THE DEXTROMETHORPHAN FAQ ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT DEXTROMETHORPHAN (DXM) William E. White ASCII Text Version 3.0 Copyright (c) 1995 All Rights Reserved Originally Written for Usenet alt.drugs ============================================================================= NOTES on ASCII TEXT VERSION This version is available from my website as an ASCII document, in two parts (as a single part it is too big for my DOS version of vi). My website, incidentally, is located at: http://oucsace.cs.ohiou.edu/personal/bwhite/start.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. Part 01/02: Beginning through Chapter 9, inclusive Part 02/02: Chapter 10 (personal reports), Appendices, References, and Glossary. Acknowledgements, Section 1 ============================================================================= 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 ============================================================================= 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-T (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://oucsace.cs.ohiou.edu/personal/bwhite/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: bwhite@oucsace.cs.ohiou.edu 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 Drixoral™ 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 (bwhite@oucsace.cs.ohiou.edu). Available on | | Usenet rec.drugs.psychedelic and on the World Wide Web via | | http://oucsace.cs.ohiou.edu/personal/bwhite/start.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). It is most commonly available in cough syrups, though some syrups contain other ingredients which can make you sick (or dead) if you take too much of them. It is also available in gelcaps and in some places in capsules. DXM can also be extracted from cough medicines, and the extract can be taken orally, injected subcutaneously, intraperitoneally, intramuscuarly, or intravenously. It can probably also be snorted or used rectally (though why one would want to I don't know). Smoking doesn't seem very effective. Some drugstores keep track of people who frequently buy DXM-containing cough preparations, especially if they buy multiple bottles at once or tend not to buy other things at the same time. This is less common in larger supermarket/drug stores. In some cities where DXM use has become popular (and come to public attention), sales have been restricted to adults. In Utah in the 1980's, DXM was placed behind the counter due to recreational use. .............................................................................. Drinking Cough Syrup DXM is widely available in cough syrups, both brand-name (such as Robitussin[tm] or Vicks Formula 44[tm]) and store brands. Most DXM- containing cough syrups also contain one or more of the following other active ingredients: nasal decongestants, antihistamines, acetaminophen, or guaifenesin (see Section 2.7). As a rule, you want to avoid all of them. Generally speaking, DXM cough syrups all taste nasty. This is for two reasons: to cover up the (even nastier) taste of DXM itself, and to prevent recreational use. The generics tend to be less thick, and thus more drinkable, than the brand names. Some people prefer to mix the DXM with sodas; others find this only makes an already unpleasant task even more unpleasant. Your Mileage May Vary. Most people who have used DXM cough syrups recreationally seem to prefer to take it on a mostly empty stomach, possibly with crackers or some other source of carbohydrates. I generally feel that you should avoid slamming your kidneys and pancreas with a lot of glucose at once; thus I think some crackers or chips beforehand would be advisable. Greasy food should be avoided both before and after taking DXM. Most people report that if carbonated drinks are ingested, they should be clear (e.g., 7-Up[tm]). .............................................................................. Gelcaps and Capsules There are "gelcaps" (liquid or gel filled capsules) available that contain DXM, but they tend to be brand-name only. One brand containing only DXM is Drixoral Cough Liquid Caps[tm]. They come in boxes of 10 or 20 gel capsules, each containing 30mg of DXM. The gel capsule itself is red colored; the liquid inside is actually clear (and tastes very, very bad). The capsules are somewhat large, and difficult if not impossible to take without liquid to wash them down. This brand also comes with a $0.50 or $1.00 manufacturer's coupon inside, which some have taken to calling Drixoral[tm] Dollars (after Camel Bucks[tm], a fake currency coupon in Camel[tm] cigarettes which could be collected and "spent" on various stuff). Note that Drixoral also makes several other liquid and capsule products, all of which contain undesirable active ingredients besides DXM. Absorption from the gelcaps takes some time, and can be sped up by cracking open each gelcap in your mouth before it is swallowed. Note, however, that the liquid inside is apt to spurt out, and it tastes bad. Really, really bad - sour and bitter and cloying all at once with a stickiness that won't go away. However, if you can stand it, you can become used to it after the first few gelcaps. You can also crack open the gelcaps and try to collect the liquid, but it tends to go everywhere. Contac CoughCaps[tm] are available in Canada, and are capsule formula- tions of DXM. I have not personally seen them. In several countries, there are over-the-counter tablet or capsule DXM pills containing 30mg per tablet/capsule; one example is Romilar[tm]. Thus far I know they are available in some areas of southeast Asia and in Saudi Arabia. .............................................................................. Pharmaceutical and Chemical Suppliers DXM is not scheduled in the USA (or most other parts of the world), and consequently should be available via pharmaceutical chemical suppliers. For example, Sigma Chemical Company (1-800-325-3010) lists DXM hydrobromide (product D2531) for US $18.20 for 5 grams, US $128.45 for 50 grams. Note that I have no affiliation with Sigma in any way; I just happened to have a copy of their catalog handy when writing this. In theory, it would be fantastically cheap and easy to order DXM this way; in practice, it's possibly difficult, and probably a Very Bad Idea. First off, most chemical companies are wary about selling to individuals (and if you're not a legal adult, forget it). Secondly, there's a significant chance that your order will be reported to the DEA, and although it's not technically illegal, if enough people do this, that may change very quickly. Still, though, if you have the courage or stupidity to try, there's no reason why this shouldn't be a reasonable source. Just use your head. And don't mention the FAQ. .............................................................................. Extracted DXM Ingestion DXM can be extracted (see Section 7.1 and 7.2) and the extracted DXM can be taken orally, either as free base or as salt (the free base should convert to the hydrochloride salt in your stomach). The salt usually available is hydrobromide, but I see no reason why hydro- chloride, or even acetate or citrate, cannot be used. The free base tends to be somewhat alkaline and should be avoided unless combined with food and/or juice (or other acidic beverage). When taken on a mostly empty stomach, the extract is generally absorbed faster than cough syrups, gelcaps, or capsules. Some extraction processes may convert some or all of the DXM into dextrorphan (DXO). Extracted DXM, unlike cough syrups and gelcaps, has no bromide toxicity (see Section 2.7). .............................................................................. Injection and Other Routes DXM hydrobromide is soluble in saline, and I see no reason why other acid salts shouldn't be - though their long-term stability may be doubtful. However, injection is a very dangerous route, especially if the substance in question is not prepared specifically to be injected. Some of the potential risks include: sterile abscesses, torn or collapsed veins, bruising, muscle fiber damage, histamine release, infection (hepatitis B, HIV, etc.), embolism (and possible resulting stroke or cardiac arrest), increased chance of addiction, overdose, and people mistaking you for a junky. True, most of these are unlikely, and if done correctly injection is generally very safe. However, the key word is correctly. If you're still interested, consult a medical text; I'm not going to teach you how to shoot up. A few notes for those brave or stupid enough to still be interested. Intravenous (IV) and intramuscular (IM) injection both seem to produce similar results in animals, and IM injection is almost always safer. DXM can also be injected intraperitoneally (IP), but that evidently requires some skill. Subcutaneous (SC) injection ("skin popping") leads to slower absorption and a great increase in the amount of DXM relative to DXO. All injected drugs should be completely pure, dissolved in the appropriate physiological saline. In the case of SC (and possibly IM) injection, injecting too large a volume of material can lead to a sterile abscess. DXM can also theoretically be snorted, although I don't generally think this is a very smart route; the nasal lining is very tender. DXM free base is probably too alkaline to try this with. It can also probably be used rectally, but somehow the thought of a cough syrup enema doesn't thrill me. Smoking DXM free base has been attempted several times by various people without success. It seems that some of the DXM is destroyed by the heat, and the remaining DXM is extremely harsh on the lungs. Too bad, really, since self-titration is usually easiest with smoking. ------------------------------------------------------------------------------ [2.6] What are some typical DXM-containing commercial preparations? Rather than listing the content of commercial DXM preparations (I gave up since there are so many!), I have decided to list brands and generic equivalents which contain only DXM. All expressions are in metric. 1tsp is approx. 5ml; a 4oz bottle is approx. 120ml, and an 8oz bottle approx. 240ml. All preparations listed contain no other active ingredients besides DXM. 1mg/ml DXM (120mg per 4oz bottle) Vicks Pediatric Formula 44[tm] (Richardson-Vicks). I am not aware of any generic equivalents. Very low DXM content. 1.5mg/ml DXM (180mg per 4oz bottle) Robitussin Pediatric Cough[tm]. Some generic / store-brand equivalents. Most pediatric DXM-only cough preparations run in this range; again a very low DXM content. 2mg/ml DXM (240mg per 4oz bottle) Benylin Cough Syrup[tm]. Note: Benylin DM[tm] should be avoided due to inactive ingredients which cause severe diarrhea. Some generic / store-brand equivalents. Not terribly common in comparison to 3mg/ml brands. Several DXM plus guaifenesin products (e.g., Robitussin DM[tm]) are 2mg/ml. Guaifenesin in high doses tends to induce vomiting. 3mg/ml DXM (360mg per 4oz bottle) Vicks Formula 44[tm], and generic equivalents. Make sure to avoid other formulae, such as Vicks Formula 44D[tm]. Robitussin Maximum Strength Cough[tm], and generics. Avoid Robitussin Maximum Strength Cough and Cold[tm] which has other ingredients. 15mg/capsule or tablet Evidently, Romilar[tm] is available in 15mg tablets or capsules. I have not personally seen them. 30mg/capsule or tablet Drixoral Cough Liquid Caps[tm] and generics (there aren't many). These are available in packages of 10 or 20 capsules (300mg or 600mg total DXM content per package). Contac CoughCaps[tm], available in Canada. Romilar[tm], available in some areas of the world (and possibly by prescription elsewhere). Also available in 15mg/tablet. ------------------------------------------------------------------------------ [2.7] What should I know about other drug ingredients? There are five main classes of active ingredients that are present in OTC DXM-containing products: decongestants, antihistamines, guaifenesin, analgesics, and alcohol. Each will be discussed in turn, followed by "inactive" ingredients. With the exception of alcohol, all should be avoided, although for differing reasons. Additionally, some of the dyes and other "inactive" ingredients may cause some people trouble. .............................................................................. Decongestants There are three nasal decongestants that are used in OTC cough formulas in the USA: PPA, pseudoephedrine, and phenyleprine (the latter is almost always found with antihistamines). PPA is also known as phenylpropanolamine (from which the acronym PPA is derived), norephedrine, and the IUPAC name [alpha-(1-aminoethyl)benzyl alcohol]. Pseudoephedrine, known as the brand name Sudafed[tm], has the IUPAC name [(+)alpha-(1-methylamino)benzyl alcohol]. Phenyleprine is [(-)-3-hydroxy-alpha-(methylaminomethyl)benzyl alcohol] (1-2). These decongestants belong to a class of chemicals known as the phenethylamines; this class also includes methamphetamine, MDMA (ecstasy), MDA, etc., and tend to be DEA scheduled. Decongestants are not scheduled by the DEA (this is USA laws) because they do not have significant psychostimulant activity. Ephedrine, which is similar to pseudoephedrine, and is (or was, depending on your state) available throughout truck stops and mail-order pharmaceutical companies in the USA, does have mild stimulant properties; thus its popularity as a form of "legal speed". All of these drugs stimulate the sympathetic nervous system (the "fight or flight" system) and are thus called sympathomimetics. What nasal decongestants do share with the more potent amphetamines is the peripheral activity common to sympathomimetics, such as vaso- constriction (constriction of blood vessels) and decreased nasal