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

❖ Promises West ➢ Outpatient treatment ➢ Residential treatment ➢ Extended care treatment What age group is most likely to use the drug? Why? ● One in every 10 teenagers has used DXM to get high ○ It is cheap, easy to get and legal ○ Parents do not know ○ Cough medicine seems safer ○ DXM is popular ● CPCS ○ 74.5% - 9 to 17 years old ○ Highest frequency DXM abuse 15 to 16 years old ○ Commonly abuse Coricidin HBP Cough & Cold Tablets www.ncbi.nlm.nih.gov/pmc/articles/PMC2257867/ Share some of your personal experiences or thoughts with the drug? 480mg of DXM experience I started my trip out by watching the 1951 version of Alice in Wonderland while burning some incenses. I had no idea what was going on in the movie, it was really hard to pay attention to. But it felt really familiar and like I completely understood how Alice felt and what she was going through. I then decided to go outside and stare up at the stars. This is when I felt this overwhelming sense of freedom. It was just me the stars and my iPod, the rest of the world was nonexistent. When I came back inside I laid on my bed and listen to music, this is when I found myself lost within my own mind, in a world I created from pure imagination. I was searching for something in this world but I didn’t know what that one thing was. I started thinking about death and what it would be like to die. I figured that once you died your spirit was free to roam the infinite expanse of dimensions. This is when I started to fantasize about dying. I was really hoping that my heart would just stop, so I could truly leave this world behind and not having to deal with the problems of life. The entire time I was on this trip I never once felt alone, although I was. I felt a presence there with me. I even stared into the corner of my room and imagined I was seeing him, or it, and talked to it. I decided this presence was my brother who committed suicide a couple weeks ago. That night was an incredible experience and I loved every moment of it. ( Tumblr, fals3proph3t)

Discuss your thoughts on how problems with this substance may be prevented. Include your thoughts on AA/NA or other types of self help groups. DXM could be prevented by the companies supplying the products to pharmacies/etc. There is a certain supply and demand that needs to be met. These sellers could only put a certain amount for the public to buy. Music influences: “Room spinnin', thinkin' he might've sipped just a little bit too much of that cough syrup, His eyelids closed shut, Sat back in the chair clutchin' that cup, Girlfriend came and a couple hours later said his name shook him but he never got up.” (Macklemore, OtherSide) “but drinking cough syrup when you didn't have a cough is ironic, because in reality you're sicker than you thought” (Flatsound, A Small List of things I would normally hide) Talk: talk to your teen about OTC cough medicine abuse Monitor: monitor your medicine cabinets and your teen’s activities Share: share what you have learned with other parents and community leaders