Dextromethorphan (DMX)

New Jersey Drug Manufacturing and Distribution Criminal Defense Attorneys, Monmouth, Ocean and Middlesex County

Drug Information About Dextromethorphan

DXM_DosesStreet names:  DXM, Tussin, Dex, Robo, Robotrippin’, Skittles

Drug Classification:  DXM is unscheduled in the US and the FDA regulates its sales. It is legal to buy, posses, and ingest without a prescription, though each product requires FDA approval prior to reaching store shelves. Some people who sold DXM have been convicted of misbranding drugs.

General Drug Information

Dextromethorphan, or DXM, is a semi-synthetic opiate derivative available legally in cough syrups and gel-caps over-the-counter in the United States. It is most commonly found in products with “DM” or “Tuss” in the name, and ingested orally (though pure DXM powder is sometimes snorted.)

DXM is chemically similar to codeine but lacks its strong sedating and pain-killing effects. This has led the widespread replacement of syrups containing codeine by syrups containing DXM.

The effects of dextromethorphan will make a user feel “spaced-out,” off-balance, or otherwise separated from their body. The drug is similar to other dissociatives like Nitrous Oxide, Ketamine, and PCP.

Dangers of Recreational Use

DXM is found in liquid cough syrups, tablets, lozenges, and gel-capsules that are swallowed in excess in an attempt to consume a large quantity of the drug. Recreational doses of DXM can be 20-50 times higher than what is medically recommended, which can create dangers when many products contain additives to discourage their recreational use. These additives may be other medications, like expectorants (like Guaifenesin), antihistamines (like Chlorpheniramine Maleate), or painkillers (like acetaminophen), that when consumed in excess induce vomiting and can cause liver damage. They may also be artificial sweeteners or food coloring that is not listed under active ingredients.

Recreational users of DXM always run the risk of ingesting a large amount of the wrong over-the-counter medication, leaving them with health problems or in a “puking fit.”

Side Effects

The effects of DXM vary according to dosage level and are generally classified into 4 plateaus. The first two, or “lower,” plateaus are similar to each other and produce mild stimulation and intoxication.

A low dose and first plateau experience generally includes light euphoria, mild stimulation, intensified emotions, and disturbances in balance and motion similar to those of alcohol. Moderate doses to the second plateau will intensify these effects, though they will eventually subside to a heavier, dreamy, more sedated feeling. This may result in a zombie-like, rigid walking motion (“robo walk”). Sounds and sights may appear “choppy” (flanging) to the user as sensory input is disrupted. Double vision, color distortions, and disorientation may occur. The likelihood of a hangover increases at higher doses.

The upper plateaus are less “recreational”  than the lower plateaus and are more shamanic and mystical. The probability of nausea and vomiting or dysphoria increases at these plateaus. Many users report intense vertigo and must lie down for their experience as moving too much induces nausea.

Upper doses may produce visual and auditory hallucinations, often blurred and choppy vision and flanging sounds or voices. The risk of panic attacks or irrational fear also increases at these doses. Users have reported profound disorientation and confusion, feelings of unreality and disconnection with the world, and unexplainable depression and fear. Many say the upper plateaus are unpleasant and that they would not take that same level of DXM again.

Physically, those under the influence of DXM will exhibit increased heartbeat, slurred speech, and poor motor function. They may itch and scratch their skin or have rashes and red blotches. Upset stomach, nausea, vomiting, and diarrhea are all common symptoms.

Signs and Symptoms of Overdose – The Dangers of DXM Abuse

Regular use of DXM produces tolerance quickly, requiring higher doses to reach the same effects. These higher doses increase the risk and severity of side effects. High doses and chronic use may cause intestinal and digestive problems, kidney damage, and even brain lesions (though additional research suggests this last concern may be unfounded). Health problems can result from ingesting large amounts of additives – acetaminophen can cause permanent liver damage. While DXM is considered non-physically addictive, many chronic users report intense mental and emotional reliance on the drug and a hangover period after usage was ended.

DXM should not be combined with alcohol, as this potentiates both drugs and increases their physical effects. DXM should also not be combined with MDMA, as both chemicals are absorbed in the same place in the liver, leading to higher effects from DXM and greater risk of heatstroke. DXM overdose is characterized by unresponsiveness, lapses in or lack off consciousness, muscle twitches, bluish fingernails or lips, and slow and shallow breathing. These are potentially signs of an impending coma.

If users have been taking MAO inhibitors or SSRI’s, recreational use of DXM may result in the dangerous and potentially-fatal serotonin syndrome where too much of the neurotransmitter serotonin is released in the brain. Signs of serotonin syndrome are muscle stiffness, convulsions, strange, bizarre, or otherwise altered state of consciousness, fever, and unstable heart rate. Both an overdose on DXM and serotonin syndrome warrant immediate emergency medical attention from professionals.

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