From: [d x m] at [froggy.frognet.net] (Max Tussin) Newsgroups: rec.drugs.psychedelic,alt.drugs Subject: Dextromethorphan FAQ Part 03/06 Date: 7 Apr 1996 23:25:39 -0400 Keywords: DXM DM Robitussin Tussin Dextromethorphan Sigma NMDA P450 X-URL: http://www.frognet.net/dxm/dxm.html passages, being full of helium, losing one's body, or having one's heart stop beating. The actual effect is most likely a sudden cutoff of sensory input from within the body - everything from all the little aches and pains to the awareness of one's own heartbeat go away. This can be very disturbing if a naive user interprets it as heart failure! The second transitional effect is a temporary loss of all sensory input (this does not always occur), as if one were in a sensory deprivation tank. This is often accompanied by severe Lilliputian hallucinations, probably because there is no internal size reference (since the rest of the universe has just gone away). One user reported feeling as if he shrunk down to the size of a proton, and the rest of the world were light-years away. It is my opinion that these transitional effects occur because a critical level of NMDA receptor antagonism (blocking) has been reached, which profoundly changes the nature of the applicable neural networks (e.g., the hippocampus). DXM seems to show two of these major transitions, once at the beginning of the third plateau and once at the beginning of the fourth. Other NMDA blocking drugs (dissociative anesthetics) tend to have only one such transition. The effects at the third plateau itself tend to be very intense, and often very different from earlier plateaus. It is much less "recreational" and much more "shamanic". Keep in mind that a third plateau trip can be terrifying to people who are not psychologically comfortable and prepared. .............................................................................. Sensory Effects The flanging of visual effects, coupled with the loss of stereoscopic vision, becomes so strong that the brain seems to completely give up trying to process vision, leading to a sort of "chaotic blindness". Simple images (e.g., a candle flame) are still recognizable, although given the loss of stereoscopic vision one tends to see two of everything. More complex images, especially images that are not sharply defined, are difficult if not impossible to recognize. Vision, when possible, has a very dream-like quality to it. Simple sounds are still understandable, and one can usually comprehend language, although it may be necessary for the speaker to phrase it in a complex rhythm (see Cognitive Effects). Music euphoria is rare. Touch, smell, and taste are subject to considerable anesthesia, and pain especially may be completely dissociated (it's still there, it just doesn't seem to apply). Body position, kinetic, and balance senses are similarly disrupted. Some people continue to report an enhanced sense of smell on the third plateau. Hallucinations may continue, although they tend to be more abstract and "pre-sensory" rather than being predominantly visual. Oftentimes there is an overall sensation of being surrounded by "grey-ness", which brightens to white light as the dosage increases. At the third plateau, the flanging of sensory input occurs both on a raw level (sounds, images) and on higher levels (words, phrases, faces, etc.) This is, to my knowledge, unique to DXM. Flanging may slow down and speed up, leading to periods of lucidity alternating with periods of semi-consciousness. .............................................................................. Cognitive Effects Cognitive function becomes severely disrupted at the third plateau. Complex tasks, such as mathematics, may be very difficult (though some report little or no difficulty with such skills). Reaction time is significantly delayed. Decision-making is somewhat degraded, although conceptual thought is less affected than concrete thought. Language changes can be quite profound. Sentences may stretch on and on, or alternately be very terse (I call this the "Hemingway Effect"). Words, syllables, and phrases are commonly repeated. This may be related to problems with working and short-term memory. Speech may occur in a very rigid (but not necessarily simple) rhythm, and the user may not respond to speech unless it is in a similar rhythm. The normal "chatter" that goes on inside everyone's brain tends to slow down or stop at this plateau, leaving a feeling of mental peace and quiet. One person reported this as "it felt like the top of my skull was opened into a clear blue sky". .............................................................................. Motor Effects At the third plateau it may be impossible to perform coordinated movements. The large, sweeping motions of the first and second plateau are no longer present. Instead, many users lack both the desire and ability to move at this plateau. Well-learned motor tasks (e.g., speaking and typing) are still possible at this plateau, provided the user doesn't attempt to think about them. In particular, some users have reported that they were able to express their thoughts via typing, without even thinking about it or realizing they were doing so; however, when they looked at the screen or keyboard, they were no longer able to type. This is evidently a phenomenon unique to dissociative anesthetics. .............................................................................. Memory Effects Short-term memory is seriously impaired; working memory is less impaired. Thoughts may get stuck in a loop. Memory encoding of the more mundane experiences of the trip tends to be very bad; expect to forget a lot of the trip itself (a few people report that they begin to recall events from the trip a few days after it has ended; I know of no mechanism for this). The sense of time can be quite distorted, both in terms of chronological placement of events and in the sense of the passage of time. The day after a third plateau DXM trip, some users feel as if there were a break in the continuity of their memory, almost like the close of one chapter and the beginning of another. Some find this a very positive feeling, like a rebirth or rite of passage. It can be disconcerting if experienced without adequate foreknowledge and preparation. One of the most significant memory effects that can occur at the third plateau is the spontaneous recall of memories, often memories which were hidden (consciously or not). This can be a positive experience if one is prepared to review the darkest secrets of one's past; otherwise it range from somewhat embarrassing