Non-medical use of dextromethorphan - AbsoluteAstronomy.com

For general information on this drug, including medical usage, see dextromethorphan
Dextromethorphan
Dextromethorphan is an antitussive drug. It is one of the active ingredients in many over-the-counter cold and cough medicines, such as Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, and others, including generic labels. Dextromethorphan has also found other uses in medicine, ranging...

.

Dextromethorphan
Dextromethorphan
Dextromethorphan is an antitussive drug. It is one of the active ingredients in many over-the-counter cold and cough medicines, such as Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, and others, including generic labels. Dextromethorphan has also found other uses in medicine, ranging...

(DXM), an active ingredient

Active ingredient

An active ingredient is the substance of a pharmaceutical drug or a pharmaceutical ingredient and bulk active in medicine; in pesticide formulations active substance may be used. Some medications and pesticide products may contain more than one active ingredient...

found in many cough suppressant cold medicines, is commonly used as a recreational drug. It has almost no psychoactive effects at medically-recommended doses. Dextromethorphan has euphoric

Euphoria

Euphoria is an emotional and mental state defined as a sense of great elation and well being.Euphoria may also refer to:* Euphoria , a genus of scarab beetles* Euphoria, a genus name previously used for the longan and other trees...

, psychedelic

Psychedelic

The term psychedelic is derived from the Greek words ψυχή and δηλοῦν , translating to "soul-manifesting". A psychedelic experience is characterized by the striking perception of aspects of one's mind previously unknown, or by the creative exuberance of the mind liberated from its ostensibly...

, and dissociative properties when administered in doses well above those which are considered therapeutic medically for cough suppression. Recreational use of DXM is sometimes referred to in slang form as "robo-tripping", whose prefix is derived from the Robitussin

Robitussin

Robitussin is a line of cold and cough medicines currently produced by Pfizer. Robitussin is available in various formulations. Robitussin contains an expectorant ; Robitussin DM adds a cough suppressant to the expectorant ; Robitussin CF is a cold formula that adds an expectorant and a nasal...

brand name of cough medicine, or "Triple Cs" which is derived from the Coricidin

Coricidin

Coricidin, Coricidin 'D , or CoricidinHBP , is the name of a drug marketed by Schering-Plough that contains dextromethorphan and chlorpheniramine maleate...

brand name of cough & cold medicine (since the pills were printed with CCC on them).

An online essay first published in 1995 entitled "The DXM FAQ" described dextromethorphan’s potential for recreational use, and classified its effects into plateaus.

Owing to its recreational use and theft concerns, many retailers in the US have moved dextromethorphan-containing products behind the counter so that one must ask a pharmacist to receive them or be 18 years (19 in New Jersey

New Jersey

New Jersey is a state in the Northeastern and Middle Atlantic regions of the United States. , its population was 8,791,894. It is bordered on the north and east by the state of New York, on the southeast and south by the Atlantic Ocean, on the west by Pennsylvania and on the southwest by Delaware...

and Alabama

Alabama

Alabama is a state located in the southeastern region of the United States. It is bordered by Tennessee to the north, Georgia to the east, Florida and the Gulf of Mexico to the south, and Mississippi to the west. Alabama ranks 30th in total land area and ranks second in the size of its inland...

, 21 in Mississippi

Mississippi

Mississippi is a U.S. state located in the Southern United States. Jackson is the state capital and largest city. The name of the state derives from the Mississippi River, which flows along its western boundary, whose name comes from the Ojibwe word misi-ziibi...

) or older to purchase them. Some retailers also give out printed recommendations about the potential for abuse with the purchase of products containing dextromethorphan.

Classification

At high doses, dextromethorphan is classified as a dissociative general anesthetic and hallucinogen, similar to the controlled substances ketamine

Ketamine

Ketamine is a drug used in human and veterinary medicine. Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar. Pharmacologically, ketamine is classified as an NMDA receptor antagonist...

and phencyclidine

Phencyclidine

Phencyclidine , commonly initialized as PCP and known colloquially as angel dust, is a recreational dissociative drug...

(PCP). Also like those drugs, dextromethorphan is an NMDA receptor antagonist

NMDA receptor antagonist

NMDA receptor antagonists are a class of anesthetics that work to antagonize, or inhibit the action of, the N-methyl d-aspartate receptor . They are used as anesthesia for animals and, less commonly, for humans; the state of anesthesia they induce is referred to as dissociative anesthesia...

