DXM

Original article by Erowid.org

Dextromethorphan is a semisynthetic opiate derivative which is legally available over-the-counter in many countries. It is most commonly found in cough suppressants, especially those with "DM" or "Tuss" in their names. It is almost always used orally, although pure DXM powder is occasionally snorted. The effects of DXM generally fall into the category of dissociatives, along with ketamine, PCP, and nitrous.

Dose
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.

Chemistry
Dextromethorphan hydrobromide (C18H25NO) is a semisynthetic derivative of morphine, a chemical found in the opium produced by opium poppies.

Pharmacology
DXM is partially converted by first-pass metabolism into the active compound dextrorphan, which exerts cough-suppressing and dissociative effects through non-competitive antagonism of NMDA receptors. It is non-analgesic and does not cause sedation or respiratory depression. It is readily absorbed and has a half life of around four hours.

Terminology / Slang
The Substance: DXM; Dextromethorphan; Robo; Tussin.
The Experience: Robo-tripping; Tussing; Dexing.

Effects
The DXM experience varies by dose. Different recreational dose ranges are sometimes described in terms of plateaus of effects. Low doses produce a mild stimulant effect. Moderate doses generally produce intoxicating effects that are sometimes compared to alcohol or cannabis use. High doses are dissociative in the sense of causing a feeling of separation from one's body, and are sometimes compared to the effects of other dissociatives such as PCP or ketamine.

Onset
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.

Duration
Effects of low doses generally last four to six hours, with large doses lasting six hours or more.

Problems
DXM causes physical and psychological effects that may be frightening or unpleasant. Nausea, vomiting, and diarrhoea are relatively common. Psychological effects can include profound disorientation, depression, a feeling of personal disintegration, or a feeling of "unreality" and disconnection that may persist for days. Chronic use may cause depression, psychological dependency, and possibly brain damage. Large doses may be associated with psychotic breaks.

In addition to the risks of DXM itself, many DXM-containing products contain other active ingredients that can be dangerous. Common additives include acetaminophen (Tylenol), which can cause fatal liver-damage in large doses. Products containing Chlorpheniramine Maleate should especially be avoided.

Contraindications
Do not operate heavy machinery. Do not drive.
Do not take while pregnant. Dissociatives can seriously affect foetal brain development.
Many DXM-containing products also contain other active ingredients which can be dangerous or fatal in high doses.
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 phenelzine, tranylcypromine, isocarboxazid, l-deprenyl, and moclobemide. Ayahuasca also contains MAOIs (harmine and harmaline). DXM and MAOIs are a potentially dangerous combination. Check with your doctor if you are not sure whether your prescription medication is an MAOI.
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.

Addiction potential
Dextromethorphan is believed to be physically non-addictive, but some heavy users report an uncommon psychological addiction. Regular use produces tolerance.

Long-term health problems
There has been concern that DXM, like some other dissociatives, causes vacuoles (small holes) in the brain - a syndrome called Olney's Lesions. However, there is some evidence that these concerns are unfounded.

- Article used with the permission of Erowid.org. Last modified January 2009.

Erowid caution and disclaimer

This Erowid article is a summary of data gathered from Erowid site visitors, government documents, books, websites, and other resources. As this field is complex and constantly changing, information should always be verified through additional sources.