to very unpleasant and disturbing. The user may also feel compelled to tell her or his companions about these memories (not always a good idea). .............................................................................. Emotional Effects Mood can range from absolute mania to panic. Many people have independently reported feeling as if they were dying, with some sense of fear, although some people do not seem to associate fear with this. Some people report a great increase in approach behavior, as if every event and object were a new experience; others find irrational fears occurring (possibly due to body load). Panic attacks have occurred at the third plateau. This can be a scary experience, especially if one finds one's heart rate skyrocketing due to the panic attack and doesn't know why. The best way to cope with this is to try and calm down, much the same as one would with a bad trip on any other hallucinogen. DXM on the third plateau has a very "shamanic" feel to it. Part of this is due to the sense of rebirth, part from the recall of suppressed and/or partially forgotten memories (some similar effects which I formerly placed on the third plateau (e.g., feelings of contact with other beings) I now place on the fourth plateau as they tend to occur at substantially different dosage levels). Complete annihilation of self can occasionally occur (up to the point of forgetting one's identity) but does not seem to be especially dangerous. Note that, to sober observers, the effects of a third plateau trip can seem very unusual and unpleasant (often much more than to the person tripping). ------------------------------------------------------------------------------ [3.5] The Fourth Plateau Information pertaining to the fourth plateau (roughly, above 15mg/kg) is limited, and what I have gathered will be presented as a general overview. Please note that dosages in these ranges are approaching the danger zone, and under no circumstances should anyone take this much DXM without a sober assistant who can take you to the hospital if the need arises! Fourth plateau doses are similar to fully dissociative doses of ketamine. Generally, people entering the fourth plateau report that they lose all contact with their bodies, often suddenly. This can be somewhat frightening. In particular, the sense of breathing is one of those missing, and people have occasionally interpreted this as evidence that they were dead. The surrounding environment may be evenly colored (usually grey or white), or it may appear vividly realistic, or cartoon-like, or anywhere in between these. Many users have reported experiences very similar to "out of body" and "near death" experiences. In such cases, many report that they have contacted other beings, whose reaction to the user is usually somewhere between curiosity and amusement. Contact with "superior being(s)" has also been reported, sometimes as a raw force, sometimes personified in some way. In the reports given to me, the "superior being" image is more often female than male. Delusions can become fairly involved at this plateau; the crucial factor seems to be whether or not the individual realizes that the belief or thought is drug-induced. Some people, especially those more experienced at this level, have reported that although they were aware that their thoughts were delusional, they didn't really care at the time. In general these delusions are fairly harmless (e.g., "I am a flower in the middle of a field"). Generally an individual in this plateau won't be moving at all, which can be frightening to observers. In many ways this state resembles dreaming. If someone in this plateau does attempt to move, his or her attendants should be very sure that he or she is conscious of these actions, and not responding to a delusional environment. Somewhat surprisingly, many cognitive abilities are still intact. Basic computational skills and long-term memory recall do not seem to be particularly affected. It is also possible for the "body" (actually body and some parts of the mind) to undergo fairly complex tasks while the conscious mind is dissociated. One individual wrote the following of the fourth plateau trip, and I think it is a good explanation both of the trip and of its possible origins: I've come to the conclusion that DXM is almost unique in it's ability to create a truly "alien" experience - one in which major aspects of one's humanity can become entirely irrelevant. Most obviously, one's body can be left behind; even forgotten. The experience of becoming or encountering bizarre life-forms seems at least somewhat common, as are weird, horizonless landscapes or space-scapes. I think alot of this "alieness" comes from having so many of one's ties to the familiar severed. When your body is gone, your mind loses its sense of how "big" or how "small" you are in relation to your surroundings. Hence hallucinations of huge things like galaxies, or of being as large as a mountain, as small as an atom, etc. I think the brain also misses subtle clues like the sensation of breathing, blood flowing through the veins, etc. - things which help remind you that you're human. And at some point, even your memories of the familiar may be suppressed. ------------------------------------------------------------------------------ [3.6] Is there anything beyond the fourth plateau? There may be yet another plateau beyond the fourth. One individual took 3000mg (I don't know his weight) and survived, although he regained consciousness in a strange location and remembered nothing of the trip. Given the toxicity of DXM at doses much higher than this, I don't think anyone should try and go there. You might not be able to come back. ------------------------------------------------------------------------------ [3.7] What happens with long-term or regular use? Long-term or regular use, especially in amounts above 6mg/kg daily, tends to produce several undesirable effects, some of which may be dangerous. These are discussed in detail in Section 4.2. Briefly, tolerance to DXM can build, and as tolerance builds, most of the positive aspects of the drug go away, leaving only the dysphoria and overall "weirdness". There is evidence that NMDA receptors may upregulate with long-term use of DXM (110,134); the practical upshot is that quitting DXM "cold turkey" after weeks of constant use could produce withdrawal symptoms similar to that of morphine withdrawal (though not as intense). Psychological dependence is certainly possible and there are numerous examples of this occurring (3-5; also personal communications). Amotivational