. Dextromethorphan generally does not produce withdrawal symptoms characteristic of physically addictive substances, but there have been cases of psychological addiction

Substance dependence

The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...

Effects

Dextromethorphan, when consumed in low "recreational doses" (between 100 & 200 mg), is described as having a euphoric effect. With middle doses (about 400 mg, or 2.5 to 7.5 mg/kg), intense euphoria

Euphoria

, vivid imagination, and closed-eye hallucination

Closed-eye hallucination

Closed-eye hallucinations and closed-eye visualizations are a distinct class of hallucination. These types of hallucinations generally only occur when one's eyes are closed or when one is in a darkened room. They are a form of phosphene....

s may occur. With high doses (600 mg, or 7.5 mg/kg and over), profound alterations in consciousness have been noted, and users often report out-of-body experiences or temporary psychosis

Psychosis

Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

. Most users find such high doses to be extremely uncomfortable and are unwilling to repeat them. Flanging

Flanging

Flanging is an audio effect produced by mixing two identical signals together, with one signal delayed by a small and gradually changing period, usually smaller than 20 milliseconds. This produces a swept comb filter effect: peaks and notches are produced in the resultant frequency spectrum,...

(speeding up or slowing down) of sensory input is also a characteristic effect of recreational use.

There is also a marked difference between dextromethorphan hydrobromide, contained in most cough suppressant preparations, and dextromethorphan polistirex, contained in the brand name preparation Delsym. Polistirex is polymer that is bonded to the dextromethorphan that requires more time for the stomach to digest it as it requires that an ion exchange

Ion exchange

Ion exchange is an exchange of ions between two electrolytes or between an electrolyte solution and a complex. In most cases the term is used to denote the processes of purification, separation, and decontamination of aqueous and other ion-containing solutions with solid polymeric or mineralic 'ion...

reaction take place prior to its dissolution into the blood. Because of this, dextromethorphan polistirex takes considerably longer to absorb, resulting in more gradual and longer lasting effects reminiscent of time release pills. As a cough suppressant, the polistirex version lasts up to 12 hours. This duration also holds true when used recreationally.

In 1981, a paper by Gosselin estimated the lethal dose to be between 50 and 500 mg/kg. Doses as high as 15–20 mg/kg are taken by some recreational users. It is suggested by a single case study that the antidote to dextromethorphan overdose is naloxone

Naloxone

Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...

, administered intravenously.

In addition to producing PCP-like mental effects, high doses may cause a false-positive result for PCP and opiates in some drug tests.

The "DXM FAQ"

A document entitled "The DXM FAQ," by William E. White, classified dextromethorphan's high-dose effects into four or five plateau

Plateau

In geology and earth science, a plateau , also called a high plain or tableland, is an area of highland, usually consisting of relatively flat terrain. A highly eroded plateau is called a dissected plateau...

s, each defined by a dosing range. The dosages are specified in ratios of milligrams (of the drug) per kilogram

Kilogram

The kilogram or kilogramme , also known as the kilo, is the base unit of mass in the International System of Units and is defined as being equal to the mass of the International Prototype Kilogram , which is almost exactly equal to the mass of one liter of water...

(of one's body mass). Doses are experientially, not scientifically derived. According to the FAQ

FAQ

Frequently asked questions are listed questions and answers, all supposed to be commonly asked in some context, and pertaining to a particular topic. "FAQ" is usually pronounced as an initialism rather than an acronym, but an acronym form does exist. Since the acronym FAQ originated in textual...

, the plateaus occur as follows:

First plateau: At a dosage of 1.5 to 2.5 mg/kg, effects include alertness, restlessness, increased heartbeat, increased body temperature, intensification of emotions, euphoria
Euphoria
Euphoria is an emotional and mental state defined as a sense of great elation and well being.Euphoria may also refer to:* Euphoria , a genus of scarab beetles* Euphoria, a genus name previously used for the longan and other trees...