secretions (the good side), and - with larger doses - insomnia, hypertension, heart rhythm abnormalities, hemorrhaging, stroke, or death (the bad side) (8). Note that these are extreme reactions, and that individual tolerance to sympathomimetics tends to vary considerably. Tolerance can build quickly, and a fatal dose for one person may have only a mild effect on another person. Because of the potential danger of hypertension, exceeding the recommended dose of DXM and decongestant containing preparations may be asking for trouble. Most people can probably handle it in smaller recreational doses, but the peripheral "speediness" can be distinctly unpleasant. Anyone with high blood pressure or the like has no business taking large quantities of decongestants. Try to avoid these drugs. .............................................................................. Antihistamines The antihistamines operate by blocking histamine receptors (see Section 6 for an explanation of receptors). Peripherally, this has the effect of reducing the symptoms of histamine activity (stuffy and runny nose, itchy eyes, hives, rashes, etc.) associated with infections and allergies. In the CNS, histamine is partially responsible for wakefulness, and antihistamines that cross the blood-brain barrier will cause sleepiness. In fact, most OTC "sleeping pills" in the USA are really just antihistamines (although melatonin is making inroads as an alternative). There are antihistamines that do not cross the blood- brain barrier (e.g., Seldane[tm]) but these are prescription in the USA. High doses of antihistamines can result in dizziness, impairment of concentration, extreme sedation (or, paradoxically, insomnia), headache, heart palpitations, dry mouth, gastric discomfort, delusions, and abnormally high blood pressure. Doses of 30-60mg/kg have been fatal in very young children; most adults, however, are very unlikely to overdose on antihistamines. Death, when it does occur, is from cardiovascular collapse or respiratory arrest (8). High doses of prescription antihistamines are much more dangerous; do not mix DXM with prescription antihistamines! The danger of an antihistamine overdose is very low when using a DXM-containing product recreationally. However, you will most likely experience some unpleasant symptoms, such as sleepiness, dry mouth, heart palpitations, etc. For this reason, I recommend against products containing antihistamines. .............................................................................. Guaifenesin Guaifenesin (gwye-FEN-a-sin) [3-(2-methoxyphenoxy)-1,2-propanediol] is an expectorant; it increases the production of respiratory tract fluids, thus making phlegm less viscous and easier to cough up. Guaifenesin has been shown effective as an expectorant, but is of no use as a cough suppressant. It is often combined with dextrometh- orphan. Guaifenesin should not be used for chronic coughs or coughs accompanied by excessive phlegm (1-2). High doses of guaifenesin tend to induce emesis (i.e., you puke). Other effects from high guaifenesin doses are not well known, but probably not serious. However, as most people do not enjoy vomiting, I would recommend avoiding guaifenesin-containing products. .............................................................................. Analgesics Acetaminophen (called paracetamol in the UK) is the most common analgesic (painkiller) present in cough suppressant formulas. It is closely related to the NSAIDs (non-steroidal anti-inflammatory drugs) of which aspirin and ibuprofen are the two most common examples. Unlike the OTC NSAIDs, however, acetaminophen/paracetamol does not tend to irritate the stomach, and thus its inclusion in cough syrups. An acetaminophen overdose is VERY DANGEROUS. Normally, acetaminophen is metabolized (broken down) in the body by two separate pathways, both of which lead to harmless metabolites. However, these two pathways can only metabolize so much before saturating. At that point, the remaining acetaminophen is metabolized by a cytochrome P450 liver enzyme. The metabolite via the P450 pathway is toxic to the liver (2,8). Furthermore, this doesn't happen right away; it can take 16 hours before any signs of liver damage show up. This delayed toxic effect has been responsible for the rather painful deaths of some people who (accidentally or not) overdose on acetaminophen, and then think they are fine when no immediate problems occur. There is an antidote (acetylcystine), but it must be administered within the first 12 to 16 hours. The toxic dose of acetaminophen can be as low as 50mg/kg; for a 60kg person this is only six acetaminophen tablets. This is unlikely but possible. DO NOT UNDER ANY CIRCUMSTANCES USE RECREATIONALLY ANY DXM PRODUCT WHICH ALSO CONTAINS ACETAMINOPHEN / PARACETAMOL! As for aspirin and ibuprofen, the other two most common OTC pain- killers, both tend to irritate the stomach at high doses. I recommend against them, especially if you have an irritable stomach. Never take large doses of aspirin or ibuprofen if you have an ulcer. .............................................................................. Alcohol Most cough syrups contain some alcohol, to act as a carrier and to numb the throat. With a few exceptions (such as Nyquil[tm]), the amount of alcohol is not usually very great. While alcohol does not, in general, mix well with DXM as a recreational drug, the amount in cough syrups should not cause trouble unless you are specifically sensitive to, or attempting to avoid, alcohol. There are alcohol- free preparations available; many gelcaps are alcohol-free. .............................................................................. Food Coloring / Dyes Some of the dyes used in cough formulas may give some people allergic reactions. Most notable among these is tartrazine (FD&C Yellow #5). Generally, these dyes are not a problem unless you take a lot of them (which recreational DXM use may involve). If you think you may be allergic to a dye, switch to a different brand (or more accurately, a different color). It is also a good idea to keep an antihistamine (not a prescription or non-drowsy one!) nearby in case an allergic reaction does occur. .............................................................................. Bromide Ions DXM is usually ingested as a hydrobromide salt. Large amounts of bromide ions can cause sedation and eventually lead to bromism (bromide poisoning), which affects (among other things) the skin and nervous system. I don't think this is terribly relevant for users of DXM (recreational or not); however it is one more reason to avoid prolonged high-dose use. You can avoid bromide ions by converting the DXM to free base and/or hydrochloride salt (see Section 7.6). Some physicians do believe that prolonged heavy use of DXM may lead to bromism (147). .............................................................................. Other "Inactive" Ingredients Cough syrups tend to contain several thickening and sweetening agents. Glucose, sucrose, invert sugar, and fructose are all commonly used as sweetening agents. Obviously, a person with blood sugar problems (diabetes or hypoglycemia) should not take large amounts of these syrups. Thickening agents are not usually a problem. Occasionally people will look on cough syrup labels and see propylene glycol or polyethylene glycol, and (thinking about ethylene glycol, i.e., antifreeze) worry about toxicity. Propylene glycol (a thickening and emulsifying agent) is not toxic, even though ethylene glycol is. The same goes for polyethylene glycol (PEG) - it's also nontoxic. About the worst you will get from any of these is an upset stomach. One general note - keep in mind that your body does eventually have to use or excrete whatever you eat and drink. Drinking huge amounts of sugars and thickening agents can put a fair amount of load on the kidneys, and should definitely be avoided if you have kidney problems already. There is anecdotal evidence that regular high-dose use of DXM cough syrups (without eating much) has led to kidney damage due to the glucose load. I cannot confirm this but I can't disprove it either. ------------------------------------------------------------------------------ [2.8] Why are so many DXM preparations in liquid form? Cough preparations are in liquid form for two reasons. First and foremost, most people have the (mistaken) belief that in order for a cough suppressant formula to work, it must coat the throat. This is complete bunk. If consumers were a bit smarter, we wouldn't have to gag down cough syrup. There are, in fact, gel-capsule cough suppressants on the market, and I expect that tablet or capsule dextromethorphan will eventually be common. Second, tablet-form DXM preparations have been kept from the market in an attempt to prevent their recreational use. ------------------------------------------------------------------------------ [2.9] Is recreational use of DXM illegal? Possibly. There may be laws making it a crime to use OTC medicines in any way other than directed on the label. Not that this stops people from using ephedrine (a bronchodilator) as a stimulant. Nor are you likely to get caught and/or prosecuted; the authorities are much too busy infringing upon our civil rights looking for the illegal drugs. But, remember - I SPECIFICALLY instruct you NOT to use any medicine in a manner inconsistent with its labeling. Furthermore, suggesting to someone that they use DXM as a recreational drug could also be violating a law - against prescribing drugs as a layperson. Again, it's not likely to happen, but it is possible. DXM is a prescription drug in Sweden (9). It is prescription and scheduled in western Australia unless combined with other active ingredients. It may become prescription in other countries. In drug stores in some areas it is kept behind the counter, and must be requested. ------------------------------------------------------------------------------ [2.10] Other (medical) uses for DXM Dextromethorphan is commonly used to determine cytochrome P450-2D6 activity (10-11). Cytochrome P450-2D6, or debrisoquine 4-hydroxylase, is a liver enzyme which converts DXM into dextrorphan, and is extensively involved in the metabolism of other drugs. About 5-10% of Caucasians seem to lack P450-2D6 entirely (12-15); in the remaining individuals, its activity can vary significantly due to minor genetic variance (15-18). By looking at the metabolites of DXM, a physician can determine P450-2D6 efficiency, and adjust drug dosage to match. One area in which DXM (as well as other NMDA blockers; see 5.3 - NMDA Receptors) shows great promise is in the prevention of brain damage resulting from excitotoxicity (over-stimulation of nerve cells to the point of cell death) and other types of nerve cell damage (19). DXM may reduce or eliminate the brain damage resulting from conditions such as fever, hypoxia (lack of oxygen) (20), ischemia (cutoff of blood to brain cells) (21-22), physical injury (23), infection (such as poliomyelitis, encephalitis, and meningitis), stroke, seizure, drug toxicity (24-25), and withdrawal from long-term dependence upon certain drugs (notably alcohol, barbiturates, and benzodiazepines such as Valium[tm]) (26-29). In the case of infection (and in particular poliomyelitis), it has been demonstrated that the damage to the CNS often occurs not from the infection, but from the body's own defenses, and notably from a chemical called quinolinic acid (a metabolite of tryptophan) (30,31). Quinolinic acid is a very potent agonist (activator) at excitatory amino acid receptors, of which NMDA is one type; DXM prevents quinolinic acid from activating NMDA receptors. (Incidentally, the function of quinolinic acid - if it has any - is not currently known; it may be involved in the immune response). As for physical trauma, hypoxia, seizure, stroke, etc., there are several experiments which indicate that the majority of the damage again comes from excitotoxicity at excitatory amino acid receptors. While DXM has shown somewhat less success there (possibly due to other factors being involved), it still has potential. DXM is currently being evaluated as an anticonvulsant (32,33). The animal data are somewhat conflicting, but the most accurate model of epileptic seizures (called kindling) responds well to DXM. Preliminary studies in humans indicates that even very low levels of DXM may help prevent seizures. This effect is not, as was originally thought, due to NMDA receptors; instead, it is probably due to sigma receptors or voltage-gated ion channels (32). Interestingly, DXM produces different side-effects in kindled (seizure-susceptible) animals than in non-kindled animals (this may be due to uncoupling of NMDA receptors). It is possible that humans susceptible to seizure may experience different effects from recreational DXM use. Another new area where DXM has potential is in combating the withdrawal symptoms of opiate addiction. DXM plus diazepam (Valium[tm]) was more effective at combating the symptoms of heroin withdrawal (goose flesh, tremors, dilated pupils, joint ache, etc.) than chlorpromazine (Thorazine[tm]) plus diazepam (34). This is most likely due to DXM's ability to block NMDA receptors. A further study (134) verified this, and found that adding tizanidine (an alpha-2 adrenergic agonist) to DXM was better yet. DXM has shown some potential for treating some of the problems associated with mental retardation (35). It may also be of use in treating Parkinson's disease (36). DXM may be useful in conjunction with opiates for alleviation of both acute and chronic pain (37). It may even be useful in fighting lung cancer (38). ------------------------------------------------------------------------------ [2.11] Drug Interactions DXM should not be used (either recreationally or at normal dosage levels) by people who are taking a monoamine oxidase inhibitor (MAOI, rhymes with "wowee") - either a prescription MAOI or a recreational one such as harmaline. Note that there is considerable confusion among drug users about what is and isn't a MAOI. MAOIs include a few drugs prescribed for depression and Parkinson's disease, and a few rare recreational drugs derived from exotic plant sources (harmine and harmaline, from Syrian Rue and Yag‚, for example). Prozac™, MDMA, cheese, beer, Seldane[tm], etc., are not MAOIs - they are things to avoid when taking a MAOI. If you are taking a prescription MAOI you will almost certainly know, as your physician will have (hopefully!) told you to avoid eating aged cheeses. Combining DXM and a MAOI has been fatal (3). Fluoxetine (Prozac[tm]) is a cytochrome P450-2D6 inhibitor (39), and will change the characteristics of a DXM trip somewhat (increasing the ratio of DXM to DXO). Other P450-2D6 inhibiting drugs will probably do the same; see Appendix 1. The duration of the trip may be greatly extended by P450-2D6 inhibitors; some users have reported effects lasting 12 to 24 hours past the normal duration. The potency of DXM may also be enhanced via other mechanisms by fluoxetine (40). DXM should not be taken (recreationally or at normal dosage levels) with the prescription antihistamine terfenadine (Seldane[tm]). This combination has been fatal (41). Terfenadine has been implicated in other drug interactions, incidentally. The reason for this interaction seems to be that terfenadine, which is normally metabolized by a P450 enzyme, induces heart irregularities when it builds up. DXM may saturate the P450 enzymes that normally metabolize terfenadine. Incidentally, this probably applies to Claritin[tm] and Hismanal[tm] as well; avoid combining them with DXM. Like other psychoactive drugs, DXM should not be used by people who are mentally or emotionally unstable. I tend to believe that NO recreational drug (legal or not) should be used unless the user is in a calm, rational mood, free from anxiety or negative emotions, and is in a controlled setting where s/he will not have to drive. Speaking of which, as DXM is an intoxicating drug, don't drive under the influence. Ever. But I shouldn't have to tell you that, right? High doses of DXM can be very dissociative. While this is not necessarily bad, you should know what you are getting into first. A high-dose DXM trip is not like an LSD trip; it more closely resembles ketamine. You will most likely encounter experiences that you didn't expect, and possibly didn't want. While this is OK for the more committed psychonaut, casual users of hallucinogens might want to think twice before taking a high dose. Prolonged use of DXM, or extended doses of DXM (including the polistirex formulation), may cause problems due to the buildup of DXM (as opposed to DXO), and the resulting activity at sigma receptors (see Section 6). Sigma receptors seem to have a potent modulatory role on neurons, possibly inducing permanent or semi-permanent changes when they are activated for long periods of time (most studies so far indicate over 3 days of high DXM concentrations are required before such changes occur). Furthermore, sigma activity seems to be correlated with delusional thinking, which should probably be avoided, especially in the inexperienced. Some people are allergic to tartrazine (FD&C Yellow #5), which is present in several cough syrups. Sensitivity to tartrazine is rare, but is frequent in people sensitive to aspirin. Avoid tartrazine if you are, or think you might be, allergic to it or to aspirin. Note that, based on anecdotal evidence, I believe that sensitivity to other dyes may develop from chronic use. The large amount of glycerine, glucose syrup, and sugars present in cough syrups can give some people problems ranging from stomach ache to sugar shock. Obviously anyone with diabetes or a family history of blood sugar problems should avoid cough syrups. ------------------------------------------------------------------------------ [2.12] What about other cough suppressants? The only other non-narcotic cough suppressant of which I am aware is a drug called noscapine (42). I have little information on it as of yet; look for more soon. Narcotic cough suppressants include primarily codeine, although any opiate can be used for that purpose (in fact, heroin was originally marketed as a cough suppressant). Opiates have an entirely different set of recreational effects than DXM, however, and are not covered here. ------------------------------------------------------------------------------ [2.13] Can DXM be detected on drug tests? As DXM itself, probably not; nobody bothers to look for it. On the other hand, anecdotal evidence indicates that some people will test positive for opiate use after using recreational DXM(1). Keep this in mind before using DXM if you have to take a drug test. If worse comes to worse, you can always claim you had a bad cold, and ask them to do a test which will discriminate between opiates and DXM. Good luck! ------------ (1) Drug tests aren't particularly good at discriminating between legal and illegal drugs. Nasal decongestants can cause you to test positive for amphetamine use, for example. ============================================================================== [3] THE DXM DRUG EXPERIENCE This section discusses some of the effects you might expect to feel if you were to use DXM recreationally (which, for legal reasons, I recommend against). ------------------------------------------------------------------------------ [3.1] What is the general character of a DXM experience? This is a difficult question to answer, because DXM's effects tend to vary widely depending on the person, their set and setting, other drugs, their physiology, and so on. DXM, probably more than most drugs, tends to exert its (recreational) effects on plateaus, rather than being linearly dose-dependent. Within a given plateau, a given set of effects will occur (at a roughly dose-dependent strength). On the other hand, once the next plateau is reached, the feeling may change entirely. A reasonable analogy is water - it exists in three states (solid, liquid, and gas) which all can exist at varying temperatures (e.g., hot water and cold water), but which have different and characteristics. Importantly, DXM and its metabolite, dextrorphan (DXO), produce different sets of effects. Normally, DXM is converted mostly or entirely into DXO, but with recreational doses, the conversion enzyme (P450-2D6) can saturate, leaving a mixture of DXM and DXO. Furthermore, another of DXM's metabolites - 3-methoxymorphinan - can also block this enzyme, so that taking divided doses leads to more DXM and less DXO than taking a combined dose of the same amount. DXM's