syndrome has been reported (usually when the drug wears off). Memory problems seem to be fairly common (and resolve shortly after quitting DXM). I have one report on a DXM addiction which may be cause for concern (related to me personally). The individual was roughly 60kg, and took a dose of 480mg, three or four times a day. The total dosage was thus 1440mg to 1920mg, i.e., 24 to 32mg/kg. This individual took the dosage regularly to maintain a constant state of profound intoxication with a great deal of opiate-like effects; neglecting the dose led to withdrawal symptoms consistent with opiate withdrawal, and possibly also withdrawal from a depressant. The individual had no history of psychological problems. The individual developed severe depression, leading to a suicide attempt and several months in drug rehabilitation. Exactly why some individuals seem to have drug dependence problems with DXM is unknown; it may be a function of chronic high-level use, or it may be a function of individual physiology. PLEASE NOTE that this user built up to this dose over a considerable time; a similar dose in a drug-naive individual could well be fatal. Over the past year I have given this incident some further thought, and I have come to the conclusion that regular high-level use of DXM is probably a very, very bad thing. I have encountered other reports of DXM addiction, as well as studies implicating the NMDA receptor in tolerance and rebound symptoms (110,134). Some of these reports show that chronic DXM use can contribute to depression (4,6,142-144), and at least one study found serious mental deterioration from long-term DXM use (137). To make matters even worse, long-term sigma activity may cause permanent changes in neurons (102), although evidently this is predominantly a problem with other sigma ligands like haloperidol (it took 3 days for DXM to produce the changes haloperidol produced in a few hours). Some users report beneficial effects of chronic high-level use. The effects usually include some antidepressant activity (entirely reasonable given the possible significance of PCP2 receptors), stimulant activity, long-term motivational effect, and cognitive and creative enhancement (this has not been quantified and may be entirely subjective). It is arguable that chronic DXM use may actually be self-medication for depression in some people. Overall, however, most people report that DXM loses its interesting characteristics when used regularly, leaving the more mundane and unpleasant aspects. One former user summed it up well by stating that "being addicted to DXM was like being addicted to heroin. Except not as fun." So please be careful and avoid regular use. ------------------------------------------------------------------------------ [3.8] What are some fun or interesting things to do on DXM? This section lists some things that various people have done on DXM that they have enjoyed. Note that not everyone will agree, and some of these activities may be unpleasant to some. Activities that are pleasant at one dosage may not be so at another. .............................................................................. Listen to Music Probably the most common fun thing to do on DXM, especially at lower doses, is listen to music. Even at higher doses, music can be quite enjoyable, and will often induce fantastic hallucinations. Many people have in fact reported they were unable to hallucinate without music. Some use music to help create an imaginary setting for their hallucinatory experiences. Why music enhances the DXM experience so much, I don't know; other dissociatives don't seem to go nearly as well with music. As for what music is best, that's a matter of personal opinion. Some prefer classical music, saying it brings a transcendent feeling and visions of flight. Rave and techno music are also popular, possibly because of the strong, regular beat. Ambient seems popular, especially towards the end of DXM trips, where it has a soothing effect. Really, though, a lot has to do with what you like. .............................................................................. Dance Many people enjoy dancing on DXM, usually at the first plateau and somewhat less commonly on the second. Third and fourth plateau doses of DXM are almost certainly not compatible with dancing (or most other motor skills). Raves are the most common DXM dancing event, although I see no reason why any other type of dance couldn't be enjoyable as well. Please note that, as with any dissociative anesthetic, DXM can make you less aware of overexertion, leaving you with a generally sore body the next day. Also, as with any stimulant, take care not to overheat or become dehydrated. .............................................................................. Go Swimming (low dose only!) A few users have reported that swimming on a first plateau DXM trip is an ecstatic experience. Evidently, the regular, rhythmic motions of lap swimming go well with DXM's rhythmic nature, and the feeling of the water supporting the body provides a deep sense of calm. There should be little danger with swimming on a first plateau DXM dose, although higher doses could become quite dangerous. Overexertion is always a possibility, but fortunately swimming's low-impact nature may minimize some potential injuries. In any case, if you do decide to try swimming on DXM, never swim alone. .............................................................................. Group Tripping One of the characteristics of the NMDA/sigma class of psychedelics is the ability of people tripping together to synchronize their experiences as they discuss them. This is not unique to DXM; ketamine users have noted the same effect, and although I have no reports I'm certain PCP would act similarly. Group use of DXM was fairly common among some members of the hardcore warehouse subculture in the 1980's in the USA. People would decide on a "destination" or goal for their trips (which some called "vacations"), and choose music, decorations, and other stimuli to match the destination. Destinations ranged from the specific to the mythological (e.g., Hell). Talking during the trip helped maintain synchronization. Most of the time, the environment (sights, sounds, smells, etc.) was carefully crafted to fit the destination. It is interesting to compare this with the use of certain plants, notably Salvia divinorum, among native peoples of Mexico and Central and South America. The "trippers" were advised beforehand on what visions to expect and how they would come, and were told to talk about their experiences