Dextromethorphan drug abuse

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. 

There is also an illicit use of dextromethorphan. Teenagers and young adults commonly abuse this drug. When dextromethorphan is abused in higher doses, it acts as a dissociative anesthetic, similar to PCP and ketamine. Slang terms for dextromethorphan include DM, DXM, Dex, skittles. Triple C, Tussin, robo, rojo, and velvet. 

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. 

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. 

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. 

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. 

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. 

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. 

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-... 

Dextromethorphan, the dextroisomer of the opioid levomethorphan is used as an antitussive, e.g. in Actifed the latter is sought as a drug of abuse by addicts. 

Many cough medicines contain dextromethorphan (DXM), a commonly abused OTC drug. 

Dextromethorphan is metabolized to dextrophan (Figure 34-40) by the cytochrome P4S0 isozyme 2D6 (GYP 2D6), which exhibits genetic polymorphism. Dextrophan also lacks analgesic activity, but it does retain antitussive action. Dextrophan may be responsible for the more pleasant psychotropic effects of high dose dextromethorphan, whereas the parent drug may cause dysphoria, sedation, and ataxia. Thus poor metabolizers (deficient in GYP 2D6 activity) may be less prone and extensive metabolizers more prone to continue the abuse of dextromethorphan. 

Both drugs are excellent antitussives. However, codeine promotes a much higher degree of constipation than does dextromethorphan. In addition, codeine has abuse potential, as it has the ability to cross into the CNS in high doses. 

Dextromethorphan, an effective antitussive drug, is the dextrorotatory stereoisomer of a derivative of levorphanol. The drug is available without a prescription and is the active component in many over-the-counter cough suppressants. Dextromethorphan has no appreciable analgesic activity and minimal abuse liability. In comparison with codeine—also an effective antitussive—dextromethorphan causes less constipation. The answer is (D). 

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