From: [d x m] at [froggy.frognet.net] (Max Tussin) Newsgroups: rec.drugs.psychedelic,alt.drugs Subject: Dextromethorphan FAQ Part 01/06 Date: 7 Apr 1996 23:25:35 -0400 X-URL: http://www.frognet.net/dxm/dxm.html THE DEXTROMETHORPHAN FAQ ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT DEXTROMETHORPHAN (DXM) William E. White Usenet-Posted ASCII Text Version 3.0-U Copyright (c) 1995 All Rights Reserved Originally Written for Usenet alt.drugs ============================================================================= NOTES on POSTED ASCII TEXT VERSION This version is posted to alt.drugs and rec.drugs.psychedelic in six parts. Chapter 10 and part of Section 7.6 (3-substituted analogs) are omitted from the posted version. Both are available via my website; go to: http://www.frognet.net/dxm/dxm.html The Table of Contents is structured so that you can search for a given section by looking for the bracketed number or letter set, e.g., [1.2] for Section 1.2; [A.2] for Appendix 2; etc. Obviously, the index is omitted from the ASCII text version, as there are no page numbers. Chapters are separated by double (====) lines; sections by single (----) lines. Subsections are separated by dotted (....) lines, and in some cases (e.g., Chapter 10), I use half-dotted (. . . ) lines. I've done my best to transfer the diagrams and drawings to ASCII, but it's still not much more than adequate. If you wish you may download and print the PostScript[TM] version from my website, or you may purchase bound, printed copies from me. See below for further info on purchasing and on license fees. The FAQ is now processed as a MIME attachment and will be automatically broken up in the process of posting. There should be around 6 parts. ============================================================================= This document is a FAQ ("fack"), i.e., a series of questions and answers. The term comes from Usenet, and stands for Frequently Asked Questions. These are the sorts of questions that people new to Usenet tend to ask frequently. When these questions become frequent enough, the question and its answer may be placed into the FAQ for the newsgroup (or for a topic within the newsgroup). A few people use the term AFAQ (Answers to Frequently Asked Questions), but most use FAQ to refer both to a frequent question and to the document written to answer such questions. This FAQ covers dextromethorphan (decks-tro-meth-OR-fan), the cough suppressant commonly found in cough medicines available over-the-counter in the USA and other parts of the world. Of course, dextromethorphan (DXM) does more than suppress coughs; otherwise, there wouldn't be so much discussion about it on alt.drugs (the Usenet newsgroup from which this FAQ originated). The bizarre truth about DXM is that it is a very potent psychoactive drug when taken in sufficient quantities. So if you've ever heard about people drinking cough syrup for fun, well, now you know why. The trouble, however, is that most cough medicines have other ingredients which can make you uncomfortable, sick, or dead, depending on the ingredient and how much you take. This document is primarily intended to combat potentially dangerous misinformation about the recreational use of DXM. My own interest in DXM came quite by accident; once, while sick with the flu, I misread the instructions on a bottle of cough syrup and drank two shots from the included shotglass instead of two teaspoons. Soon after I noticed that music and motion had become very satisfying experiences. This left me puzzled, and my reaction was to go to the library and research DXM through Medline, medical journals, and books. Of course at that point I was hooked - not on DXM, but on neuropharma- cology. I decided to learn as much as I could about DXM, and found it to be one of the most unique and interesting of all recreational drugs in terms of how it works on the brain. About this time I noticed a number of incorrect and potentially dangerous posts (articles) about DXM appearing on alt.drugs. So, I decided to gather the information I had and write a FAQ. It eventually became much more than a FAQ, giving explanations and information in addition to answers, but by then the name had stuck. The FAQ took me over 150 hours to complete - I figured if I'm going to do it, I'd better do it right. After publishing the DXM FAQ, the reports of DXM use started coming in. People who had been using DXM but were uncomfortable talking about "getting high off cough syrup" shared their stories with me. Some were good, some were bad, some indifferent. I've been trying my best to get all of these personal reports together into a coherent whole, but this FAQ is written in my free time and I don't get paid for it (although donations are acceptable. :-) Please note that it is not my intention to get a bunch of people hooked on cough syrup (actually addiction is very rare, but you get my point). It is my intention for people to know the truth so they don't make bad decisions for lack of knowledge. DXM is not safe and harmless; nothing is. Nor is it universally enjoyable; in fact, some find high-dose DXM experiences terrifying. But I believe that people can only make good decisions, or learn from bad decisions, if information is available. So please, use your head! William White May 10, 1995 ============================================================================= IMPORTANT INFORMATION REGARDING DRIXORAL COUGH LIQUID CAPS[tm] Since this document was completed, Drixoral Cough Liquid Caps[tm], one of the most popular forms of DXM for recreational use, have disappeared from the market. The official stance of Schering-Plough (the manufacturer) is that they were simply not popular. I strongly suspect, however, that recreational use was a major factor, if not the only factor, in their decision to pull the product from the market. Replacing this product is a similar product (Drixoral Cough and Fever, if I remember correctly), which contains acetaminophen. Recreational use of any