as they occurred. I have strong suspicions that NMDA/sigma agents are not unknown among ethnobotanicals. In any case, if you are planning a group DXM trip, it might be a good idea to make sure that everyone is experienced with DXM beforehand, so that they know what to expect. Try to adjust dosage for everyone to place everyone at roughly the same place in the same plateau (group tripping seems most effective at the upper second plateau). If desired, pick a destination beforehand, and adjust your setting to match. Be wary of intense or potentially unpleasant destinations (the "vacation to Hell" mentioned above was undertaken by very experienced DXM users). Try to make sure everyone stays together; many people have reported that having someone leave can ruin the experience. And above all, make sure someone sober is available to watch over you and make sure nothing goes wrong. .............................................................................. Have Sex Sex on DXM is certainly possible, and although many people don't particularly enjoy it, others are enthusiastic about it. DXM can make it difficult for males to achieve orgasm; I have no data on its effects on females. Very large doses of DXM can cause (temporary) impotence, but lower doses usually do not impair, and sometimes enhance, erectile ability. As a consequence of this (enhanced erectile capability and delayed orgasm), at least one DXM user reported that his partner really enjoyed the sex even if he didn't. .............................................................................. Shamanic Journeying (see also Section 3.12) A few users have successfully attempted shamanic journeying and other out-of-body or "psychonaut" work. From a skeptical viewpoint, these experiences are nothing more than hallucinations, although I'd like to point out there's a lot more we don't know about the mind and brain than we do know. In any case, success seems to depend on several factors. Prior experience, both with DXM and with journeying or other out-of-body work, are strongly encouraged if not necessary. The day should also be spent in preparation of the experience, preferably in a natural environment, as the imagery of the journey may be composed of bits and pieces of your daily experience. Simple, regular drumming is, of course, always useful and may be very beneficial for DXM-induced journeying (drumming tapes are available from New Age and occult suppliers). .............................................................................. Hang out in a Sensory Deprivation Tank Call "Tools for Exploration" at 1-800-456-9887 and order their catalog. Yes, you can buy them, they're about $4000; you can also make one yourself. Basically, you float in darkness in a foot of water saturated with half a ton of Epsom salts (I have no idea exactly where one gets half a ton of Epsom salts, but that's another problem). You can also pipe in music. I have no affiliation with this company, by the way. Anyway, the end result is that you manage to cut off sensory input. This sounds somewhat redundant, but can actually be quite useful for dissociatives from what I understand. Hey, if you do it often enough, maybe they'll make a movie about you. (Just don't turn into a monkey). ------------------------------------------------------------------------------ [3.9] What are some things to avoid on DXM? This is a small list of some of the things which people have reported were particularly unpleasant, boring, or otherwise unenjoyable. .............................................................................. Heavy Exercise Most individuals who have exercised under the influence of DXM have reported negative effects such as nausea, vomiting, cramping, and a general loss of the more enjoyable aspects of the trip. This seems to become more and more significant with higher doses of DXM. The one exception seems to be swimming, which if done on a first plateau DXM dose can be enjoyable. .............................................................................. Driving DXM is an intoxicating drug, and no intoxicating drug should be used when you are driving. Ever. If you're pulled over, the cops will know you are on something, as DXM strongly interferes with normal eye movements at recreational levels. They may not know what you're on, but they can still bust you, and even if you never get formally charged, this is definitely not a fun tripping experience. Not to mention, by driving (or operating heavy machinery) on DXM you are placing yourself and potentially a lot of other people at risk. The highways are full of enough carnage as it is, and there's no excuse for adding to it. Quite frankly I think that anyone who drives while intoxicated (on anything) is committing an act of attempted manslaughter (if not murder) and repeat offenders should be charged and tried as such. That's probably an extreme position, but I think far too many people are willing to blame the alcohol (or drug) for the user's arrogance and stupidity. .............................................................................. Going to Class or School Many people have had the experience of going to classes drunk, stoned, or otherwise intoxicated. Going to class on a low dose of DXM should be fairly similar. Once probably won't hurt you, although it certainly isn't going to help you either. Doing this regularly is definitely bad news, as DXM will interfere with memory when used regularly, and may cause cognitive impairment with long-term use. High doses of DXM are even worse, since the dissociative effects can lead to highly inappropriate behavior. To top it off, as it becomes more difficult to judge the appropriateness of behavior, the fear at doing something that will get you laughed at (or worse) can make a trip turn unpleasant. A special note for people still in high school (or younger): don't do DXM, or any other drug, in school. Yes, school can really suck. The classes are boring, repetitive, unchallenging, and full of potentially useless information. The teachers are often (but not always!) more interested in hearing you regurgitate facts than have an original thought. The administrators generally aren't interested in you as a person, they're interested in making sure the school runs smoothly and that they get paid. And your peers usually don't give a rat's ass about your feelings; they're too busy coping with newly found hormones and playing Cooler Than Thou. And so, I might add, are you, in all likelihood. During this time, many students with half a brain in their heads end up going through the usual