, loss of balance, and slight intoxication.
Second plateau: At 2.5 to 7.5 mg/kg, effects are similar to the first plateau, but with heavier intoxication, choppy sensory input, a dreamlike state of consciousness, some detachment from outside world, and closed-eye hallucination
Closed-eye hallucination
Closed-eye hallucinations and closed-eye visualizations are a distinct class of hallucination. These types of hallucinations generally only occur when one's eyes are closed or when one is in a darkened room. They are a form of phosphene....

s.
Third plateau: At 7.5 to 15.0 mg/kg, effects include flanging of visual effects, difficulty recognizing people or objects, chaotic blindness, dreamlike vision, inability to comprehend language, abstract hallucinations, delayed reaction time, decision making impairment, feelings of peace and quiet, near complete loss of motor coordination, short-term memory
Short-term memory
Short-term memory is the capacity for holding a small amount of information in mind in an active, readily available state for a short period of time. The duration of short-term memory is believed to be in the order of seconds. A commonly cited capacity is 7 ± 2 elements...

impairment, and/or feelings of rebirth.
Fourth plateau: At 15.0 mg/kg or more, an individual may experience a perceived loss of contact and control with their own body, changes in visual perception, out-of-body experience
Out-of-body experience
An out-of-body experience is an experience that typically involves a sensation of floating outside of one's body and, in some cases, perceiving one's physical body from a place outside one's body ....

s, perceptions of contact with "superior" beings, other miscellaneous delusions, lack of movement or desire to move, rapid heart rate, complete blindness, increased hearing, and intensification of third plateau effects.
Plateau Sigma: 2.5-7.5 mg/kg every three hours for 9–12 hours; occurs by prolonging dosage. Plateau sigma is marked by the presence of psychosis with visual and auditory hallucinations. Users have reported that inclinations manifest as auditory hallucinations; rather than simply feeling tired and sitting down, a user might hear a voice saying, "sit down now, you're tired," and feel inclined to obey. White says that of all the reports of Plateau Sigma experiences he received, over half were described as unpleasant.

Risks associated with use

Dextromethorphan has been shown to cause vacuolization

Vacuolization

Vacuolization is the formation of vacuoles within or adjacent to cells, and, in dermatopathology, often refers to the basal cell-basement membrane zone area....

, also known as Olney's lesions

Olney's lesions

Olney's lesions, also known as NMDA receptor antagonist neurotoxicity , are a potential form of brain damage. They are named after John Olney, who conducted a study investigating neurotoxicity caused by PCP and related drugs in 1989.-History:...

, in rats, however oral administration of dextromethorphan did not cause vacuolization in laboratory tests. Oral administration of dextromethorphan repeatedly during adolescence, however, has been shown to impair learning in those rats during adulthood. The occurrence of Olney's lesions in humans, however, has not been proven or disproven. William E. White, author of the DXM FAQ, has compiled informal research from correspondence with dextromethorphan users suggesting that heavy abuse may result in various deficits corresponding to the brain areas affected by Olney's lesions; these include loss of episodic memory

Episodic memory

Episodic memory is the memory of autobiographical events that can be explicitly stated. Semantic and episodic memory together make up the category of declarative memory, which is one of the two major divisions in memory...

, decline in ability to learn, abnormalities in some aspects of visual processing, and deficits of abstract language comprehension.

A formal survey of dextromethorphan users showed that more than half of users reported experience of the following symptoms individually for the first week after dextromethorphan use: fatigue, apathy

Apathy

Apathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.They may lack a sense of purpose or meaning in...

, flashbacks, and constipation

Constipation

Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

. Over a quarter reported insomnia

Insomnia

Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

, nightmares, anhedonia

Anhedonia

In psychology and psychiatry, anhedonia is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. hobbies, exercise, social interaction or sexual activity....

, impaired memory, attention deficit and decreased libido

Libido

Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...

. Rarer side effects included panic attacks, impaired learning, tremor

Tremor

A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the...

, jaundice

Jaundice

Jaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...

, urticaria

Urticaria

Urticaria is a kind of skin rash notable for pale red, raised, itchy bumps. Hives is frequently caused by allergic reactions; however, there are many non-allergic causes...

(hives) and myalgia

Myalgia

Myalgia means "muscle pain" and is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections...

. Frequent and long-term usage at very high doses could possibly lead to toxic psychosis and other permanent psychological problems.

Erectile dysfunction and diminished libido can be a longer-term effect (years to decades) of many narcotic analgesics due to development of central hypogonadism

Hypogonadism

Hypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males...