effects are in some ways much more subtle than DXO's. Whereas DXO produces a heavy "stoning" or intoxicating effect, DXM is only lightly intoxicating. DXM, however, can alter the thought processes, leading to highly abnormal, psychosis-like mental states. It is possible that DXM, via sigma activation, may induce a mental state similar to that of schizophrenia. Whether or not this is fun to you is, of course, up to you. As to how many plateaus DXM exhibits, this is debatable. I previously listed three; however, some daring (or foolish) individuals have pushed into a qualitatively different level which I call the fourth plateau. Some people will undoubtedly disagree with this classification method, but I think this is the best way to represent DXM's effects. Note that both the third and fourth plateaus have significant dissociative characteristics, much like ketamine. Keep in mind that the effects in different plateaus can be very different. For example, on the first plateau, DXM tends to have a stimulant effect, often quite potent. Upon reaching the second plateau, however, the stimulant effect may no longer be present. The beginning of the end of a DXM trip can come abruptly. Often, the user will know when it's starting to end by noticing the return of normal sensory processing. Coming down from there may take a significant amount of time. The following table can be used as a general guideline for the plateaus. For convenience I give example dosages in gelcaps and 3mg/ml syrup for 75kg and 150lb adults; adjust up or down by the amounts indicated per 10kg or 25lb. Calculating with the mg/kg is more accurate, but it's easy to make mistakes when using non-metric measures. Dosage will vary considerably from person to person, by as much as 5 times! Also, these mg/kg figures should evidently be adjusted down for higher mass (e.g., maybe 6mg/kg to 13mg/kg third plateau for a 150kg adult). Note that kg = pounds * 0.45. o------------------------------------------------------------------------o | Plateau --> | First | Second | Third | Fourth | |================+=============+=============+=============+=============| | Dosage Range | 1.5-2.5 | 2.5-7.5 | 7.5-15 | >15 mg/kg | | (mg/kg) | mg/kg | mg/kg | mg/kg | | |================+=============+=============+=============+=============| | Gelcaps (30mg) | 4 to 6 | 6 to 18 | 18 to 37 | >37 gelcaps | | for 75kg adult | gelcaps | gelcaps | gelcaps | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 1/2 to 1 | 1 to 2.5 | 2.5 to 5 | 5 gelcaps | | 10 kg | gelcap | gelcaps | gelcaps | | |================+=============+=============+=============+=============| | Gelcaps (30mg) | 3 to 5 | 5 to 17 | 17 to 34 | >34 gelcaps | | for 150lb adult| gelcaps | gelcaps | gelcaps | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 1/2 to 1 | 1 to 2.5 | 2.5 to 5.5 | 5.5 gelcaps | | 25 lb | gelcap | gelcaps | gelcaps | | |================+=============+=============+=============+=============| | Syrup (3mg/ml) | 37 to 62 ml | 62 to 187 | 187 to 375 | >375 ml | | for 75kg adult | | ml | ml | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 5 to 8 ml | 8 to 25 ml | 25 to 50 ml | 50 ml | | 10 kg | | | | | |================+=============+=============+=============+=============| | Syrup (3mg/ml) | 2 tbsp to 2 | 2 oz to 5.5 | 5.5oz to 11 | >11oz | | for 150lb adult| oz (.25cup) | oz (2/3cup) | oz (1+1/3c) | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 1 tsp to | 2 tsp to 1 | 2tbsp to 2 | 2oz | | 25 lb | 2 tsp | oz (1/8cup) | oz (1/4cup) | | o------------------------------------------------------------------------o Table 1: DXM Plateaus and Dosages The specific effects at each plateau will be listed according to the following categories: Sensory, Cognitive, Motor, Memory, and Emotion. ------------------------------------------------------------------------------ [3.2] The First Plateau The first plateau generally occurs around 1.5 to 2.5 mg/kg, but this may vary enormously depending on metabolism and other factors. The first plateau is probably the hardest to hit; many people "overshoot" it. Please keep in mind that these effects listed are general effects, and that individual results may vary considerably. A first plateau trip usually takes between 20 and 40 minutes to start (on an empty stomach), peaks about 1.5 to 2 hours later, and lasts between 4 and 6 hours. Gel capsules take up to 1 hour additional to dissolve. Hangovers are very rare from this plateau, but if they do occur, they tend to consist mainly of lethargy. The primary effects of the first plateau are general euphoria, euphoria specifically linked to music and motion, slight disturbances in balance, moderate stimulation, and very slight intoxication. The intoxication and balance disturbances are similar to that induced by alcohol, but much weaker and without the mental confusion; there is little if any mental sluggishness or confusion with a first plateau trip. Some people have difficulty hitting the first plateau. It can take several trials; as a general guideline, if you notice double vision, you've gone way too far. A lot of the more pleasurable first plateau effects, in particular the music euphoria, are set and setting dependent. Being in good physical condition, avoiding excessive caffeine, and being in a good mood are all important factors in achieving a good first plateau dose. .............................................................................. Sensory Effects Most of the effects of the first plateau relate to the senses. The best known, and probably the most responsible for first plateau use of DXM, is the effect upon hearing (specifically upon music). Sounds may seem "richer" or "deeper", and music in particular is affected (the difference between listening to music on DXM versus sober has been compared to the difference between music in a concert hall versus on a cheap radio). In addition to the change in the nature of hearing itself, music can bring a sense of euphoria, often quite intense. In comparison to the positive effects on music reported by some users of cannabis, the DXM music effect is usually characterized as much "speedier". The type of music with which this effect most strongly occurs will tend to vary from person to person. Rave music is one of the most commonly affected, possibly due to the regular beat (at higher plateaus especially, much of DXM's sensory effects seem beat or rhythm related). Classical and Celtic/folk also seems to be popular. Really, though, the strongest indicator of personal response to a given piece of music seems to be 1) that the user enjoys it, and 2) that it has an "intense" or thematic quality. Visual effects are not particularly strong at this plateau. If present, they usually consist of motion trails (as if afterimages of each "frame" of vision were not clearing quickly enough). There may be some deterioration of stereoscopic