sort of teenage existential angst (you'll know it when you get there). This is, I think, one of the rites of passage of today's youth, which has the potential to liberate one from being completely under the control of what one's peers think of as cool. It also has the potential to get you into a lot of trouble, especially with drugs, and DXM is no exception. Don't get me wrong; I don't think drug use is inherently any more or less wrong for teenagers than for adults. In practicality, however, one needs a certain level of emotional and intellectual (and possibly physical) maturity before responsible drug use becomes likely. And responsible people know there are times and places not to use intoxicating or otherwise mind-altering substances. So in the mean time, avoid using drugs in school. Many of your teachers and administrators will know (they may seem dumb as a post. Don't believe it). Your grades will probably suffer, and for all their seeming irrelevancy, good grades are really one of the better tickets out of a life of boredom. You may also develop a stubborn habit, as the use of a drug becomes associated with the everyday activity of going to school. Finally, the bad trip potential shouldn't be ignored. As for what to do instead, well, there's no easy answers there. Some people find fulfillment in reading Sartre and Thoreau, others in reading X-Men and romance novels. Regular exercise really does help, as with so many other problems in life, and it helps one to cope with boredom and mundanity. Don't neglect your mind either, even if your teachers do; you can be your own teacher (and a damned good one at that). Question everyone and everything; it's the only way to learn. And above all else, try to keep a sense of humor; things that seem vastly important now will seem a lot less serious in a few years. .............................................................................. Dose "Boosting" and Redosing Simply put, dose boosting (i.e., taking a second dose as the first one wears off) doesn't work. By the time you take the second dose, the NMDA receptors have already started to compensate, and saturation of P450-2D6 by 3-methoxymorphinan means that most of the DXM you take won't be nearly as effective. Sigma agonist activity will increase, bringing an overall sense of dysphoria and (temporary) disturbances in thought. Sorry, but there doesn't seem to be an easy way around this; even if you used DXO, the brain still responds quickly to NMDA blockade, as users of ketamine or PCP will attest. Just wait a few days to a week and try again. The one exception to this seems to be a first plateau dose, which (with practice) can be maintained for some time, leading to a prolonged stimulant effect. This is probably due to the dopamine reuptake inhibiting effect of DXM (absent with DXO), similar to that of bupropion (Wellbutrinú) or cocaine. Prolonging this will, however, intensify the "crash" and is probably not a good idea. ------------------------------------------------------------------------------ [3.10] Why does DXM affect different people so differently? Several reasons. First off, there is a liver enzyme known as cytochrome P450-2D6 (also CYP2D6, or debrisoquine 4-hydroxylase), which metabolizes DXM. Some people lack this enzyme, and of those who have it, subtle genetic variations can result in different activity (10-18). Thus, while one person may metabolize DXM quickly, another may not (there are other pathways which are much slower). Certain drugs - such as fluoxetine (Prozacú) can inhibit this enzyme (39). A list of P450-2D6 inhibiting drugs is given in Appendix 1. Second, some of the effects of DXM are due to the DXM itself, and some are due to its metabolite dextrorphan (DXO), which is more similar to PCP and ketamine in its neuroreceptor activity (43). Some individuals may metabolize high doses of dextromethorphan to dextrorphan more quickly than others. Incidentally, my opinion - based on anecdotal evidence of recreational DXM use while on fluoxetine - is that both DXM and dextorphan are responsible for the psychoactive effects (yes, I changed my mind). There is evidence to show that DXM is definitely involved, and may be responsible for most of the lower plateau effects (32). Third, NMDA receptors are intimately involved in many areas of the brain where a great deal of processing takes place, such as the hippocampus and the cerebellum. In contrast to the biogenic amine neurotransmitters (serotonin, dopamine, noradrenaline, histamine, and acetylcholine) which seem to play a modulatory role, excitatory amino acids and NMDA receptors are involved in the "nitty gritty" of brain processes. It is possible that, due to this extensive involvement, many different cortical and limbic circuits may be affected. In fact, DXM affects at least four different binding sites (see Section 5.2), and each of these is subject to subtle variance from person to person (44). There are probably a gazillion other reasons why DXM has such a wide range of effects. Subtle differences in brain chemistry, notably in terms of sigma receptors, may also be involved. Psychological set, as well as setting, are undoubtedly also part of the problem. ------------------------------------------------------------------------------ [3.11] How does DXM compare with other dissociatives? Third and especially fourth plateau DXM experiences seem to resemble ketamine experiences, and based on reports of people who have done both, the similarity is considerable. This is not surprising, since both DXM and ketamine block NMDA receptors. Although I have yet to receive any reports comparing DXM to PCP, I would imagine that, since PCP and ketamine are similar, upper DXM plateaus should resemble PCP as well. Lower DXM plateaus, however, seem to show a number of differences from other dissociatives. This is most likely due to DXM's unique potency at the dopamine reuptake site (the PCP2 receptor) and the sigma receptor. DXM's ability to block dopamine reuptake is probably the biggest factor in its popularity at lower plateaus; neither ketamine nor PCP have substantial ability to do this. When DXM is taken in divided doses, or when it is taken with an inhibitor of the P450-2D6 enzyme (e.g., fluoxetine), its sigma agonist activity becomes much stronger in comparison to its effect at the NMDA receptor. As expected, DXM taken under these conditions differs from other dissociatives, and is sometimes reported to induce schizophrenic-like thought processes and other unpleasant effects. ------------------------------------------------------------------------------ [3.12] Is there any connection between DXM and out-of-body or shamanic experiences? Maybe. It is somewhat established that many aspects of DXM trips, especially higher plateaus (3rd and 4th), have shamanic or out-of-body characteristics. Some users have reported experiences which are very similar to published out-of-body and/or near-death experiences (many of the users who reported these are fairly skeptical about that sort of thing). One note though - DXM hallucinations and imagery tend to derive to a great extent from what you've encountered throughout the day. If you've played DOOM[tm] all day, you're going to have a difficult time coming up with any images other than muck-walls and demons. I can think of two explanations for the shamanic character of higher DXM plateaus.. The first one, which I prefer, is less fun but probably a lot more useful. Basically, it is possible that many of the aspects of out-of-body or shamanic journeying experiences derive from neural network states which DXM can approximate. To start with, unlike most drugs which target very specific, limited clusters of neurons, DXM tends to affect entire neural nets (via the NMDA receptor). A general "shutdown" or interference with some of these neural nets may produce many of the experiences associated with near-death, and could possibly be mimicked by DXM. Some (very simple) models have demonstrated "spontaneous memory recall" effects when the network is severely disrupted or disconnected; again, DXM may mimic this. The only problem here is that the NMDA receptor, although extensive, is involved in learning more than "ordinary" neural network signals. There is also a somewhat different, and possibly more compelling, neural network model. It is possible that, in addition to encoding short-term memory, NMDA receptors are involved in "synchronizing" or "interfacing" the conscious mind to the rest of the brain and body. After all, we experience things in terms of our previous experiences, so raw sensory data must be translated into the "language" of memory before it can be consciously experienced. When enough NMDA receptors are blocked, the mind and body/brain lose the ability to communicate. Each is still capable of "doing its thing", however; in particular this might explain why it is possible to undertake fairly complex tasks under partial or full dissociative anesthesia, but attempting to consciously control these tasks fails. I'm also of the opinion that hypnosis and trance states may involve the same processes. Although the exact reason is unknown, several techniques for inducing shamanic journeying involve the use of regular, even drumming. Several high-dose DXM users have reported flanging of sound in a very similar pattern and frequency to this drumming. If the flanging is the result of the "uncovering" of a regular neural network "sweep" wave, it is possible that drumming may induce network states similar to those caused by DXM. At higher levels especially, there is considerable saturation of sigma receptors. These receptors may be involved in psychotic states and schizophrenia. While I don't believe that people who have out-of-body experiences are psychotic, it is possible that these states may be temporarily inducible in anyone. The other explanation, which is considerably further out on a limb than I want to go, is that DXM, by disconnecting the senses from the mind, allows the mind to wander freely in the spiritual universe. Some users have reported feeling like this at the time, in particular feeling that the physical world wasn't real, that they weren't a part of it anymore. I wouldn't advise testing this out. In any case, and regardless of what you choose to believe, there are some general guidelines that seem to be fairly universal to most systems of shamanic journeying. Accept or reject them as you see fit (remember, though, better safe than sorry). o If you go somewhere, always return by the same path. o Treat any entity you encounter with respect. They can't physically hurt you, but they can make your trip (and possibly your life) distinctly unpleasant. You can't really hurt them, either, but your chances of being able to make their lives unpleasant are probably a lot slimmer. o Remember, if you leave your body behind, another entity may want to use it. Although some cultures encourage this, most people find it disturbing. It may be possible to prevent or control this by leaving "guards" or defenses. This is beyond the subject of this text, but serious psychonauts may wish to investigate this aspect of magick. o Unpleasant entities generally feed off fear and anger; avoid getting stuck in a vicious cycle. o If an entity gives you its name, consider it your secret, and don't tell anyone else. ------------------------------------------------------------------------------ [3.13] Why can't I hallucinate on DXM? Some people have trouble achieving hallucinations on DXM. Here are some suggestions that may be helpful, based on reports I have received (note: none of this should be taken as advice in any way; I'm just passing this along): o Place yourself in partial or complete darkness. Most NMDA/sigma agents seem to give the best hallucinations when there is little or no visual input. o Close your eyes. It is almost always easier to get closed-eye visuals (CEVs) than open-eye visuals (OEVs), and DXM is no exception. o Listen to music. Music often brings about intense visuals, sometimes even open-eye visuals. o Mentally focus on your phosphenes - those little blips and squiggly patterns that appear in your field of vision in darkness (yes, everyone has them; not everyone notices). For whatever reason, this seems to help start hallucinations. o Imagine things. This seems to help start the process in some people. o Dose with other people and synchronize your trips. o Increase the dosage the next time you trip. o Decrease the absorption time the next time you trip. If you are taking gelcaps, break them open. If you are drinking syrup, drink it on an empty stomach. o Increase the absorption time the next time you trip. Some people have reported this to be useful. For example, if taking gelcaps, take one every 5 minutes until all are taken. o Combine with cannabis (marijuana). (Note: this is, of course, illegal, and I advise you not to do this). o Inhale a balloon of nitrous oxide (again, this is probably illegal, and I'm advising you against it). ============================================================================== [4] DXM SIDE EFFECTS AND OTHER THINGS TO AVOID Like all drugs, DXM has side effects and risks. While mild in most people, they