; this appears to be especially common in individuals with significant melanin

Melanin

Melanin is a pigment that is ubiquitous in nature, being found in most organisms . In animals melanin pigments are derivatives of the amino acid tyrosine. The most common form of biological melanin is eumelanin, a brown-black polymer of dihydroxyindole carboxylic acids, and their reduced forms...

deficiencies, as the hormones tied to melanin production affect the absorption and conversion of these analgesics into progesterone. Additionally, the haplotypes of about 48% of the indigenous population of Great Britain

Great Britain

Great Britain or Britain is an island situated to the northwest of Continental Europe. It is the ninth largest island in the world, and the largest European island, as well as the largest of the British Isles...

aggravate the condition, as the E647 sequence underwent epigenetic degradation and became a pseudogene

Pseudogene

Pseudogenes are dysfunctional relatives of known genes that have lost their protein-coding ability or are otherwise no longer expressed in the cell...

. The chance of vulnerability is doubled for males, as the critical sequence is located on the X chromosome.

Misuse of multi-symptom cold medications, rather than using a cough suppressant whose sole active ingredient is dextromethorphan, carries significant risk of fatality or serious illness. Multi-symptom cold medicines contain other active ingredients, such as acetaminophen (paracetamol), chlorpheniramine, and phenylephrine

Phenylephrine

Phenylephrine is a selective α1-adrenergic receptor agonist used primarily as a decongestant, as an agent to dilate the pupil, and to increase blood pressure...

, any of which can cause permanent bodily damage such as kidney failure, or even death, if taken on the generally-accepted recreational dosing scale of dextromethorphan. Sorbitol

Sorbitol

Sorbitol, also known as glucitol, Sorbogem® and Sorbo®, is a sugar alcohol that the human body metabolizes slowly. It can be obtained by reduction of glucose, changing the aldehyde group to a hydroxyl group. Sorbitol is found in apples, pears, peaches, and prunes...

, an artificial sweetener found in many cough syrups containing dextromethorphan, can also have negative side effects including diarrhea and nausea when taken at recreational dosages of dextromethorphan. Guaifenesin

Guaifenesin

Guaifenesin INN or guaiphenesin , also glyceryl guaiacolate, is an expectorant drug sold over the counter and usually taken by mouth to assist the bringing up of phlegm from the airways in acute respiratory tract infections.-History:Similar medicines derived from the guaiac tree were in use as a...

, an expectorant commonly accompanying dextromethorphan in cough preparations, can cause unpleasant symptoms including vomiting

Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

, nausea

Nausea

Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

, and headache

Headache

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

.

Combining dextromethorphan with other substances can compound risks. CNS stimulants such as amphetamine

Amphetamine

Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...

and/or cocaine

Cocaine

Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...

can cause a dangerous rise in blood pressure and heart rate. CNS depressants such as ethanol (drinking alcohol)

Ethanol

Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...

will have a combined depressant effect, which can cause a decreased respiratory

Breathing

Breathing is the process that moves air in and out of the lungs. Aerobic organisms require oxygen to release energy via respiration, in the form of the metabolism of energy-rich molecules such as glucose. Breathing is only one process that delivers oxygen to where it is needed in the body and...

rate. Combining dextromethorphan with other CYP2D6 substrates can cause both drugs to build to dangerous levels in the bloodstream.

Combining dextromethorphan with other serotonergic drugs

Serotonergic

Serotonergic or serotoninergic means "related to the neurotransmitter serotonin". A synapse is serotonergic if it uses serotonin as its neurotransmitter...

could possibly cause serotonin toxicity, an excess of serotonergic activity in the central nervous system (CNS)

Central nervous system

The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...

and peripheral nervous system (PNS)

Peripheral nervous system

The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...

Pharmacology

Dextromethorphan's hallucinogenic and dissociative effects can be attributed largely to dextrorphan

Dextrorphan

Dextrorphan is a psychoactive drug of the morphinan chemical class which acts as an antitussive or cough suppressant and dissociative hallucinogen. It is the dextro-stereoisomer of racemorphan, the levo-half being levorphanol. Dextrorphan is produced by O-demethylation of dextromethorphan by CYP2D6...

(DXO), a metabolite

Metabolite

Metabolites are the intermediates and products of metabolism. The term metabolite is usually restricted to small molecules. A primary metabolite is directly involved in normal growth, development, and reproduction. Alcohol is an example of a primary metabolite produced in large-scale by industrial...

produced when dextromethorphan metabolizes within the body. Both dextrorphan and dextromethorphan are NMDA receptor antagonist

NMDA receptor antagonist

s, just like the dissociative hallucinogenic drugs ketamine

Ketamine

Ketamine is a drug used in human and veterinary medicine. Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar. Pharmacologically, ketamine is classified as an NMDA receptor antagonist...

and phencyclidine

Phencyclidine

Phencyclidine , commonly initialized as PCP and known colloquially as angel dust, is a recreational dissociative drug...