product containing acetaminophen could easily kill you. As of this update, the Drixoral Cough Liquid Caps[tm] are still available in a few stores which have not sold or destroyed their stock. Another brand may come out with a similar product (or it may not; I don't know). If you wish to continue using DXM, I strongly suggest you switch to the extraction processes listed in Section 7.1 and 7.2. These processes will allow you to remove the DXM from cough syrups, using easily available materials, and yielding a pure product. Furthermore, since the DXM formed is the free base, rather than the hydrobromide salt, you can avoid excessive bromide intake (a potential problem with regular use of DXM - see Section 2.7). If you choose to switch to, or continue using, cough syrups (e.g., Robitussin Maximum Strength Cough[tm] or Vicks Formula 44[tm]), please be aware that the large amount of glucose, thickeners, etc., may be hard on your kidneys and pancreas. Precipitated DXM is probably safer. I anticipate that DXM-only products will continue to disappear from the market, as more and more people learn of DXM's psychoactive potential. In response to this I am currently researching methods to extract DXM from DXM+guafenesin and DXM+acetaminophen products, giving high yield of pure DXM, and using easily available materials. I hope to complete these experiments by the end of the year (1995). ============================================================================= THE DEXTROMETHORPHAN FAQ ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT DEXTROMETHORPHAN (DXM) TABLE OF CONTENTS [ACK] ACKNOWLEDGEMENTS [1] PRELIMINARY [1.1] Restrictions and Disclaimer (Read This First!) Distribution Restrictions General Disclaimer How to Reach the Author [1.2] Why a DXM FAQ? [1.3] Keeping DXM Legal [1.4] How to Use This Document [2] GENERAL INFORMATION ABOUT DXM [2.1] DXM Quick Reference Page [2.2] What is Dextromethorphan (DXM) Hydrobromide? [2.3] What is Dextromethorphan Polistirex? [2.4] What is Dextrorphan (DXO)? [2.5] How does one obtain and use DXM? Drinking Cough Syrup Gelcaps and Capsules Pharmaceutical and Chemical Suppliers Extracted DXM Ingestion Injection and Other Routes [2.6] What are some typical DXM-containing commercial preparations? 1mg/ml DXM (120mg per 4oz bottle) 1.5mg/ml DXM (180mg per 4oz bottle) 2mg/ml DXM (240mg per 4oz bottle) 3mg/ml DXM (360mg per 4oz bottle) 15mg/capsule or tablet 30mg/capsule or tablet [2.7] What should I know about other drug ingredients? Decongestants Antihistamines Guaifenesin Analgesics Alcohol Food Coloring / Dyes Bromide Ions Other "Inactive" Ingredients [2.8] Why are so many DXM preparations in liquid form? [2.9] Is recreational use of DXM illegal? [2.10] Other (medical) uses for DXM [2.11] Drug Interactions [2.12] What about other cough suppressants? [2.13] Can DXM be detected on drug tests? [3] THE DXM DRUG EXPERIENCE [3.1] What is the general character of a DXM experience? [3.2] The First Plateau Sensory Effects Cognitive Effects Motor Effects Memory Effects Emotional Effects [3.3] The Second Plateau Sensory Effects Cognitive Effects Motor Effects Memory Effects Emotional Effects [3.4] The Third Plateau Sensory Effects Cognitive Effects Motor Effects Memory Effects Emotional Effects [3.5] The Fourth Plateau [3.6] Is there anything beyond the fourth plateau? [3.7] What happens with long-term or regular use? [3.8] What are some fun or interesting things to do on DXM? Listen to Music Dance Go Swimming (low dose only!) Group Tripping Have Sex Shamanic Journeying (see also Section 3.12) Hang out in a Sensory Deprivation Tank [3.9] What are some things to avoid on DXM? Heavy Exercise Driving Going to Class or School Dose "Boosting" and Redosing [3.10] Why does DXM affect different people so differently? [3.11] How does DXM compare with other dissociatives? [3.12] Is there any connection between DXM and out-of-body or shamanic experiences? [3.13] Why can't I hallucinate on DXM? [4] DXM SIDE EFFECTS AND OTHER THINGS TO AVOID [4.1] What are the potential side effects and risks of occasional use? Nausea and other gastric disturbances Itching and allergic reactions Hangovers Pupil dilation Tachycardia (Increased heart rate) Hot and cold flashes Hyperthermia Panic attacks Overexertion Psychotic episodes Hypertension (high blood pressure) Miscellaneous [4.2] What are the potential side effects and risks of regular use? Mania Cognitive impairment Memory impairment Habituation and Psychological Addiction Tolerance and Physical Addiction Neurotoxicity Excitotoxic Rebound Psychosis Kidney damage Bromide poisoning Miscellaneous [4.3] Is DXM addictive? [4.4] Is DXM withdrawal dangerous? [4.5] DXM hangovers - avoiding and alleviating [4.6] How toxic is DXM? What is the LD50? Should I worry? [4.7] Do you recommend DXM for recreational use? [4.8] Help! What do I do if... Itching (the "Robo Itch") Fast Heartbeat and Panic Attacks Irregular Heartbeat, or "Skipped Beats" Nausea, vomiting, gas, and diarrhea Unconsciousness High body temperature / fever Shortness of breath Sensation of choking one's tongue Nosebleeds Feeling "dead" / losing one's body Hangovers (lethargy and feeling "not all there") Prolonged dissociation from the real world [5] PHYSIOLOGICAL EFFECTS OF DXM [5.1] How does DXM inhibit the cough reflex? [5.2] How does DXM cause its psychoactive effects? General Information Contribution of the PCP2 Binding Site Contribution of the Sigma Binding Sites Contribution of the NMDA Receptor Contributions of Indirect Activity Flanging Hyper-Abstraction Delusions and Memory Problems [5.3] Why does DXM exhibit plateaus? Plateaus 1-3: Multiple Receptors The Fourth Plateau [5.4] Why is this so complicated? [5.5] How does DXM get metabolized? (Pharmacokinetics) Factors Affecting DXM's Metabolism [6] NEUROPHARMACOLOGY OF DXM [6.1] What is a receptor, anyway? (Basic Neuropharmacology) [6.2] What are Sigma Receptors? Sigma 1 Receptors and General Sigma Information Sigma 2 Receptors Sigma 3 Receptors [6.3] What are NMDA