cannot be ignored. DXM is not a "safe drug" or a "harmless drug" (two oxymorons if there ever were). ------------------------------------------------------------------------------ [4.1] What are the potential side effects and risks of occasional use? Although generally very safe, you should be aware of some of the possible adverse effects that can occur with occasional use of DXM. These are ordered roughly by frequency of reporting, but I don't have any hard figures yet. .............................................................................. Nausea and other gastric disturbances Probably the most commonly reported side effect is nausea, most likely a simple result of gagging down a bottle or two of cough syrup. People who use the gelcap or capsule preparations do not, in general, experience nausea, although DXM itself can occasionally cause nausea (this is uncommon). Many cough syrup preparations can cause considerable amounts of bloating and gas. Expect to pass gas for the next day. Stomach cramps and other gastric disturbances, probably from the amount of sugars and glycerine, are also common. Preparations with guaifenesin tend to induce vomiting at recreational DXM levels. Mixing DXM with large amounts of alcohol can have the same effect; one poor individual who mixed DXM with a large quantity of alcohol vomited for over two hours. .............................................................................. Itching and allergic reactions Ah, the "Robo Itch" . Some people get it and some don't. There's evidence that at least some of the cases of "Robo Itch" are a psychological reaction to mild anesthesia, but some are probably a result of histamine release - not necessarily an allergic reaction per se, but a possible consequence of DXM's pharmacology. The itching tends to go away, and although scratching is pleasurable (and a loofah is wonderful), take care not to overdo it. Actual allergic reactions have occurred, and often these are a result of the "inert" ingredients, usually one of the dyes (e.g., tartrazine). A topical antihistamine spray might be a good idea. You should probably always keep an oral antihistamine on-hand, at least during your first few DXM experiences (or when trying out new preparations). Just remember not to use any prescription, non-drowsy antihistamine with DXM. Diphenhydr- amine (Benadryl[tm]) is a good OTC antihistamine that is regarded as safe to combine with DXM. Note that some people find the itching to be extremely unpleasant. .............................................................................. Hangovers Yes, hangovers can happen. See Section 4.5. .............................................................................. Pupil dilation Although it doesn't happen to everyone, many report substantial pupil dilation on DXM, similar to the pupil dilating effect of LSD. This is probably a dead giveaway that you're "on something", so you might want to know if it happens to you before trying to get away with being on DXM in public. And may your eyes dilate to the size of saucers and attract cops for miles around if you ever drive on DXM! .............................................................................. Tachycardia (Increased heart rate) This seems to be fairly common but not particularly serious; generally, a heart rate in the range of 90 to 120 can occur. This is probably a side effect of the stimulant qualities of DXM. Substantially higher heart rate may indicate a panic attack. .............................................................................. Hot and cold flashes Hot and cold flashes during the trip are to be expected, and are not generally serious. One user reported frequent extreme hot flashes, which eventually got bad enough that he sought medical assistance. A few people have reported hot flashes several days after the DXM trip is over. .............................................................................. Hyperthermia One user reported a case of hyperthermia (increased body temperature) which could have been dangerous. See Section 4.8. .............................................................................. Panic attacks Several users have reported panic attacks, and I am beginning to think some people may be susceptible to this from DXM. This seems to be worse when the DXM is combined with other drugs, including marijuana (cannabis). The trouble with a panic attack is, once you realize you're having one, it can make you feel out of control of the drug experience, which makes the panic attack even worse. This is a difficult vicious circle for some people to break. Fortunately this mostly seems to happen with high doses (around 10mg/kg and up). .............................................................................. Overexertion As DXM is a dissociative anesthetic, it will make you less aware of the normal body senses, including muscle fatigue and pain. As a result you can easily over-exert or over-stretch yourself, especially if you are out dancing or engaging in other physical activity. Pay close attention to your body if you plan on moving a lot. On a somewhat related note, many people report that heavy exercise under the influence of DXM can cause nausea. This seems to occur mainly at the second plateau and above; in contrast, one user reported swimming on a first plateau dose to be a very pleasant experience. .............................................................................. Psychotic episodes Psychological side effects can be quite varied. Bad trips are certainly possible, as with any drug. As with other psychoactive drugs, especially hallucinogens, there is always the chance that a mental illness may be triggered by the experience. Keep in mind that DXM is related (although distantly) to PCP, and some people really don't get along well with dissociative anesthetics. The chance of experiencing a psychotic episode probably increases with dosage. Many of the cases of DXM "abuse" in literature have concerned psychotic episodes (the same is true for LSD). This probably seems more disturbing than it really is; after all, these are cases compiled from hospital visits. The vast majority of DXM users do not experience psychotic episodes. .............................................................................. Hypertension (high blood pressure) I have heard of this happening exactly once, when DXM was used in combination with pseudoephedrine. DXM itself may be capable of inducing hypertension, since it is a dopamine reuptake inhibitor; however, at doses high enough to do this, DXM's NMDA blocking