ADA Final Paper ( DXM )

DXM Identify the substance of abuse ● DXM: is a cough suppressant found in more than 120 OTC (over the counter) cold medications. ● Dextromethorphan Hydrobromide, C 18 H 25 NO ● The common street names are CCC, Dex, DXM, Poor Man’s PCP, Robo, Rojo, Skittles, Triple C, and Velvet. ● DXM can come in the forms of: Cough Syrup, tablets, capsules, or powder ● DXM can be found at almost any pharmacy, Powder can also be purchased on the internet ● DXM takes 20 minutes to 1 hour to take effect, with higher doses generally taking longer. Peak effects of recreational doses begin 1 1/2 to 3 hours after onset. Oral DXM Dosages Light 100 - 200 mg Common 200 - 400 mg Strong 400 - 600 mg Heavy 600 - 1,500 mg Risk of Death 2,500 - 20,000 mg Duration 4 -8 hours (DXM Hydrobromide) Duration (extended release) 6 - 12 (DXM Polistirex) Include a brief historical perspective ● 1958 : DXM is approved by the FDA for use as an antitussive ● 1960s-1970s : DXM is available over the counter in tablet form sold under the brand name Romilar. Romilar was introduced as a replacement for codeine containing cough remedies in an effort to cut down on abuse. ● 1962 : Description of early recreation use of DXM containing cough syrup ● 1967 : An early case report about toxic psychosis due to ingestion of Romilar brand DXM tablets. ● 1973 : Romilar DXM containing tablets are removed from the market after an upswing in sales due to recreational use ● 1977 : DXM continues to be available in cough syrups designed to limit recreational use due to the unpleasantness of consuming large volumes of syrup ● Late 1980s : Recreational DXM use is prominent among the punk subculture ● 1992 : The FDA advisory committee is convened to discuss epidemiological studies on

DXM abuse ● 1990s-2003 : Recreational DXM use continues. A number of deaths have been documented due to the recreational use of DXM although a majority of these have been the result of products (such as Coricidin Cough and Cold) that combine DXM with other substances that become dangerous in high doses. Discuss some of the physical & mental effects of the drug POSITIVE ● euphoria, mood lift ● increased giggling and laughing ● dissociation of mind from body (positive when sought) ● creative dream-like experiences ● increased tactile sensation ● some users report empathic feelings, forgiveness, warm feelings towards others ● Some users report reduced depression for days or weeks following a single use. NEUTRAL ● pupil dilation ● visual stop motion effect (flanging or strobing) ● Visual and aural (auditory) hallucinations ● decreased sexual functioning (difficulty achieving orgasm) ● confusion, disorientation ● skin sensitivity, alters tactile (touch) and skin sensations ● robotic, zombie-like walking, "robo-walk" ● discoordination, reduced agility ● Loss of appetite ● Involuntary flexing of muscles ● Feelings of merging with adjacent objects like a couch or bed (with higher doses) NEGATIVE ● upset stomach, vomiting ● dizziness ● body itching ● rash, red blotchy skin ● diarrhea ● fever ● tachycardia (racing, pounding heart) ● some users report feeling disconnected, isolated from others ● some users report hangover/depression on the following 1-2 days. ● Some users report lasting depression and irritability for weeks following heavy use. What are the symptoms of withdrawal? ● Nausea and other gastric disturbances ● Dizziness ● Mild allergic reactions and histamine release ● Sexual dysfunction ● Diaphoresis (sweating) ● Impaired judgement and mental performance ● Hangovers ● Tachycardia (increased heart rate) ● Pupil dilation or constriction ● Hot and cold flashes