Receptors? NMDA and Other Glutamate Receptors NMDA Receptor Function and Structure NMDA and Excitotoxicity [6.4] What are PCP2 Receptors? [6.5] What are Na+ and Ca2+ channels? [6.6] How does DXM compare to other drugs at these receptors? [6.7] Endopsychosin and the Big Picture [7] DXM CHEMISTRY AND EXTRACTION [7.1] How can I extract DXM from cough formulae? [7.2] How can I get rid of other drug ingredients? [7.3] How do I use free base DXM? [7.4] How can I synthesize DXM? [7.5] What can I synthesize from DXM? Dextrorphan Levorphanol / Levomethorphan 3-substituted Analogs [NOT IN POSTED VERSION] [8] MIXING DXM WITH OTHER RECREATIONAL DRUGS [8.1] Alcohol [8.2] Barbiturates and Benzodiazepines [8.3] Amphetamines and Other Psychostimulants [8.4] Cannabis (Marijuana) [8.5] LSD, psilocybin, and other 5HT hallucinogens [8.6] Opiates [8.7] PCP and ketamine [8.8] Nicotine [8.9] Nootropics (Smart Drugs) [8.10] Miscellaneous Other Drugs [9] DXM DRUG CULTURE [9.1] Is there, or was there, a DXM drug culture? [9.2] Why haven't I ever heard about it? [9.3] Is there a "drug slang" for DXM? [9.4] Are there any street names for DXM? [9.5] How do I explain to my friends that I'm getting high off cough syrup? [10] DXM EXPERIENCES AND PERSONAL REPORTS [NOT IN POSTED VERSION] [10.1] First and Second Plateau Experiences Positive Experiences Negative Experiences [10.2] Third and Fourth Plateau Experiences Positive Experiences Negative Experiences [10.3] Long-term Use Experiences Positive Experiences Negative Experiences [10.4] Multiple Drug Experiences DXM + Cannabis + Alcohol + Opium DXM + Cyclizine DXM + Psilocybe mushrooms + LSD + Cannabis + Nitrous Oxide [A] APPENDICES [A.1] Appendix 1: P450 Inhibiting Drugs [A.2] Appendix 2: Receptor Binding of Recreational Drugs [A.3] Appendix 3: Other Sigma and NMDA Ligands [R] REFERENCES [G] GLOSSARY [I] INDEX [NOT IN ASCII VERSIONS] ============================================================================= Figure 1: DXM Molecule Figure 2: Possible Basis of Plateaus Figure 3: Fourth Plateau Pruning Hypothesis Figure 4: DXM Metabolism Figure 5: DXM Metabolism, normal and abnormal P450-2D6 Figure 6: Effects of doubled and repeated dosing Figure 7: Ion Channel Figure 8: NMDA Channel Figure 9: Partially Open NMDA Channel Figure 10: Fully Open NMDA Channel Table 1: DXM Plateaus and Dosages Table 2: DXM Binding Sites Table 3: Differential Solubility Data Table 4: 3-Substituted DXM Analogs ============================================================================= [ACK] ACKNOWLEDGEMENTS First and foremost I would like to thank my wife, Nicole, for providing me with a seemingly endless supply of love and support, and for putting up with my idiosyncrasies. I doubt anyone else could have coped with being married to someone whose idea of fun is spending hours in a library researching tripping off of cough syrup. I would also like to thank Barbara Adeanna and Peter Zachariah Kramer who helped me proofread the FAQ and who took the time to tell me when I was confusing, unclear, or simply full of it. Additionally I would like to thank them for their support and encouragement throughout the writing process. I would like to acknowledge Schering-Plough, Richardson-Vicks, and other OTC pharmaceutical companies, for giving me something to write about. How about bringing back DXM-only pills, folks? The evolution of this document also owes a great deal to the participants of Usenet alt.drugs, alt.psychoactives, and rec.drugs.psychedelic, notably including P. L. and all the people who made hyperreal.com what it is today. And to the hundred or so people who contributed their experiences to the FAQ, thank you; my understanding of DXM came about because of your assistance. Finally, thanks to my friend H., who taught me about DXM in the first place. ============================================================================== [1] PRELIMINARY [1.1] Restrictions and Disclaimer (Read This First!) This text covers the recreational and medical uses of dextromethorphan, a cough suppressant in common use in over-the-counter (non-prescription) cough medicines. This is version 3.0-U (Usenet Posted ASCII Text). Distribution Restrictions Distribution in electronic form is permitted, free of charge, except as otherwise specified below. o When distributed electronically, this document may be broken up into sections, provided all sections receive the same distribution and all are distributed within 1 day. (The exception is the Quick Reference Page, which may be distributed by itself). o When distributed by the author via Usenet, some sections may be omitted at the author's discretion. Automatic redistribution (i.e., Usenet news) may legally duplicate this pattern of omissions. o You are permitted to make a printed copy of the electronic document for personal use, and encouraged to pay the US$10.00 license fee when convenient. Any additional printed copies may be made at a license fee of US$10.00 per copy, sent to my address (see below). You may also purchase bound, printed copies of this text for US$20.00 plus shipping and handling; email, mail, or telephone me for information. o Sale of this document in any form (electronic or printed) by anyone other than the author is expressly forbidden. o When distribution in electronic form, this document must remain in the same format as received (e.g., ASCII, PostScript[tm], etc.). For information regarding specific formats, please contact me. o The HTML format hypertext files on my website may not be distributed without my approval; please use my site for them. You may, however, provide links to them. o Once a given version number has been released, no prior versions may be distributed without written permission. Please stick to this rule if you can; I try and keep the information in this document as up-to- date as possible. o This document may be cited as: White, William E. (1995) The Dextromethorphan FAQ: Answers to Frequently Asked Questions about Dextromethorphan (DXM), (v. 3.0-T). Usenet newsgroup