constipation, insomnia, nightmares, and decreased libido. Severe cases may involve panic attacks, impaired memory, tremors, and skin discoloration. Prolonged and heavy usage can also result in toxic psychosis and permanent psychological issues.

Tolerance and Cross-Tolerance

Tolerance to DXM's effects develops with prolonged use, requiring larger doses to achieve similar effects over time. Additionally, DXM produces cross-tolerance with other dissociatives, diminishing their effects after DXM consumption.

Irreversible Tolerance

Some users report an irreversible tolerance to DXM, which may develop after prolonged and heavy usage. This phenomenon, often referred to as the "50 trip limit," involves the gradual disappearance of DXM's unique effects, possibly indicating neurotoxicity.

Overdose Risks and Interactions

Potential for Overdose

Anecdotal evidence suggests that DXM overdose becomes significant at doses ranging from 15mg/kg to 20mg/kg, leading to a wide range of effects, including delusions, hallucinations, psychosis, confusion, panic attacks, and increased heart rate. More severe complications, such as respiratory depression, seizures, and dangerously high fever, may also occur.

Dangerous Interactions

DXM can interact dangerously with various substances, including benzodiazepines, cannabis, DOx, MDMA, alcohol, opioids, and MAOIs, potentially leading to serotonin syndrome, respiratory depression, or other serious health issues. It is crucial to conduct thorough research on substance interactions before consumption.

Legal Status

DXM's legal status varies by country, with some countries allowing over-the-counter sales and others restricting its availability to pharmacies or requiring prescriptions. Users should familiarize themselves with their local laws and regulations regarding DXM usage and purchase.

Frequently Asked Questions (FAQ)

Q: What is DXM?

A: DXM, or dextromethorphan, is a dissociative substance commonly found in over-the-counter cough and cold medications.

Q: What are the physical effects of DXM?

A: Physical effects of DXM can include stimulation, sedation, perception of bodily lightness, bodily control enhancement, spontaneous bodily sensations, physical euphoria, appetite suppression, changes in felt bodily form, motor control loss, nausea, temperature regulation suppression, increased bodily temperature, increased blood pressure, increased heart rate, muscle spasms, and more.

Q: What are the visual effects of DXM?

A: Visual effects of DXM can include enhancements such as color enhancement, magnification, and peripheral vision enhancement, as well as suppressions like double vision, pattern recognition suppression, and frame rate suppression. Distortions such as drifting, environmental cubism, and visual stretching may also occur.

Q: Is DXM safe to use?

A: The safety of DXM use depends on various factors including dosage, frequency of use, and individual health conditions. Responsible use, adherence to dosage guidelines, and awareness of potential risks are essential for minimizing harm.

Q: What are the potential risks of DXM overdose?

A: DXM overdose can lead to severe complications such as delusions, hallucinations, psychosis, confusion, respiratory depression, seizures, dangerously high fever, and even death in rare cases. It is crucial to be aware of dosage limits and seek medical attention if overdose symptoms occur.

Q: Can DXM interact with other substances?

A: Yes, DXM can interact dangerously with substances such as benzodiazepines, cannabis, MDMA, opioids, and MAOIs, potentially leading to serotonin syndrome or respiratory depression. It is important to research potential interactions before combining substances.

Q: What is the legal status of DXM?

A: The legal status of DXM varies by country, with some allowing over-the-counter sales and others restricting its availability to pharmacies or requiring prescriptions. Users should familiarize themselves with local laws and regulations regarding DXM usage and purchase.