Dextromethorphan - What Kind of Drug Is It?

What Kind of Drug Is It?

Dextromethorphan (DXM) is an ingredient in more than 100 over-the-counter (OTC) cold, flu, and cough remedies. It is used specifically to suppress coughs. The drug is widely used in OTC medications because, at normal dosages, it does not produce side effects in most people. Dextromethorphan is a synthetic drug, meaning that it is manufactured in a laboratory.

The chemical is derived from levomethorphan—a synthetic substance that mimics the behavior of opiatesAny drug derived from the opium poppy or synthetically produced to mimic the effects of the opium poppy; opiates tend to decrease restlessness, bring on sleep, and relieve pain. such as heroin, morphine, or codeine. In its pure form, levomethorphan shows many similarities to the opiates, including the potential for addiction. Separated from the levomethorphan, dextromethorphan loses its painkilling component and is also thought to be non-addicting.

Higher Doses and Dangerous Combinations

Because so many easily purchased products contain dextromethorphan, it can be obtained legally for abuse in higher doses. It is not a controlled substance, and no one needs a prescription to purchase it. Nevertheless, emergency doctors, pharmacists, and law enforcement officials are aware of the problems that the drug can cause when abused. They warn of the drug's potential for producing a whole host of dangerous effects on the brain and central nervous system when taken in high doses or in combination with other drugs or alcohol.

Dextromethorphan has been described as a "dissociative anesthetic." This means that it is a substance that alters perception. As one young user told People Weekly magazine in 2004, "You start feeling numb. And finally, you're gone. You're out of your body. You're not there anymore." This is a basic description of "dissociative" feelings.

Official Drug Name: d-3-methoxy-N-methylmorphinan (commonly called dextromethorphan, pronounced dekstroh-meth-ORR-fan); sometimes referred to by shortened name DXM

Also Known As: DM, DXM, dex, drex, red devils, robo, robo-tripping, skittles, triple-C, tussin, velvet, vitamin D

Drug Classifications: The U.S. Department of Justice, Drug Enforcement Administration Diversion Control Program does not list dextromethorphan as a controlled substance; it has no Schedule listing

The drug is also well known for producing: 1) hallucinations—visions or other perceptions of things that are not really present; and 2) an inability to walk or communicate. In worse case scenarios, the drug has caused psychotic behaviorA dangerous loss of contact with reality, sometimes leading to violence against self or others..

Using dextromethorphan with other drugs from ones medicine cabinet can be dangerous. Andrew Brookes/Corbis.
Using dextromethorphan with other drugs from one's medicine cabinet can be dangerous. © Andrew Brookes/Corbis.

Robert Finn compared the use of dextromethorphan to the use of the hallucinogenicA substance that brings on hallucinations, which alter the user's perception of reality. drug PCP (phencyclidine) in a 2004 article for Family Practice News. Finn wrote: "While some symptoms of DXM intoxication are similar to those of PCP intoxication, there's one important difference: People on PCP are able to walk and they're able to become violent. On the other hand, people on DXM become immobilized." (An entry on PCP [phencyclidine] is also available in this encyclopedia.)

One of the greatest dangers of dextromethorphan use is that it is commonly sold in combination with other medications. These include: 1) acetaminophen (pronounced uh-SEE-tuh-MINN-uh fenn), a non-aspirin pain reliever, such as Tylenol; 2) antihistamines, drugs that block histamine, a chemical that causes nasal congestion related to allergies; and 3) guaifenesin (pronounced gwy-FENN-ess-inn) or other expectorantsA cough remedy used to bring up mucus from the throat or bronchial tubes; expectorants cause users to spit up thick secretions from their clogged breathing passages.. Multisymptom cold and cough medications are formulated for correct use by the proper dosage. The use of larger doses not only delivers high quantities of dextromethorphan, it can also deliver large doses of the other ingredients. This can lead to nausea, anxiety, and organ damage.

Abusers of dextromethorphan try to find it in preparations that do not contain these other ingredients, sometimes even purchasing it in powdered form from Internet sites. In this case, problems arise with doses. Unlike many abused drugs, which act predictably as dosage increases, dextromethorphan works as a "plateau" drug. High doses cause a different set of reactions in the brain than lowdoses. Thus, a mismanageduse of dextromethorphan can cause an inexperienced abuser to undergo a bewildering hallucination-filled tripAn intense and usually very visual experience produced by an hallucinogenic drug., possibly ending in a seizure or a coma.

Dangerous in High Doses

Medications available in the local drug store can be very dangerous, even deadly, when taken in high doses or combined with other drugs. Over-the-counter medications sometimes combine dextromethorphan with other ingredients meant to ease the multiple symptoms of colds and flu. Some of these other ingredients, and their potential as poisons, include:

  • Acetaminophen (uh-SEE-tuh-MINN-uh-fenn), a pain reliever such as Tylenol. In high doses, this substance causes severe damage to the liver and other internal organs. It can lead to death.
  • Guaifenesin (gwy-FENN-ess-inn), a mucusthinner and expectorant. In high doses, it causes nausea and vomiting.
  • Pseudoephedrine hydrochloride (SUE-doh-ih-FEH-drinn high-droh-KLOR-ide), a decongestant. Overdoses of this medication can lead to nervousness, insomnia, heart palpitations, and breathing problems.
  • Chlorpheniramine maleate (KLOR-fenn-earuh-mene MAL-ee-ate), an antihistamine such as Chlor-Trimeton. This drug is broken down by the same liver enzyme as dextromethorphan. Overdoses of the two drugs taken together can be fatal.