Dextromethorphan abuse

Dextromethorphan is sold alone or, when mixed with other drugs such as phenylpropanolamine or ephedrine, is marketed as ecstasy, after the widely abused street drag. Of course, this formulation is not the same compound as ecstasy. It has also been used to deceive persons who are seeking to buy narcotics such as heroin. The greatest amount of dextromethorphan abuse so far has occurred with the over-the-counter cough formulas. Reportedly, dextromethorphan is also being sold on the Internet in pill and capsule forms as well as the powder. 

Noonan, Craig, et al. Dextromethorphan Abuse Among Youth. Archives of Family Medicine 9 (2000) 791. 

Dextromethorphan. Dextromethorphan has the opposite steric configuration to codeine and morphine, is devoid of analgesic effects, but is as potent an antitussive as codeine. It is the most commonly used antitussive worldwide. Systematic studies concerning its abuse liability are few. In the earliest report (Isbell and Fraser 1953), no abuse liability was found with oral doses up to 100 mg. However, there are many case reports of dextromethorphan abuse and endemic use principally among young people (McElwee and Veltri 1990). 

Modi D, Bhalavat R, Patterson 2nd JC. Suicidal and homicidal behaviors related to dextromethorphan abuse in a middle-aged woman. J Addict Med Mar-Apr 2013 7(2) 143-4. 

Logan BK, Yeakel JK, Goldfogel G, Frost MP, Sandstrom G, V Kckham DJ. Dextromethorphan abuse leading to assault, suicide, or homicide. 

Anecdotal reports of abuse of dextromethorphan-containing cough/cold products has increased, especially among teenagers. 

Dextromethorphan hydrobromide is the D-isomer of levorphanol. It lacks CNS activity but acts at the cough center in the medulla to produce an antitussive effect. It is half as potent as codeine as an antitussive. Anecdotal reports of abuse exist, but studies of abuse potential are lacking. It has few side effects but does potentiate the activity of monoamine oxidase inhibitors, leading to hypotension and infrequently coma. Dextromethorphan is often combined in lozenges with the local anesthetic benzocaine, which blocks pain from throat irritation due to coughing. 

Dextromethorphan is the dextrorotatory stereoisomer of a methylated derivative of levorphanol. It is purported to be free of addictive properties and produces less constipation than codeine. The usual antitussive dose is 15-30 mg three or four times daily. It is available in many over-the-counter products. Dextromethorphan has also been found to enhance the analgesic action of morphine and presumably other -receptor agonists. However, abuse of its purified (powdered) form has been reported to lead to serious adverse events including death. 

Similarly, some OTC medications, such as cough and cold medicines containing dextromethorphan, have beneficial effects when taken as recommended but they can also be abused and lead to serious adverse health consequences. Parents should be aware of the potential for abuse of these medications, especially when consumed in large quantities, which should signal concern and the possible need for intervention. 

For each drug, the prevalence of abuse was partly attributable to its absolute availability — for example, the over-the-counter status of dextromethorphan (DXM) or the expansion of fentanyl and butorphanol from inpatient to outpatient use. But the pattern of abuse for each drug was distinctive and probably could not have been predicted from the available experimental abuse-liability data. 

Darboe, M.N., Keenan, G.R., Jr., and Richards, T.K., The abuse of dextromethorphan-based cough syrup a pilot study of the community of Waynesboro, Pennsylvania, Adolescence, 31, 633, 1996. 

There is increasing concern over the street abuse of dextromethorphan, which is available in a variety of products. There have been a few reports of abuse and a handful of case reports of overdose and death. Nevertheless, dextromethorphan was specifically left out of the Controlled Substances Act (CSA) of 1970 and has not been added to the Drug Enforcement Administration (DEA) scheduling process despite these reports. This decision was made because dextromethorphan is not considered a narcotic and is generally thought to have a low addiction potential. However, the DEA is monitoring dextromethorphan and may add it to its list of controlled substances at some point in the future. 

There have been reports that dextromethorphan is sometimes sniffed when used in a recreational abusive situation. 

Contrary to the effects associated with the therapeutic use of dextromethorphan, those who abuse the drug report a variety of mind-altering effects such as visual hallucinations, changes in time perception, and an increased sense of perceptual awareness. It has been determined that a small amount of Robitussin can produce intoxication in most persons. Abusers have been found to use anywhere from one-half bottle to three or four bottles of Robitussin every day. Drinking large amounts of Robitussin or other cough syrups tends to cause vomiting. 

A recent survey of 315 students in the fourth through twelfth grades who used over-the-counter medications to become intoxicated found that a majority used a medication that contained dextromethorphan. The study found that the risk of abusing dextromethorphan increased with age, and that dextromethorphan has a greater abuse potential than previously identified in scientific literature. 

Dizziness may occur in a small proportion of cases when dextromethorphan is used therapeutically. Mental confusion and central nervous system overstimulation may occur when there is an overdose of the drug. When dextromethorphan is abused, there is an increased risk of motor impairment that could affect activities that require quick judgment and reaction, such as operating heavy machinery. 

No serious long-term effects are associated with the therapeutic use of dextromethorphan. However, information has not been adequately collected on the health effects associated with the long-term abuse of dextromethorphan. 

While there is a general belief that dextromethorphan is not addictive, there is an increasing amount of information that suggests otherwise. The fact that many abusers repeatedly abuse the drug makes it a strong possibility that dextromethorphan is an addictive drug. 

The World Health Organization classified dextromethorphan as a non-analgesic, non-addictive substance in the late 1960s. In 1970, the Controlled Substance Act further added weight to this notion that dextromethorphan is not in the same class of drugs as its opiate forbearers in its abuse potential. This led to the decision of the DEA to leave dextromethorphan off its schedules of controlled substances. 

Despite the undoubted increase in the abuse of dextromethorphan, it is not scientifically known how addictive the substance is. Officially, it is not considered a strongly addictive substance. However, the pattern of abuse would suggest that its addictive potential is greatly underrated. 

Conventional treatment programs can help those who abuse dextromethorphan, but they must become informed about the specific features of the drug. These programs must also test for the drug using a less familiar test. 

With the exception of some restrictions on product placement in states such as Utah, there are no significant legal consequences for using, abusing, producing, and selling dextromethorphan. 

The Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA) are aggressively monitoring the use and abuse of dextromethorphan. It is conceivable that dextromethorphan could be first classified as a drug obtainable only with a prescription. Furthermore, the DEA could place dextromethorphan on one of its schedules of controlled substances, which would force physicians, pharmacists, nurses, and hospitals to record the administration of the drug. At this stage, the former is far more likely than the latter since it has not been proven that dextromethorphan is an addictive substance. 

Many of these sites have graphics that are purportedly similar visually to the mental images that are sometimes generated when abusing the drug. These Web sites also contain information about how to purchase, produce, and take the drug. Some of the more responsible sites offer information about risks and side effects. Other sites contain information about how to obtain bulk quantities of dextromethorphan powder that enables individ-... 

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