Dextromethorphan (DXM) Use in Members of an !Online DXM Community!

!

!Michael P. McDonald, George Pringle, Kara I. Gabriel!

Dept of Psychology, Central Washington University, Ellensburg, WA !

INTRODUCTION!Dextromethorphan (DXM) is used as a cough suppressant in more than 125 over-the-counter medications, and may also be useful as a neuroprotective agent or in the treatment of opiate withdrawal. At high doses, DXM acts as a nonselective serotonin reuptake inhibitor and a N-methyl-D-aspartate (NMDA) receptor antagonist, with effects similar to those of phencyclidine (PCP) and ketamine.!!Unfortunately, recreational intake of high-doses of DXM has been documented in case reports of adolescents and young adults in the United States, Germany, Thailand, and Iran, and may be facilitated by legal access to the drug as well as by information available on the Internet. !!Despite growing awareness of the prevalence of DXM use, little systematic information is available on use patterns and preferences among recreational DXM users, on such users’ perceptions and attitudes toward DXM use, or on the impact of the Internet on DXM use. Given DXM’s legal availability, better understanding of DXM users’ intake patterns could aid in developing targeted intervention or treatment approaches, particularly online. Lastly, because DXM and illicit drug use co-occur, and drug use alters the perceived danger of drugs, knowledge of DXM users’ behavior and perceptions of DXM may contribute to a better understanding of illicit and polysubstance drug use in general. !!The purpose of the current research was to seek information on DXM intake patterns, preferences, and perceptions of DXM from a sample of adult DXM users participating in a DXM-focused online community. !

METHODS!Participants!

!Sixty individuals were recruited from an online community dedicated to DXM issues, Dextroverse.org, via discussion threads on that community’s forums. Fifty-two indicated it was their first time taking the survey, of whom nine (17.3%) were women and 43 (82.7%) were men. The mean reported participant age was 23.6 ± 7.3 years old (range: 18 – 63; median: 21.5). !

!Materials!

!The survey included sections on demographics, illegal and prescription drug use, perceptions of DXM, perceived effects of DXM, and specifics on DXM use and preferences. Response options varied by item, and included yes/no, multiple choice, free response, and Likert-style scale options. !!!!The content of the open response questions was analyzed for the presence of specific themes by two coders. Disagreement triggered a review by both coders until agreement reached 100%. !!

RESULTS AND DISCUSSION!!Informed, Sophisticated, Polysubstance Use Patterns!!•  Majority of users (82.7%) reported using other substances to modify or

enhance the effects of DXM.!•  79% of those listed more than one substance!•  In addition to drugs such as cannabis, alcohol, and other psychotropics,

users frequently consumed non-psychoactive substances solely to amplify or modulate the effects of DXM (e.g. grapefruit juice, magnesium, cimetidine).!

•  Participants displayed proficiency with biological properties of DXM as well as substances used to modify its effects – one user cited DXM as motivation to pursue graduate studies in biochemistry!!

•  Preferred using DXM alone (84.3%) rather than socially (15.7%).!!Early Age of First Drug Use!!•  First Illegal Drug: 15.7 ± 3.1, Range = 7-27.!•  First Prescription Drug w/o Prescription: 16.6 ± 2.3, Range = 11-22.!•  First use of Recreational DXM: 17.1 ± 3.2, Range = 12-30.!!Perception of DXM as Safe and Beneficial!!•  Users saw their DXM use as having been more beneficial than harmful.

across a variety of life areas, finding DXM especially beneficial for their mental health. Responses across the areas were highly consistent (Cronbach’s α = 0.83).!

!Goal Oriented Drug Use!!•  Majority of respondents (79%) reported using DXM to explore their

consciousness or alter their state of mind.!•  While many respondents mentioned DXM’s accessibility (legal, readily

available, cheap) as a reason or benefit of using DXM, the focus was on specific effects, such as dissociation and visual hallucinations.!

•  Users tended to avoid products containing non-DXM ingredients (such as Coricidin® Cough & Cold, or CCC). These products have been more frequently reported in prior studies of DXM abuse, potentially due to the increased likelihood of hospitalization.!

•  Few respondents had ever been arrested (7.7%) or visited an emergency room (17.3%) as a result of DXM use.!

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ACKNOWLEDGEMENTS!!The authors would like to thank the administrative staff, moderators, and members of the online community Dextroverse.org for their support and participation in this study.!

Number of respondents ranking specific DXM-containing products as their 1st, 2nd, and 3rd choice for most preferred and most used!

Themes present in!open-response questions:!

“What are the main reasons you use DXM?”!“Is there anything else you would like to say

about DXM?”!

Substances used concurrently with DXM to modify or enhance its effects!

Concentrated DXM hydrocitrateOther cough syrup

DXM and guaifenesin syrupCoriciden Cough and Cold

ZicamDXM and guaifenesin pills

OtherPowder DXM

Delsym cough syrupCough gelcaps

DXM−only cough syrup

0 10 20 30 40Count

Prod

uct

UsedFirstSecondThird

DXM and guaifenesin syrupOther cough syrup

Concentrated DXM hydrocitrateCoriciden Cough and ColdDXM and guaifenesin pills

OtherDelsym cough syrup

ZicamCough gelcaps

DXM−only cough syrupPowder DXM

0 10 20 30Count

Prod

uct

PreferredFirstSecondThird