rec.drugs.psychedelic. Available in HTML at: http://www.frognet.net/dxm/dxm.html o As I do not wish my motives to be misrepresented, no citation or quotation of this document may be used so as to explicitly or implicitly suggest that I am in favor of the illegal use of any drug (legal or not), or any other illegal activity, subject to USA law. (This restriction is also present in the general copyright notice). o No modified version of this document may be distributed in any form. (This restriction is also present in the general copyright notice). .............................................................................. General Disclaimer This text discusses some rather controversial topics. Currently, there are laws in most places of the world that make it illegal to use certain drugs for recreational purposes. It doesn't take a genius to figure out that the medical nature of the drugs in question has nothing to do with their legal status (otherwise, alcohol would be illegal and we'd all be smoking dope(1)). In particular, a lot of people are making a lot of money from the illegal drug trade. The distributors, manufacturers, and sellers of illegal drugs are among them, of course. So are the law enforcement agencies and politicians, and the manufacturers and distributors of legal drugs like nicotine and alcohol. In the past few years, many scientists, physicians, journalists, and others have suggested legalization as a way to reduce the harm associated with the drug trade. It is not my desire to address this topic in depth here. What is important is that, in response to these suggestions, the proponents of the War on Drugs (and its equivalents elsewhere) have become increasingly aggressive. One of their goals is to prevent the dissemination of information about recreational drugs (unless it's their own propaganda). As such, anyone even discussing drug use is walking on thin ice, and once you go about telling people how to do it, the ice becomes a lot thinner. I have no intention of being thrown into prison so that they are forced to release rapists, murderers, and child molesters in order to make room for me. I'm not planning to become a martyr any time soon; I'd much prefer for the Drug Peace to come without violence (legal or physical). However, I feel it is important to provide true information about drugs. J. S. Mill argued very eloquently that if an idea is true, then it can only become stronger when it is confronted with falsehood; to prevent debate in the hope of protecting the "truth" only leads to lies. I agree entirely, and quite frankly I think anyone even thinking of getting into politics should be familiar with (and hopefully agree with) Mill and his arguments. Honest and open discussion of drugs can only lead to better policy and less harm. In any case, like so many others, I am walking on somewhat thin ice here, and must take certain steps to protect myself. Thus the following rather verbose disclaimer, which may or may not be worth anything in an actual court of law: It is not my intention to influence anyone to commit an illegal act. I explicitly instruct all readers not to violate any international, national, state, regional, city, or other applicable laws governing any of the information presented in any document authored by me or made available by me through electronic or other publishing methods, including this document. Specifically, I hereby advise everyone not to ingest, inject, smoke, snort, shove up your ass, or otherwise administer any legal or illegal drug (except for legal drugs under order of a physician), or to engage in the manufacture, distribution, synthesis, analysis, or other processing of any legal or illegal drug, regardless of anything you may see in the aforementioned documents. I advise everyone not to follow any procedures listed. All information is presented for EDUCATIONAL PURPOSES ONLY! None of the information in this document is guaranteed to be accurate or valid in any way. Anyone attempting any such action or process takes full responsibility for any outcome resulting from such, and neither I, nor my access provider, nor any other subset of the Usenet/Internet or world community (except for the person or persons attempting the action) may be held responsible. By proceeding past this Disclaimer, you agree to assume all responsibility for any actions, legal or not, that you may take. If any part of this disclaimer is found to be invalid, then all rights to access and distribute this information are revoked. .............................................................................. How to Reach the Author Any questions or comments may be addressed to me: Email: [b w hite] at [frognet.net] PGP 2.6.2 block available by finger Encrypted mail preferred. US Mail: William White PO Box 536 Athens, OH 45701 USA Telephone: 1-614-594-3434 (USA) 10:00 - 21:00 Eastern Standard Time A number of people have reported difficulties obtaining my PGP key via finger. If you experience problems, you can compare it against the following (assuming, of course, someone hasn't dorked with this document). If you're really paranoid, call me up and I can read it to you. -----BEGIN PGP PUBLIC KEY BLOCK----- Version: 2.6.2 mQCNAi1lhpkAAAEEALzR0vS+W7qdMjQJz0Lc+TQm86HMpHu1ZEGDtGHcZShBy/tB xoDueEe7vy0nPJpvrfoEUjp8KhR55/Eb1i27CCTP47+5IvJNlV+1D0xrnaX6gSWr OVPjz/rLOvi8BHQxu7XNQ1BfUaaV0CPs8McPSUyeEqzNNadKouCp8NBoN4HlAAUR tC5XaWxsaWFtIEUuIFdoaXRlIDxid2hpdGVAb3Vjc2FjZS5jcy5vaGlvdS5lZHU+ =qyt4 -----END PGP PUBLIC KEY BLOCK----- Please don't call me up, telling me I'm going to Hell or somesuch nonsense. I don't believe in it and I don't have the time or inclination to listen to that sort of drivel. Thus far I've gotten only good responses, and I thank everyone who has taken the time to email me, call me, or otherwise contact me. Testimonials and personal data are presented anonymously. I do not maintain copies of the sender's name, address, or personal information, either online or offline, and thus I cannot