DXM

In short

DXM (dextromethorphan hydrobromide) is a widely used over-the-counter cough suppressant. It is known to have powerful dissociative effect when used in much higher doses than the standard ones. Many pharmaceutical products that use DXM contain also other active ingredients such as Paracetamol or Chlorpheniramine maleate, which could be hazardous or even lethal if taken in high doses.

What is DXM?

DXM is a synthetic opiate derivative, which is easily accessible in the pharmacies. It is usually used in the production of cough suppressants, especially in those having “DM” or “Tuss” in their trademark names. They are taken orally, while the pure DXM powder is snuffed. Together with ketamine, Phencyclidine (PCP) and nitrous (also known as laughing gas or sweet air), DXM is known as one of the dissociative compounds.

Where does it come from?

DXM was approved as a cough suppressant in the 1950s. Soon afterwards it became wide-spread under the form of pills as a non-narcotic alternative of the up-to-now opiate cough suppressants. At the end of the 1970s, cough syrups appeared to replace the pills, thus preventing their non-proper application.

How is it used?

DXM is almost always taken orally. When powdered, it is snuffed.

What does the user feel?

DXM effects vary by dose. Low doses cause a mild stimulant effect. Moderate doses can cause intoxication that could be compared to the alcohol or cannabis intoxication. High doses have dissociative effects, making the user feel as if he is detaching from his own body (that is why DXM can be compared to other dissociative drugs such as PCP or ketamine). Extremely high doses can significantly alternate the state of mind.
The effects DXM causes could be divided into pleasant, neutral, and unpleasant:
Pleasant effects:
•   Euphoria, mood lift
•   laughing
•   disassociation of the mind from the body (being pleasant when deliberately wanted)
•   creative dream-like experiences
•   increased sensitivity
•   some users report for increased empathy and warm feelings towards other people

Neutral Effects:
•   pupil dilation
•   visual and auditory hallucinations
•   decreased sexual functions (orgasm hardly reached)
•   confusion , disorientation
•   skin sensitiveness, changes in the sense of touch
•   robot- or zombie-like body movements
•   coordination impaired, lack of agility
•   lack of appetite
•   involuntary muscle contractions
•   when taken in higher doses, DXM may create a sense of becoming one with the surrounding objects (for example, bed or sofa)

Unpleasant effects:
•   stomach upset, vomiting
•   dizziness
•   itches throughout the body
•   rashes, reddish spotted skin
•   diarrhea
•   fever
•   tachycardia
•   some users report they feel as if being isolated and detached from the other people
•   other users report for hangover or depressive symptoms over the next one-two days

DXM effects usually start to manifest from 20 minutes to one hour after the drug is being taken, with this period increasing proportionally with the higher dosage. They reach their peak after 90 to 360 minutes. In low dosage the effects last for between 4 and 6 hours, while the effects of high dosages can last for 6 hours and even more than 6 hours.

Does it lead to addiction?

It is considered that DXM can not cause physical addiction, but some chronic users report of uncommon psychological addiction. Moreover, the frequent use leads to an increase in the tolerance towards the product.

What are the risks?

DXM causes physical and psychological effects that might be frightening or at least unpleasant. Vomiting, nausea, and diarrhea are among the most common ones. Psychological effects could be manifested in grave disorientation, depression, sense of disintegration of one’s personality or of sense of “unreality” and “switching off” that can last for days. Chronic usage may cause depression, psychological dependence and, very likely, brain damages. Extremely high doses could be blamed for causing psychotic paroxysms.
In addition to the risks related to the usage of DXM itself, many of the pharmaceutical products that contain DXM have other active ingredients, thus creating a possibly hazardous combination (for example, Acetaminophen (widely known as Paracetamol) and Chlorpheniramine Maleate).

•   The use of pharmaceutical products that contain active ingredients other than DXM should be prohibited because:
-   When taken in high doses, Acetaminophen (Paracetamol) could cause liver damages, liver insufficiency and even death. Many of the products whose active ingredient is DXM contain also Acetaminophen.
-   High doses of Chlorpheniramine Maleate may lead to such severe and even life-threatening symptoms as convulsions, loss of consciousness, bleeding from the skin, mouth and rectum, and even to death. Many of the DXM-containing products use also Chlorpheniramine Maleate.
-   READ THE PRODUCT DESCRIPTION!

•   Do not use DXM if you take MAOIs (Monoamine oxidase inhibitors) or if you have taken such over the last two weeks. MAOIs are some kinds of antidepressants that are sold under prescription. Ayahuasca, also contains MAOIs (harmine and harmaline). The combination between DXM and MAOIs is hazardous since it may cause the so-called “serotonin syndrome” including fever, high blood pressure and arrhythmia.

•   Operating machines and driving should not be allowed after taking DXM.

•   Expectant mothers, too, should not take DXM since its dissociative compounds could severely affect the fetus’ brain development.
•   Taking DXM together with alcohol should be avoided.

•   Do not use DXM if you take or if you have taken SSRIs (Selective Serotonin Reuptake Inhibitors) over the last two weeks. SSRIs are some kinds of antidepressants sold on prescription. The combination between DXM and SSRIs, too, may cause the above-mentioned “serotonin syndrome” manifested by fever, high blood pressure and arrhythmia.

•   Nausea, vomiting, diarrhea and stomach spasms are among the common effects and may last for several days after the intake.

•   Itches and other skin reactions are also possible to occur.

•   The high quantity of glucose, thickening agents and other ingredients commonly used in cough suppressants burden the kidney and pancreatic functions.

•   Chronic or frequent use of DXM may lead to strong desire for experiencing again the same feeling or even to psychological dependency. Although that it is not the common case, some users take DXM everyday and can hardly quit.

•   Despite the scarce data on correlations between DXM usage and physiological dependency with abstinent syndromes, some users report for “hangovers” that last one to two weeks after they have quit. This may be referred to as light abstinent syndrome. However, there are no data proving that DXM causes life-threatening abstinent syndromes.

•   Chronic DXM usage leads to increased tolerance and thus higher doses are needed for the initial effect to be experienced again.

•   Some scientists assume that the use of DXM, as well as of other dissociative compounds, causes small brain holes. This syndrome is known as Olney’s Lesions. However, there are no enough researches to prove this assumption.