activity seems to counteract this problem. In any case, be careful when mixing DXM with other stimulants (caffeine is probably OK), and don't use DXM if you have high blood pressure. .............................................................................. Miscellaneous Even though DXM has been successfully used to prevent seizures, it may actually induce them at high dosage levels (45), especially in epileptics (145). You want to avoid this. Some users who have taken very high dosages of DXM (above 15mg/kg) have lost motor function to the point of choking on their tongues (or at least feeling like it; I've been told that this is technically impossible). Obviously, nobody should be experimenting at this level without a (sober) assistant. If this happens, seek medical assistance. While I cannot vouch for the efficacy or safety of this procedure, I have been told that one can maintain the airway by grabbing the person's tongue and holding it out of his or her mouth until motor function is regained. Don't try to insert anything into the person's mouth; it could slip and make the problem worse. One user with a blind spot in one eye due to a stroke reported hallucinations in the blind spot persisting for several days. This eventually went away but was not particularly enjoyable. LSD, cannabis, and alcohol all failed to induce this effect. Ketamine did, however. ------------------------------------------------------------------------------ [4.2] What are the potential side effects and risks of regular use? Mania Prolonged, regular use of DXM has some definite risks. The most common is mania; this has been reported in people who used large amounts of DXM (especially to self-medicate depression) (1-3,133,137,142-144). This is probably a result of dopamine reuptake inhibition, but sigma receptors may be involved as well (see Section 6). On the other hand, one user who had formerly used the antidepressant bupropion (Wellbutrin[tm]) reported a similar but somewhat stronger antidepressant effect from DXM, though with greater adverse side effects. .............................................................................. Cognitive impairment Recently, an article in Journal of Psychiatry and Neuroscience presented a case of significant cognitive impairment associated with long-term DXM use. The individual consumed 1500mg DXM, plus 5000mg guaifenesin, at least once per week for at least a year. From the article it seems that he was probably a slow metabolizer, lacking the normal P450-2D6 enzyme. It also mentions that he abstained for "several weeks" without improvement, possibly indicating permanent brain damage. The authors hypothesize that this unfortunate individual may have had a temporal lobe seizure disorder (137). The reports I have received from several long-term (1-2 years) high-dosage users do not show lasting cognitive impairment, and this case seems to be the exception rather than the rule. Personal susceptibility may have a lot to do with it. Still, please be careful about regular use. .............................................................................. Memory impairment DXM, like any other NMDA blocking agent (including alcohol), will impair short-term and possibly long-term memory. This should go away after the user has stopped taking DXM, although it may take some time for things to return to normal. .............................................................................. Habituation and Psychological Addiction Addiction is certainly possible but not common; see Sections 4.3 and 4.4. .............................................................................. Tolerance and Physical Addiction Again, possible but not common. See Sections 4.3 and 4.4. .............................................................................. Neurotoxicity Another possible effect of long-term DXM use is neurotoxicity, specifically toxicity to 5HT (serotonin) secreting neurons. This has not been observed, but would be consistent with DXM's hypothesized ability to induce 5HT and dopamine release (52). Such neurotoxicity would be similar to the neurotoxicity resulting from use of MDMA (ecstasy). On the other hand, MDMA's neurotoxicity in humans is itself doubtful. Recently, animal studies have shown that PCP can cause damage to specific types of brain cells, probably as a result of neurotransmitter release triggered by NMDA blockade (101,136). This effect is known as NMDA Receptor Hypofunction (NRH), and currently it is not known just how much of a problem it is. It is possible that NRH may be partly responsible for alcohol's neurotoxicity. However, nobody knows if NRH is relevant in humans, nor is it known whether DXM would induce the same effect as PCP. .............................................................................. Excitotoxic Rebound Excitotoxic rebound is a process by which brain cells, accustomed to a lower level of activity, essentially "burn themselves out" when a depressant drug is removed. Alcohol, benzodiazepines (tranquilizers, e.g., Valiumú), and barbiturates (sedative-hypnotics or "downers") are well known for causing severe excitotoxic rebound. It is possible that regular use of DXM could lead to an upregulation (i.e., increase in number) of NMDA receptors as the body tries to compensate for the blocking effect of DXM. Sudden cessation of DXM could leave the brain cells with too many NMDA receptors, leading to excitotoxicity. This is certainly just speculation, and although probably nothing to worry about, it might be another good reason to avoid regular DXM use. .............................................................................. Psychosis Some research has linked sigma receptors to schizophrenia (46-49), and chronic use of NMDA antagonists has been shown to upregulate (increase the number or activity of) dopamine receptors (50). This could theoretically mean that DXM could trigger schizophrenia in susceptible individuals, although nobody knows for sure. PCP has been known to trigger psychosis in susceptible individuals, and DXM may have the same capacity. Along a similar line, people using dissociative anesthetics on a regular basis sometimes develop a temporary psychosis a bit like mild schizophrenia. Usually the users don't notice until people tell them they are beginning to act inappropriately or weird. DXM may cause this problem if used regularly. Some researchers have suggested that chronic NMDA blockade and/or sigma activity may be responsible for schizophrenia or Alzheimer's disease (101). ----------------------------------------------------------------------