give information as to their identities. Any personal information, testimonials, or reports as to DXM's effects that were or are sent to me will be considered anecdotal and not specifically referring to the sender. I encourage anyone with applicable data to send it to me anonymously. Any data sent PGP encoded will be decoded on my private system (MS-DOS) which is offline. After decoding, all information regarding the sender's identity is overwritten (200 pass random pattern). Thus I cannot link testimonials or information to senders after this operation. Note that my system is NOT TEMPEST(2) SECURE (not that I've noticed any strange vans near my house). ------------------------------------------------------------------------------ [1.2] Why a DXM FAQ? There is the philosophy among some in the USA (and probably the rest of the world) that the best way to prevent people from making mistakes is to withhold information from them. For example, this is particularly noticeable in the case of sex education, where some assert that teaching children about sex is equivalent to giving them permission to copulate, and that, since no sex is perfectly safe, and since teenagers especially have a tendency to take risks (e.g., no birth control), we ought not to teach sex education in the schools. One might just as easily say that teaching children about cars is equivalent to giving them permission to drive, and that, since no driving is perfectly safe, and since teenagers especially have a tendency to take risks (e.g., racing down Main St.), we ought not to teach driving education in schools. This misguided philosophy of "ignorance is strength" is just as often applied to information pertaining to drug use. In the case of drug use, however, good information is immediately useful towards preventing drug-related injuries. In the case of DXM, there are several possible mistakes people can make, and the chance for making a mistake is compounded by the fact that people hear "you can get high off cough syrup" as advertisement for DXM use. At best they are unprepared for the trip; at worst, they get hold of an acetaminophen-containing preparation and end up in the hospital or dead. Make no mistake; this information will probably encourage some to try, and continue to use, DXM. That is not my intention. A few of these people may end up addicted, or at least habituated to the point of trouble. That is certainly not my intention. My intention is to make sure that everyone out there knows what the risks and effects of DXM use are, so that s/he can make intelligent choices for herself or himself. An intelligent choice is not always right, but it is fair, and you always learn from it. This text sprung out of the Usenet newsgroups alt.drugs and alt.psychoactives(3), where about 1 or 2 questions a week about DXM would appear. After responding weekly, or in some cases daily, I decided to put together all the questions (and a few questions I thought would follow) and write a full explanation of DXM. Some of the material is fairly technical, but I thought it better to give too much information than not enough. It is distributed once a month (more or less) on the Usenet newsgroups rec.drugs.psychedelic and alt.drugs (until the latter disappears); please distribute it beyond Internet and Usenet (subject to the restrictions above). It is my sincere hope that this type of information may help the Internet fulfill its potential as an information source. Those of us who have the time and ability to provide good information should feel obligated to do so; if we set a standard of high signal and low noise, perhaps others will follow. ------------------------------------------------------------------------------ [1.3] Keeping DXM Legal Right now, DXM is legal for over-the-counter use in most places. This seems to be for two reasons primarily. First, there is no substitute for DXM that does not also have abuse potential. Nor is there likely to ever be one; everywhere the cough reflex can be blocked involves some type of receptor associated with recreational drug effects. Second, pharmaceutical companies don't want to lose a major chunk of their income. DXM works as a cough suppressant, and it works well. Besides, nobody wants to have to go to the doctor to get a prescription every time they get a cold. However, it is possible that DXM-only preparations might disappear from the market. This would be unfortunate, both for recreational users and for the general public; the most likely additive - guaifenesin - makes some people vomit even at low doses. Another possibility would be the addition of something which would be harmless at regular doses but induce nausea (or other unpleasant effects) at recreational doses. The best answer is probably prevention, which unfortunately involves two conflicting goals. On the one hand, it is essential that DXM related deaths do not occur - this was my primary motivation in making this FAQ in the first place. Several DXM cough medicines can be dangerous if consumed recreationally, due to the presence of other ingredients. There is also the problem of drug interactions, e.g., DXM + Seldane[tm], which can be fatal. On the other hand, the spread of information to keep people from hurting themselves is also likely to inform people who didn't know about DXM, and will want to try it. DXM is still an unknown to many people (although not as big an unknown as most think - pockets of recreational DXM use have existed as long as DXM has). I've come to the conclusion that I'd rather have a bunch of people doing it safely than a few doing it dangerously - but then again, I'm also in favor of sex education. Thus, I encourage anyone who may want to try DXM or tell her or his friends to try it (which I again explicitly tell you not to do) to make sure and emphasize all the risks and dangers involved. Don't rush into high dosages. Don't trip alone, or without a designated sober person. Don't encourage people who are not psychologically mature to