vision (and thus depth perception). Colors may seem slightly more vivid. Taste, smell, and touch do not seem to be appreciably affected, although some users have reported that taste and smell are enhanced and mildly euphoria-linked. Others have reported the same effect for touch. Balance and body position sense can be significantly affected, ranging from a mild disturbance (some call it "sea legs") to a near total loss of position and balance sense (generally this only happens on upper plateaus). The changes seem to relate to an anesthesia of the body senses in particular. The effect (like the other sensory DXM effects) can be euphoric; some users like to roll around, do cartwheels, dance, march, whatever. Interestingly, I have not heard any reports of motion sickness (as might be expected if balance sense were blocked). .............................................................................. Cognitive Effects Even though DXM has a slight "stoning" or intoxicating effect on the first plateau, there are surprisingly few deficits of cognitive function. Language is the most strongly affected, although these effects are usually limited to occasional word and syllable repetition (especially in already-repeated syllables, e.g., "banana" to "banananana"), spoonerism (e.g., "share boulders" instead of "bare shoulders"), and difficulty coming up with specific words. Some users report that they feel more creative and capable of non-linear thought on DXM, and this seems to be maximized on the first and second plateaus. Whether this is, in fact, true, or just seems true because of the drug, I have no idea; to my knowledge there are no studies on this. Another cognitive characteristic that occasionally occurs at the first plateau (but more commonly at the second) is that things can seem much more interesting, or at least much less dull and boring, than they usually are. There may be an overall increase in approach-related behavior. Many DXM users report a moderate to strong stimulant effect at the first plateau, which disappears at higher dosages. This seems to be enhanced by caffeine. One user reported being able to stay up for 48 hours by maintaining a first plateau level. (Note that I don't recommend this). Another characteristic of first (and second) plateau trips is a lowering of inhibitions related to conversation. Many people find they can discuss painful or embarrassing topics without difficulty. This is usually described as a very positive effect, and those who have experienced it often state that they feel more comfortable with themselves after the trip. Some have reported a strengthening of friendships due to this effect. It's interesting that as the third plateau is approached, recall and discussion of such topics seems to become more and more "mandatory". .............................................................................. Motor Effects The other main characteristic of a first plateau DXM trip is its effect upon motion and motor skills. Users tend to walk and move in specific ways (varying somewhat from person to person) characterized by large, fluid movements. In fact, it may be difficult to perform small or abrupt motion. Motor tasks initiated may continue beyond their targets (this can range from fun to distracting). To an outside observer, this can seem quite strange, especially the changes in gait. It is possible, however, to move normally. These changes may be related to euphoria linking of body kinetic sense (see Sensory Effects, above) which would make large and sweeping motions more enjoyable. It is also possible that something more directly involved in the planning and carrying out of complex motor tasks may be at work. .............................................................................. Memory Effects The memory effects of a first plateau trip are slight but usually noticeable. Most of the effects probably come from a general deterioration of short-term memory. Working memory (the "train of thought") can become stuck in repetitive thoughts; other times it can be very easy to become distracted. Recall of events prior to the trip does not seem to be degraded. Encoding (i.e., making new memories) may be worsened, so that after the trip there is some difficulty in recalling events during the trip. Also probably because of the deterioration of short-term memory, it may be easy to lose track of time. .............................................................................. Emotional Effects Mood enhancement is the most regular emotional effect of the first plateau; many people find themselves fairly bouncy and happy, occasionally euphoric. Unlike many drugs, there is not usually much "let-down" when the trip ends. Fear is rare at the first plateau. There may be a sense of energy or drive. The effects upon libido evidently tend to vary from person to person. Some people report an increase in sex drive; others find that playing, physical contact, music, etc., seem much more interesting and enjoyable than sex. The effects on sexual performance itself are not very strong at the first plateau, though males may have some difficulty in achieving orgasm. When orgasm does occur, it is often accompanied by extreme muscle tension and profuse sweating. ------------------------------------------------------------------------------ [3.3] The Second Plateau With the second plateau (around 2.5-7.5mg/kg), several new effects become evident. The most profound is that DXM begins to take on a heavier "stoning" characteristic, and senses and cognitive function are affected accordingly. Hallucinations start for some people on the second plateau. Some of the first plateau effects, e.g., the music and motion linked euphoria, may diminish or stop entirely. Second plateau trips usually take between 30 and 60 minutes to start (on an empty stomach), peak about 2 to 3 hours later, and last about 6 hours. Again, gel capsules take up to 1 hour additional to dissolve. Hangovers are not common with lower second plateau trips, but some people experience them. .............................................................................. Sensory Effects The most general sensory effect of the second plateau is "flanging". Flanging, also called phlanging, phasing, stop-action, framing, strobing, etc., is the sensation that continuous sensory input has been chopped up into frames (as if you were watching a badly animated cartoon), often with some echo effect of each frame. There does not seem to be any loss of sensory content; instead, it is as if the ability to keep sensory input time-continuous were disturbed. The best analogy from other drugs may be the effects of nitrous oxide upon sound. The best analogy from non-drug experiences is listening to a voice through an echo/delay effects box (which is where the term "flanging" comes from). An interesting and probably associated sensory phenomenon