(PCP); however for that purpose, dextrorphan is more potent than dextromethorphan.

Just like all NMDA receptor antagonists, dextrorphan and dextromethorpan inhibit a neurotransmitter

Neurotransmitter

Neurotransmitters are endogenous chemicals that transmit signals from a neuron to a target cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to...

called glutamate from activating receptor

Neurotransmitter receptor

A Neurotransmitter receptor is a membrane receptor protein that is activated by a Neurotransmitter. A membrane protein interacts with the lipid bilayer that encloses the cell and a membrane receptor protein interacts with a chemical in the cells external environment, which binds to the cell...

s in the brain. This can effectively slow or even shut down certain neural pathways, preventing areas of the brain from communicating with each other. This leaves the user feeling dissociated (disconnected) or potentially "out-of-body."

Dextromethorphan's euphoric effects have sometimes been attributed to the triggering of an increase in dopamine

Dopamine

Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...

levels, since such an increase generally correlates to a pleasurable response to a drug, as is observed with some antidepressants and recreational drugs. However the effect of dextrorphan and dextromethorphan on dopamine levels is a disputed subject. Studies show that some NMDA receptor antagonists, like ketamine and PCP, do raise dopamine levels. Other studies show that dizocilpine

Dizocilpine

Dizocilpine , also known as MK-801, is a non-competitive antagonist of the N-methyl-d-aspartate receptor, a glutamate receptor. Glutamate is the brain's primary excitatory neurotransmitter...

, another NMDA receptor antagonist, has no effect on dopamine levels. Some findings even suggest that dextromethorphan actually counters the dopamine increase caused by morphine

Morphine

Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

. Due to these conflicting results, the actual effect of dextromethorphan on dopamine levels is yet to be determined.

Legality

Antitussive preparations containing dextromethorphan are legal to purchase from pharmacies in most countries, with some exceptions being Sweden, Estonia and Latvia.

United States

No legal distinction currently exists in the United States between medical and recreational use, sale, or purchase. Some states and/or store chains have implemented restrictions, such as requiring signatures for DXM sale, limiting quantities allowable for purchase, and requiring purchasers to be over the age of majority in their state.

The sale of dextromethorphan in its pure powder form may incur penalties, although no explicit law exists prohibiting its sale. There have been cases of individuals being sentenced to time in prison and other penalties for selling pure dextromethorphan in this form, because of the incidental violation of more general laws for the sale of legitimate drugs — such as resale of a medication without proper warning labels.

Dextromethorphan was excluded from the Controlled Substances Act

Controlled Substances Act

The Controlled Substances Act was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. The CSA is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain...

(CSA) of 1970 and was specifically excluded from the Single Convention on Narcotic Drugs

Single Convention on Narcotic Drugs

The Single Convention on Narcotic Drugs of 1961 is an international treaty to prohibit production and supply of specific drugs and of drugs with similar effects except under licence for specific purposes, such as medical treatment and research...

. Dextromethorphan is still excluded from the CSA (as of 2010); however, officials have warned that it could still be added if increased abuse warrants its scheduling. The motivation behind its exclusion from the CSA was that, under the CSA, all optical isomers of listed Schedule II opiates are automatically Schedule II substances. Since dextromethorphan is an optical isomer of the Schedule II opiate levomethorphan

Levomethorphan

Levomethorphan is the l-stereoisomer of methorphan. The effects of the two isomers are quite different. Dextromethorphan is an antitussive at low doses and a dissociative at much higher doses, whereas levomethorphan is an opioid analgesic...

(but does not act like an opiate), an exemption was necessary to keep it a non-controlled substance. Because of its chemical similarity to levomethorphan, DXM could also be treated as a Schedule II drug under the Federal Analog Act

Federal Analog Act

The Federal Analog Act, , is a controversial section of the United States Controlled Substances Act which allowed any chemical "substantially similar" to a controlled substance listed in Schedule I or II to be treated as if it were also listed in those schedules, but only if intended for human...

External links

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.