experiment with DXM. And please use common sense and be safe. In the event that DXM-only preparations do get pulled, the best answer is probably to have an isolation method that will separate the DXM from other ingredients. In my opinion, the most likely additive is guaifenesin (although people were using Robitussin DM[tm] long ago, and just toughing out the inevitable extreme nausea). I've been working on a way to separate the DXM from guaifenesin, using commonly available substances, and producing a pure, safe product. We don't want another "cat" (methcath- inone) media-scare on our hands(4). Currently I offer a method for evaluation only; this method is not proven. I'm posting it with the FAQ so that other people can give it their consideration. In conclusion I'd like to remind everyone that we may be walking on thin ice here. I've tried my absolute hardest to make this FAQ as accurate and scholarly as possible, so that if anyone who matters ever does get a look at it, they'll get bored somewhere around the explanation of P450-2D6 polymorphism :-). Still, please use common sense. ------------------------------------------------------------------------------ [1.4] How to Use This Document I have tried to make this document useful for a variety of audiences, and as such it can sometimes get fairly technical. If confused, consult the glossary; if still confused, check with a basic neuropharmacology text. I unfortunately do not have the time to answer general questions about neuropharmacology; I'm employed full time, attempting to start a business, entering graduate school, and married. This document is broken up into chapters and sections by subject, with appendices, references, glossary, and index. At present, figures and diagrams are fairly minimal; I'm trying to improve that aspect. Also, sometimes I simplify things a bit. If you take exception to anything, email me with references and I'll consider modifying it. If you're lucky enough to be reading this via the World Wide Web, congratulations. I originally maintained the WWW copy as the primary one, and derived a text copy; in recent months I've had to reverse this tradition. I've also tried using several HTML editors before coming to the conclusion that they all suck, and gone back to the trusty UNIX[tm] vi editor. One Gen-Yoo-Wine Drixoralú Dollar to the first person who can prove me wrong - and it had better be able to convert from MS Word[tm]. So in any case, I've had to go to maintaining the WWW copy concurrently, and thus it might not always look exactly the same as the printed copy. From the WWW, on my site, you can also download the text version in the following formats: Microsoft Word[tm] text source (changes locked out), PostScript[tm] printouts, and plaintext. Email me for requests for any other format. Requests for oddball printer formats will be redirected to the bit bucket. Again, apologies; I just don't have much time anymore. If this is coming to you via Usenet, please note that the Usenet version is subdivided into sections; some news machines choke on very long files. I do not post the section on what you can synthesize from DXM, since it's mostly specialized information. Email me if you want it. Otherwise, posting is once a month, with the DXM Quick Reference being posted weekly. If I'm eating up your bandwidth, I'm sorry; recently a lot of DXM use has been going on and I want to make sure everyone has the facts available. --------------------- 1 Even moderate quantities of alcohol are toxic to the brain and the liver; while the liver can sometimes recover, the brain cannot. Withdrawal from alcohol addiction is physically dangerous, kills large number of brain cells,and can cause brain damage, coma, and death. The difference between a recreational dose of alcohol and a toxic dose is very small (about one order of magnitude). Contrast this with marijuana, which does not damage brain cells, doesn't harm the liver, isn't physically addictive, and is so non-toxic that nobody has ever died of a marijuana overdose. 2 Transient ElectroMagnetic Pulse Electronic Surveillance Technology. Computers give out a lot of electromagnetic noise, which can be monitored from up to a mile away. Typically, signals from the keyboard and monitor are detected. This is actually amazingly easy (and inexpensive) to do, unless your computer is specifically TEMPEST shielded. 3 The Usenet newsgroups rec.drugs.misc and rec.drugs,psychedelic (note the singular form) have since been created. Discussion of DXM is appropriate in the newsgroup rec.drugs.psychedelic. alt.psycho- actives is geared more towards nootropics and non-recreational psychoactive drugs. 4 Methcathinone, or "cat", is an amphetamine-like substance which can be made using commonly available materials and ingredients. Unfortunately, most people don't bother to purify it, leading to all sorts of health problems. ============================================================================== [2] GENERAL INFORMATION ABOUT DXM This section covers general information about dextromethorphan, herein referred to as DXM. IUPAC chemical names are in a sans serif font, in square brackets. Note the following abbreviations: CNS Central Nervous System (brain and spinal cord) CYA Cover Your Ass. Remember this one! DXM Dextromethorphan DXO Dextrorphan OTC Over The Counter (i.e., non-prescription) PCP [1-(1-phenylcyclohexyl)piperidine] (phencyclidine, "angel dust", etc.) PLEASE NOTE that the UK (and European?) name of acetaminophen is paracetamol. They refer to the same substance. If you get nothing else out of this FAQ, let it be this: Remember that the use of DXM is, in general, safe, but please remember the following basic guidelines: o Do not use DXM on a constant or frequent basis! Like alcohol, constant or frequent (more than once or twice a week) use may be dangerous. o Do not use DXM if you have a history of: mental illness, seizures, epilepsy, liver or kidney disorders, or hypertension. o Do not use DXM if you are pregnant or