is that it seems as if one is aware of several temporal stages of sensory processing all at once. In other words, a sentence may be heard not sound for sound or word for word, but all at once (this is difficult to describe). Similarly, visual images may be jumbled together with previous images. This may be due to an excessive persistence of sensory buffering. Vision in particular is changed on this plateau. Depth perception is often lost, and the ability to keep both eyes focused on the same thing is diminished (leading to slight double vision). This is most noticeable in people without a dominant eye. Sound, as already mentioned, tends to be flanged. With the sense of touch, there is not necessarily flanging so much as a noticeable delay between the stimulus and recognition of it. Pain especially tends to be somewhat dissociated. Taste and smell are usually simply dulled, though a few people report a vastly improved sense of smell. The sense of balance is severely disrupted, as is body position and kinetic sense. Keep in mind that dissociation of pain and the disruption of body sense together make physical exertion somewhat risky, as it is possible to over-exert and not notice. Hallucinations tend to begin at the second plateau (and in fact are the reason I distinguish this from the first plateau). Usually these are not "true" hallucinations, but instead are considerable enhancement of imagination, up to fully eidetic imagery (i.e., you experience lucidly what you imagine). This is especially powerful with memories; some users are able to re-experience past events, or "simulate" future events, as if actually there, interacting with the environment (I call this the "Holodeck Effect"). Many users report this to be quite useful for introspection. Actual hallucinations, if they do exist, tend to be abstract and cartoon-like. There seems to be an emphasis on linear structures - long, thin lines, or long queues of simple objects. There may also be Lilliputian hallucinations (everything seems either way too big or way too small, or both). Some people find considerable similarity with fever hallucinations. This can be unpleasant to some people. Your experiences throughout the day will influence the hallucinations you see and the imagery you can create. For example, if you have spent the day playing DOOM[tm], your hallucinations are likely to involve scenes and elements from the game. Eidetic imagery works a little different - you can conjure up images, but they are likely to have a "DOOM[tm]-esque" feel to them (bitmapped textures, ugly walls, etc.). This is an interesting effect, and my hunch is that DXM hallucinations and imagery may be very dependent upon what's already stored in short term memory. So it might be worth planning the events of the day with your trip objectives in mind. This may also be possible to some extent during the trip itself; e.g., if you want to imagine yourself in space, go to a planetarium. .............................................................................. Cognitive Effects Higher reasoning is still not appreciably affected at the second plateau; in fact one of the more interesting aspects of DXM at the first and second plateau may be its ability to disturb one function of the mind while leaving another almost untouched. An interesting cognitive effect that is pronounced at the upper second through the third plateau is a change in self-referential thinking. Self-referential thoughts or ideas (e.g., "this statement is false") may seem much more easily understandable, both in the abstract and on a "gut level". Thoughts can, in fact, get quite abstract, sometimes to the point of seeming meaningless to other observers. Quite a few people have reported some sort of self-referential or abstracting aspect to thoughts, such as a "self-creating and self-invoking meme" that consists of the concept of itself. Another example is abstracting the concept of abstraction (and abstracting that, and so on and so on). Language becomes difficult, partly due to cognitive changes (as in the first plateau) and partly due to difficulty in coordinating the mouth and tongue motions. Similarly, interpreting spoken language is difficult due to sensory flanging. However, thinking in language is still fairly easy. The curious detachment from painful or embarrassing topics of conversation that occurs at the first plateau continues and is much stronger at this plateau. Again, this is generally viewed as a positive event, although if you're not prepared to encounter and possibly discuss your deepest, darkest secrets, you might want to avoid higher doses until you're comfortable with DXM. .............................................................................. Motor Effects The first-plateau effects on motor skills continue to exist, and may be considerably stronger. Some users find themselves contorting their limbs into rigid positions, others may extend and stretch themselves. These effects are not always immediately apparent; when they are, the user usually reports that it just "feels right" to be in that position. It is still possible to override this. Another accentuation of first-plateau motion effects that sometimes occurs is that the large, sweeping motions, once initiated, may continue for considerable time (looking somewhat like a cross between modern dance and Huntington's disease). Again, it just "feels right" to do. .............................................................................. Memory Effects Short-term memory and working memory may be severely disturbed, although experience with DXM seems to help people compensate. Possibly because of the changes in memory, it may be very difficult to get bored, even with repetitive tasks. At this plateau, a lot of time may get lost, and the more mundane aspects of the trip are easily forgotten after it is over. .............................................................................. Emotional Effects The other primary characteristic of the second plateau (hallucination being the first) is probably the motivational aspects. Repetitive, mundane, boring tasks suddenly become doable, and (if one can avoid distraction) may be easily accomplished, even if they take hours. There may be a considerable stimulant effect remaining at the second plateau. The euphoria from the first plateau continues but diminishes as dosage across the second plateau increases. ------------------------------------------------------------------------------ [3.4] The Third Plateau At the transition between the second and third plateau, (roughly 7.5 to 15mg/kg), several unrelated effects may occur. These probably belong more to the transitional stage than to a given plateau, and will be dealt with here. The first is a sensation that has been described as the opening of nasal 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. .......................