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Dear
Worried Mom,
Assuming that you are giving the medicine to your son
at the indicated dose, you needn't be terribly concerned.
On the other hand, in a report published in the news bulletin
of the American Society of Addiction Medicine last year (Drug
Trends: DM: A Store-Bought Dissociative?" Bobo, W.V.,Miller,S.C.,
Jackson,J,et.al., ASAM News, Jan-Feb,2001), warns that there
is apparently good reason to advise physicians; drug and alcohol
counselors; educators and parents to educate themselves about
the dangers of the intentional misuse of DM.
To borrow
heavily from that report: Dextromethorphan (DM) is used in
more than 50 OTC cough remedies. At indicated doses, DM safely
and effectively inhibits the brain's cough centers to approximately
the same extent as opiates, such as codeine, but without other
negative opioid effects (analgesia, CNS depression,etc.).
However, at excessive doses, intentional or recreational,
a toxic syndrome may emerge despite early reports indicating
a total lack of CNS effects or addiction potential. Authorities
now warn that DM carries a significant addiction potential,
and that abuse of this seemingly benign cough medicine has
become increasingly popular among adolescents and young adults.
The National Clearinghouse on Alcohol and Drug Information
(NCADI) recently added DM to its list of other addictive dissociative
agents, such as ketamine and PCP, each of which, within 15
to 30 minutes of ingestion, can cause effects such as increased
perceptual awareness, altered time perception, hyper-excitability,
pressure of thought and disorientation.
The DM
"high" may last anywhere from 3 to 6 hours. Such
effects require the ingestion of large amounts of the substance,
with doses estimated as ranging from 300 to 1,800 mg/kg (more
than 100 times the amount in a normal prescribed dose). This
translates to over 4 ounces of DM-containing cough syrup,
prompting some abusers to ingest the drug in a concentrated
powder form which is reportedly available both on the street
and on the Internet.
As with
the better-known drugs of abuse, users of DM have developed
a social culture around the drug over the past 30 years. Popular
street names include "DM," "DXM," "DMX,"
"Skittles," "Vitamin D," "Dex,"
"Tussin" or "Robo." Numerous internet
sites dedicated to the misuse of DM further this cultural
movement by explaining how to acquire the drug, either directly
through mail order or by chemical extraction. Some of these
sites also display the artwork of artists who use DM to "enhance
their creative expression" in ways similar to the early
users of LSD and other hallucinogens. DM has been distributed
at dance parties or "raves," where there is open
use and sale of other psychoactive agents as well.
There
is very little data are available to report the extent of
DM abuse. While it appears that the drug has become especially
popular among adolescents, it is likely that the social impact
of the problem has yet to be fully investigated. There are
relatively few deterrents to abusing DM by prospective and
active users. ....It is an inexpensive, legal product that
is available over-the-counter to any age group. Because it
is produced by pharmaceutical companies, abusers may believe
it is safer to use than the illicit drugs, or even legal substances
such as nicotine and alcohol, both of which come with Surgeon
General warnings. Further, DM is not among the substances
routinely tested for on urinary or serologic toxicology screens,
and the legal consequences of a positive drug screen for DM
are questionable at best. Individuals who test positive could
claim that they are simply self-medicating for a cough. In
short, A WARNING: DM has many characteristics that make it
an attractive choice for adolescents who experiment with drugs.
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