nursing. Dissociatives affect fetal development. o Never use a product containing acetaminophen/paracetamol (Tylenol[tm]). Large doses of acetaminophen/paracetamol can cause liver damage or death. o Never take DXM if you are taking, will take, or have taken within the past two weeks, a monoamine oxidase inhibitor (MAOI). MAOIs include harmine, harmaline, and some prescription drugs for depression and Parkinson's disease. o Never take DXM if you are taking, will take, or have taken within six weeks, the prescription antihistamine terfenadine (Seldane[tm]), or any other prescription, non-drowsy antihistamine (e.g., Claritin[tm] or Hisminal[tm]). o Don't start out with a high dose, or rush in to higher dosage levels. Instead, gradually increase from your last experiences. DXM can be very different at different dosage levels. o Never experiment with hallucinogens without a sober person around to help you in case you get into trouble. o NEVER, EVER, EVER drive under the influence of any intoxicating drug including DXM! o Avoid all products containing DXM and other active ingredients. o Avoid the following DXM-only products, which when taken at recreational doses cause unpleasant effects: Benylin DM o Remember that DXM can sometimes trigger panic attacks in susceptible individuals, especially those inexperienced with DXM. This is a major cause (if not the major cause) of tachycardia (high heart rate) from DXM. All the more reason not to rush in to anything. o Always remember: recreational use of DXM is still a great unknown. The brain you are risking is your own. ------------------------------------------------------------------------------ [2.1] DXM Quick Reference Page [the following can be printed out on one page (66 lines)] o----------------------------------------------------------------------------o | Dextromethorphan (decks-tro-meth-OR-fan), or DXM, is a cough suppressant | | found in over-the-counter medications. It has also been used recrea- | | tionally for at least 30 years, without much harm or publicity. | | Although chemically related to opiates, its effects are closest to | | ketamine's. In addition to suppressing coughs, DXM is used medically | | for diagnostic purposes, and may be useful for a variety of conditions | | from seizures to heroin addiction. In the brain, DXM blocks the | | dopamine reuptake site, activates the sigma receptor, and blocks the | | open NMDA channel. (None of these effects are permanent). | | Occasional recreational use of DXM is probably safe, though side effects | | and risks have been noted (I hereby tell you not to use any recreational | | drug including DXM). Many cough medicines contain ingredients other | | than DXM; some, like acetaminophen (paracetamol) can be fatal when an | | overdose is taken. The commercial preparations which can be used recre- | | ationally are those containing DXM only. In the USA this includes | | mostly Vicks Formula 44 [tm], Robitussin Maximum Strength Cough [tm], | | Drixoral Cough Liquid Caps [tm], and generic equivalents. All should | | list ONLY dextromethorphan hydrobromide under active ingredients. Avoid | | Benylin DM[tm]. The above cough syrups have 3mg/ml (15mg per teaspoon), | | for 360mg per 4oz bottle and 720mg per 8oz bottle; the cough gelcaps | | have 30mg each. Preparations like Robitussin DM [tm] which contain guai- | | fenesin may cause vomiting. | | Never take DXM with, or up to two weeks before or six weeks after, the | | prescription "non-drowsy" antihistamines (allergy medications) | | Seldane[tm], Claritin[tm], or Hisminal[tm]. Never take DXM with, or up | | to two weeks before or three weeks after, a MAOI (Monoamine Oxidase | | Inhibitor) - certain drugs for depression; you will probably be told by | | your doctor if your drug is a MAOI (Prozac[tm] isn't). Never drive under | | the influence of DXM. Don't take DXM more than once or twice a week. | | Don't take DXM if you have a history of mental illness, panic attacks, | | seizures, liver or kidney disease. Some people react very badly to DXM; | | others don't experience anything at all, partly from inherited lack of | | an enzyme. Prozac[tm] blocks this enzyme and may lengthen or change the | | DXM trip. Recreational DXM use may be illegal. DXM may cause false | | positives on drug tests. | | DXM trips vary depending on dosage, and can be lumped into four very | | different plateaus, or types of trips, depending on the amount taken. | | Dosages are given in milligrams per kilogram, so multiply the figure by | | your mass in kg (or pounds divided by 2.2). The first plateau, 1.5 to | | 2.5 mg/kg, is like a slightly intoxicating stimulant; music and movement | | are often pleasurable. The second plateau, 2.5 to 7.5 mg/kg, is intoxi- | | cating, with a "stoning" a bit like that of nitrous oxide or marijuana; | | sounds and sights seem to be on strobe-effect ("flanging"), short-term | | memory is somewhat disrupted, and there are occasional mild hallucina- | | tions. The third plateau, at 7.5 to 15mg/kg, consists of strong intoxi- | | cation, hallucinations, and overall disturbances in thinking, senses, | | and memory; third plateau trips can be unpleasant. The fourth plateau, | | above 15mg/kg, is similar to a sub-anesthetic dose of ketamine, with | | dissociation of the mind from the body, and may be dangerous physically | | and psychologically. Most recreational use of DXM happens at the first | | and second plateau. DXM starts to become toxic around 20 to 30mg/kg. | | While occasional recreational use of DXM is probably safe, some people | | react very badly to dissociatives, especially at high doses, and may | | panic. Frequent DXM use, like frequent alcohol use, may be dangerous and | | should be avoided. Please be safe, be sensible, and use your brain; | | it's the only one you'll ever have. | |----------------------------------------------------------------------------| | From The Dextromethorphan FAQ: Answers to Frequently Asked Questions about | | DXM, v3.0T, by William White ([b w hite] at [frognet.net]). Available on Usenet | | newsgroup rec.drugs.psychedelic and on the World Wide Web via | | http://www.frognet.net/dxm/dxm.html This section may be freely printed | | or photocopied separately provided it is kept intact, on one page. | o----------------------------------------------------------------------------o ------------------------------------------------------------------------------ [2.2] What is Dextromethorphan (DXM) Hydrobromide? o----------------------------------------o Dextromethorphan hydrobromide | 6-methyl group ---> CH3 | is the water-soluble salt of | | | dextromethorphan (DXM) and | N-----CH2 | hydrobromic acid. DXM is a | H : | | synthetic morphine analog, | ___\: | | similar to levorphanol. DXM | / \ | | has been in use in the USA for | ____ / H...