Dextromethorphan
Dextromethorphan hydrobromide (DXM for short) is a cough suppressant drug with chemical formula C18H25NO HBr, found in certain over-the-counter cold remedies and cough suppressants. Other names of this substance include d-Form hydrobromide of Racemethorphan and demorphan hydrobromide, though both of these names are quite uncommon and dextromethorphan hydrobromide typically appears in labeling.
The advantages of DXM over codeine are the absence of constipation and (physical) addiction; it is also less sedative, and has little to no psychological effect in the doses used medically (typically no more than 30 mg, or slightly more, spread over several hours; 10-15 mg is a common dose in cough syrups).
In significantly higher doses of 150 mg to 2 g, DXM is recreationally used as a psychedelic drug that can cause dissociation and dreamlike mental effects, as well as visual and aural hallucinations that can last eight hours or longer in sufficiently high dosage, and can even include "out of body experiences" at very high doses, though this is uncommon; some use high doses for attempts at spirituality or self-knowledge.
Low quantities of DXM can cause euphoria of a sort, though most would not suggest that DXM be used as a substitute for marijuana or ecstasy, both of which can - unlike large quantities of DXM - be used alone in relative safety.
At and above the second plateau (see below) the user generally feels "disconnected" from reality, or disoriented. DXM can also cause vomiting, fever and death. There is also the possibility of psychological addiction.
Slang terms for DXM include tussin (from the brand name Robitussin). Other names depend on the subculture of users; DXM is not one of the most commonly abused drugs, at least deliberately; see mention of MDMA below.
Unlike ketamine and PCP, DXM is legal in most places. The dissociative experiences associated with DXM are similar to those of ketamine. DXM has a longer biological half life than ketamine, and the unpleasant side effects are considered by some to be worse. Since DXM is legal, it is available in pure form from several online sources, typically for "research purposes only". The price for a high dose of two grams is typically under five dollars; this kind of dose will typically lead to a completely dissociative experience, or can be broken up for more casually recreational use; see below.
Most over-the-counter cough medicines contain other drugs besides DXM and can be quite dangerous when taken in high doses. These ingredients include acetaminophen (possibility of liver damage) and the anticholinergic drug contained in Coricidin. Cough supressents also often contain Guaifenesin which contributes to the nausea and vomiting that some experience when taking this drug. Acetaminophen in particular deserves more detailed discussion. There are three enzymatic pathways used in the liver to break it down, and the two typically found are safe for the body. When these two become overwhelmed, the third pathway processes acetaminophen into a chemical that is quite toxic to the liver. Fatal liver damage can occur before any symptoms become evident, causing a lingering death over several weeks; additionally, a user who is in a hangover from significant quantities of DXM may not notice that anything is wrong even once symptoms begin to occur. To put it simply, acetaminophen-containing preparations are not safe for recreational use, and in high recreational quantities death is the more probable outcome.
Other preparations contain high doses of pseudoephedrine, a stimulant drug that's very closely related to ephedrine. It is unwise for high doses of these drugs to be used together because DXM gives stimulant effects itself.
Coricidin Cough and Cold in particular, known as CCC in the community, is a typical source of DXM for casual users, especially those in high school who may not have credit cards and so cannot buy pure DXM from online merchants, and who see it as a preferable alternative to large quantities of cough syrup. Many deaths or psychotic breaks have resulted from abuse of Coricidin in particular. It contains a drug that is broken down by the same liver enzyme that decomposes DXM, and taking more than the recommended dose of Coricidin can be highly hazardous. Also, some young users have taken to shoplifting CCC and similiar preparations to such an extent that some stores do not carry them, or make them available only by asking the pharmacist.
Most drugs have an effect that, essentially, is proportional to the dose; drinking twice as much coffee will make one more alert and restless, but will not have significantly different effects. DXM, however, is unusual in that its effects are grouped into "plateaus", of which there are typically regarded to be four. The first plateau is mildly euphoric, and tends to allow physical activity. The second plateau can result in delusion, and those encountering the user will be likely to realize they are high. The third and fourth plateaus, which according to most should not be explored without a sober trip sitter, are partially to fully dissociative. For more info, see the DXM FAQ, available by searching the web, or from several of the links below. This resource was last officially maintained in the 20th century, but is still extremely useful for anyone considering use of DXM.
It should be noted that the symptoms of upper second plateau and higher DXM use are nearly impossible to conceal, and may be quite frightening, especially to those who do not know that the user has used a drug; they are similiar to a temporary psychosis, and at the fourth plateau the individual has little to no connection with external reality, and may have extreme difficulty moving. Most users find that use at or below the second plateau is more pleasant; the two upper plateaus are quite frightening, and are largely used for spiritual self-improvement. Psychotic breaks are more common in the upper two plateaus.
While DXM is not a safe drug (and some would argue that there are no safe drugs) by any means, and has a truly horrific taste (in its pure form, or as cough syrup), it is recommended that users do not smoke it, since this creates toxic materials. Additionally, users should not inject DXM, since injection, even with sterile equipment, can be quite hazardous in the hands of the inexperienced. Swallowing may not be pleasant, but it is the safest option.
There is speculation that high doses of DXM may cause brain damage. John Olney demonstrated that high doses of NMDA antagonists, the class of drugs to which DXM belongs, caused brain cell death in animal studies. Since detecting the cell death requires an autopsy, it has not been studied in humans. Furthermore, DXM ingestion has been linked to several deaths, including some where only pure DXM was involved.
Since DXM is legal, it is often sold as MDMA (aka Ecstasy), a practice that endangers users of MDMA.
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