A Recreational Drug for All Seasons

The subject of this month’s Name that Drug is a curious, strange substance to be sure. This drug entered the American pharmaceutical market in 1958 and had been in various stages of chemical adjustment since the mid-50’s. The chemistry blueprint for this drug was remarkably similar to the molecular format established for morphine. In fact, morphologically speaking, this month’s drug has a name that has obvious connections to morphine itself; however, this drug is NOT a narcotic. The drug is currently sold in compounds that are available in prescription and in over-the-counter formulas. Until a few years ago, the drug had toiled along as a medicinal workhorse in the treatment of tens of millions of needy patients, an overlooked and overworked drug that few people appreciated.

With the rapid expansion of pain management medicine in America during the late 90’s, the drug got a booster shot on life. Although its role in pain management was not cutting edge news, the drug found itself combined with sustained release opiates and membrane stabilizing drugs to reduce patient need for more powerful narcotics. Depending on whom you talk to, the drug was either a pleasant surprise, or it was a wasted experiment in pain management. In some circles, the drug is still used as an adjunct to treat pain. This month’s drug is chemically part of a family of medications and recreationally abused drugs that we call NMDA antagonists. Without getting you the reader wrapped around the axle of neurochemistry minutiae, let’s just say that this class of drug acts as a quasi-electric barrier for some of the vital chemical messages that transmit back and forth from the brain to the spinal column. Other interesting character-drugs in this group of dissociative anesthetics ketamine andPCP, possess powerful properties as NMDA antagonists and are fellow members. PCP and ketamine have both substantiated themselves as powerful general anesthetics, although PCP is no longer in the American medical formulary, ketamine is a widely used anesthetic with special applications in pediatrics emergency medicine and surgery.

Over the past decade, this month’s drug has vaulted up to the top of the law enforcement watch list due to its rapid ascent as an abused drug with populations of adolescents and young adults. For these groups, this drug is an obvious recreational drug choice due to its availability in various over-the-counter formulas. In the public eye, the drug is instantly associated with a popular over-the-counter drug that is sold in a recognizable big orange box. Ingesting 3 to 4 times the recommended clinical dose of the drug, this drug’s effects take on the mixed characteristics of ketamine and LSD. Unfortunately, there are no instant urinalysis-screening devices for the detection of this drug. There have been dozens of overdose deaths associated with the abuse of the drug. In some states, the over-the-counter version of the drug is stored behind the counter under the watchful supervision of pharmacy staff.

A controversy has recently erupted over the efficacy of this month’s drug for the role it has sustained as a cough suppressant. Several respected studies have cast doubt on claims that the drugs have any power beyond that of a placebo in its direct effects. On the other hand, several more pointed studies have established that when taken in modest amounts, this month’s drug can indeed reduce the potential for cough. Recreational or abusive utilization of this drug will not cause a physical drug dependency.

In over-the-counter preparations (OTC), the drug can be found in medications such as Robitussin, Coricidin and Delsym. Recreationally, this drug has carved out a role as a popular alternative in the Rave and Club drug scene. Addicts to this month’s drug have flooded treatment centers throughout the country; there is not an agreed upon standard of care for those who are addicted to it. This month’s drug has a unique set of effects in that it impacts neurochemical systems that regulate the actions of two very important central nervous system transmitters. Dopamine and serotonin transporter systems are both influenced by the actions of this drug. The net effect is an unusual high that is both stimulating and soothing. Users report feelings of euphoria, self-confidence and artistic sorts of self-expression. They feel cut-off from the problems of the world and are able to tune in, turn on and drop out.

Because of overdoses and deaths associated with the recreational use of this month’s drug, many states now require pharmacists to store and safeguard the drug behind the front counter. Nevertheless, the drug is quite simple to purchase and abuse. To achieve a high from the consumption of this drug, it is widely believed that 3 or 4 times the average concentration of a clinical dose must be achieved. One of the chief complaints of people who abuse this drug is that a disabling nausea develops; others complain that the drug can precipitate an unending headache along with ringing in the ears (tinnitus). The low cost of this drug in its over-the-counter form makes it a great alternative choice for drug users whose budgets might be suffering from the pinch of the worldwide recession. On the street, the drug has been acquired names of DXM, DM, Dance and Robo. The drug is regularly compounded into cough preparations such as Robitussin DM and Coricidin; detxromethorphan can be purchased in a concentrated extended release liquid called Delsym.

Readers who would like more information about DXM and its physical and psychological effects can contact the MEDTOX DAR Program

This month’s drug: Dextropmethporhpan.

Reproduced with permission from The MEDTOX® Journal