\ _|__ | approximately 30 years, and has | / ---- \ / | \ | replaced codeine as an OTC | / \ ____ /....CH2 \ | cough suppressant. It has no | \\ // \ / | traditional opiate-like | \\____// \ ____ / | activity, and is not a substi- | / | tute for codeine as an anal- | CH3O <--- 3-methoxy group | gesic (1-3). | | | Figure 1: DXM Molecule | DXM has been popular as an o----------------------------------------o "underground" recreational drug for at least 30 years (3). It is probably one of the few OTC medicines with any serious recreational use potential (ephedrine might also qualify). It is both extremely safe and very effective as a cough suppressant. DXM's IUPAC name is [(+)-cis-1,3,4,9,10,10a-hexahydro-6-methoxy-11-methyl- 2H-10,4a-iminoethanophenanthrene], and is also (and more commonly) known as 3-methoxy-17-methyl-(9alpha,13alpha,14alpha)-morphinan; CAS-125-71-3 (1). Note: the 3-methoxy and 6-methyl groups are pointed out for later notes. (Oh, just as a side note, I'm proud to say that for once I actually got the IUPAC name right all by myself - the Merck Index lists the same thing). The recreational use potential of DXM has not, in general, been well known, either by drug users or by physicians. Not too long ago, many physicians denied that dextromethorphan was psychoactive at all; whether this was out of ignorance or a desire to prevent recreational use, I do not know (probably the latter). At present, there is an increasing body of knowledge about DXM's potential for recreational use (and abuse) available in medical journals (3-7,133,137,142-144). DXM is unique among recreational drugs for several reasons. First, it is pharmacologically unlike most other recreational drugs (PCP and ketamine being its nearest relatives). Second, its effects can vary considerably from individual to individual. Finally, it can cause quite different effects at different dosage levels, ranging from mild euphoria to full dissociation. ------------------------------------------------------------------------------ [2.3] What is Dextromethorphan Polistirex? Dextromethorphan Polistirex is a time-release formulation of DXM; the "polistirex" refers to a sulfonated styrene-divinylbenzene copolymer complex (1-2). It is occasionally spelled polystirex or polystyrex. Unlike the HBr salt, which is absorbed fairly quickly, this compound is intended for longer duration cough suppression. Most, but not all, people who use DXM recreationally tend to prefer the HBr form (which is also much more readily available). The polistirex preparation will probably increase the ratio of DXM to DXO (see next section). Dextromethorphan polistirex may be more toxic than the hydrobromide version, possibly due to buildup of DXM in the bloodstream (146). ------------------------------------------------------------------------------ [2.4] What is Dextrorphan (DXO)? Dextrorphan is a metabolite of DXM (i.e., the body converts DXM to dextrorphan). The conversion from DXM to DXO occurs via removal of the methyl group at position 6, a process called "O-demethylation". DXO is very similar chemically to DXM, and reacts with the same receptors in the body, but with a very different spectrum. Whereas DXM is strongest at the PCP2 and sigma receptors, DXO primarily targets the NMDA receptor (see chapter 6). The practical upshot is that the dissociative and intoxicating or "stoning" effects are stronger with DXO, whereas the stimulation, cognitive alterations, and psychotomimetic (literally, "psychosis-like") effects are stronger with DXM. Most DXM users find some balance between the two to be the most pleasurable. Too much sigma activity is usually regarded as unpleasantly dysphoric and disturbing, and if prolonged, may be dangerous (102,136). Fortunately, you don't have to worry about converting DXM to DXO; the body does it for you via an enzyme called P450-2D6 (debrisoquine 4-hydroxylase). However, between 5 to 10% of the Caucasian population lacks this enzyme (12-15), and in the rest of us it can vary. Many drugs can temporarily block P450-2D6 from working (10-11) and thus alter the balance between DXM and DXO. For a list of these drugs, see Appendix 1. One of DXM's metabolites, 3-methoxymorphinan, can itself block P450-2D6. As a consequence, taking a second dose some time after the first dose of DXM will probably increase the ratio of DXM to DXO in the bloodstream. Taking the dose all at once, on the other hand, will probably increase the relative amount of DXO. Generally, then, the quicker the dosing, the more DXO and less DXM, and the more NMDA blockade (like ketamine) and the less sigma and PCP2 activity. Subcutaneous injection leads to very little conversion from DXM to DXO. When discussing effects, this text often uses "DXM" to refer to both dextromethorphan and its metabolite, DXO. ------------------------------------------------------------------------------ [2.5] How does one obtain and use DXM? DXM is available at drugstores throughout the world; generally it is not available on the street (I wouldn't trust anyone saying he or she had street DXM; it's probably ketamine, PCP, or something totally unrelated). ----------------------------------------------------------------------