Seriously, holy shit it has a terrible reputation it really does not deserve. Unfortunately it's the OTC high of choice for desperate teenagers, and nigh universally found in cough syrups and cold remedy gel caps where it is accompanied by acetaminophen and guaifenesin.
Acetaminophen overdose is a horrid way to go. It will absolutely wreck your liver if you try to use an associated DXM product in tripping quantity.
Guaifenesin is a lot less horrifying, but at high doses will give you intense nausea and make you vomit. It's not hard to see why this would ruin the headspace of any trip.
And last but not least, cough syrups and gel caps are not meant to be taken in large quantities needed to get an effective dose of DXM. They are full of artificial sweeteners that will give you bad diarrhea and a painful, upset stomach.
All of this is to say, most people who try DXM end up with a horrible, shitty experience. In the worst case, the acetaminophen will literally kill you. Most prospective drug users are savvy enough to avoid formulations with APAP, but this is where DXM get its reputation as a particularly hard drug on your liver and kidneys. It's not, it's actually almost as physically benign as opiates are, it's metabolized in the exact same way and has a similar chemical structure despite the fact that it doesn't activate opioid receptors. There is a rare possibility of bladder damage, but this is a property it shares with Ketamine and other dissociatives.
Recently the FDA approved a new prescription antidepressant called Auvelity that features a combination of DXM and Bupropion. It's approved for daily use at a much larger dose than recommended by cough medicine, so I'm not talking out of my ass here when it comes to the safety profile.
Finding OTC formulations without guaifenesin is hard, though. Even harder still is finding non-gel cap/non-cough syrup formulations. Taking any of those is very likely to make you feel as if you poisoned yourself. When DXM is the only active ingredient, people are going to blame that before they blame the inactive ingredients.
And that was how I thought of DXM for a long time because my first experiences with it came in the form of gel caps. I recently had the opportunity to try a more pure formulation of Dextromethorphan HBr, and it is amazing. It doesn't feel like a dirty high at all, and the comedown comes with this peaceful, dreamy, almost opiate-like afterglow feeling.
In smaller doses you get an intoxicating alcohol-like high without any of the downsides like hangovers, liver damage, or obvious loss of motor control.
In larger doses you get what many compare to a more psychedelic, more introspective Ketamine-like trip. But unlike psychedelics, there is a far lower chance of having a bad trip because of how dissociative it is. In my experience, it totally blunts feelings of paranoia and anxiety.
Anyway, I'm on a DXM afterglow right now and thought I'd use this vibe to put my thoughts to paper on it.
You take 10-15x the DXM dose to robotrip compared to Auvelity. On the other hand, Bupropion interacts with DXM to vastly reduce how quickly it metabolizes aka you need way less to get higher. I made this mistake by taking regular cough medicine with DXM and tripping out of my mind because I take Bupropion.
Yeah that's true, I only brought up Auvelity to say that it probably isn't going to cause liver or kidney damage at similar doses. Cough medicine typically recommends 15mg, whereas Auvelity starts at 45mg DXM twice daily and has a lot of leg room to go higher without real concern about organ damage. I don't know much about how Bupropion is expected to interact here, but if it's about onset of effect you could probably replicate that by spreading out smaller doses of DXM rather than taking it all at once.
Robotripping doses are much higher than Auvelity would ever recommend, but my main point is that DXM can be a great, safe drug at much smaller doses than are needed to trip. Even just 100mg gets me feeling pretty nice all day, especially in combination with weed.
despite the fact that it doesn't activate opioid receptors
It does for one of the types, I want to say mu opioid receptors?
That's why it's such a great cough suppressant like the classic opioids
Yeah, Mu opioid receptors are the main ones responsible for opioid highs. There is data showing that DXM and some of its metabolites can activate them, but the binding affinity is orders of magnitude lower than actual opioids to the point where any opioid action must be either totally negligible or mediated indirectly.
I'm on a daily dose of Buprenorphine maintenance, 16mg. That causes a blockade effect at the mu opioid receptor, if I used Heroin on that I wouldn't feel shit. Yet lower dose DXM still feels almost like an opioid without causing opioid withdrawal upon cessation.
DXM is easily one of my favorite drugs period, extraordinarily underrated. Hbr is best for high doses and robotripping, but if you just want a decent high, the energetic drunk feeling, I'd say Polistrex is the absolute shit.
Weed and dabs on DXM are lovely and really round out the high, I like doing edibles with DXM. Cigs are also absolutely godly on DXM.
As far as safety profile goes, I'd say this is overstated and understated. Respiratory depression with DXM is really minor. As far as mixing it with downers, it's fine to be mixed with anything except opiates. However, DXM is extremely dangerous to people who take SSRIs or other forms of antidepressants. DXM's danger isn't in respiratory depression, it's the potential of serotonin syndrome. If you take any meds, make sure you look into interactions before taking DXM because it's a serious one
Thanks for bringing up the potentially dangerous interactions with other drugs, I probably should have elaborated more on that in my post, but I was more focused on talking about the popular perception that using DXM too often is asking for organ failure. Serotonin syndrome is the biggest risk here, anyone who is on SSRIs should absolutely not use DXM, unfortunately.
That said, I've never heard of it being dangerous in conjunction with opioids. I know there's some data out there showing it can reverse opioid tolerance, and that it can potentiate opioids, but I've never heard of it causing lethal respiratory depression like taking benzo/opioid/alcohol combinations does. I feel it really makes my maintenance Buprenorphine dose feel more like a full agonist without any of the extreme sedation.
I know of too many people who have died mixing opiates and DXM. A maintenance sub dose wouldn't be too worrisome, but for people in the cycle with opiates with constantly changing tolerances, it's a pretty unsafe mix.
Damn, that's scary, I had no idea. I probably should have figured that my experience is heavily influenced by how benign Buprenorphine is when it comes to respiratory depression rather than thinking DXM is totally safe to use with opioids in general.
Is there any research on the mechanism of how DXM interacts harmfully with opioids? Like is that unique to DXM or would Ketamine have similar issues?
I don't personally know, but I know the tolerance rollback is 100 percent real. I can look for some today before I go to work.
I looked into it and couldn't find anything specific. While some of the people I know who ODed on the combo were using clean opiates, I'd assume that my generation's love of fentanyl probably throws a wrench in it. If you're on a maintenance dose that's fine, but if you ever take more than your daily dose, I'd suggest avoiding dextro for safety.
Speaking of maintenance, this is good info for you with DXM. My girlfriend is on methadone, and there have been a few times where her doses were fucked up (pressure boiled over on flights) so she had 20mg a day when she normally takes 65mg a day. Low dose dextro was enough to keep her out of withdrawal for weeks. If you ever get fucked on your Suboxone, like you're out of town and lose a few doses, DXM is an essential in your toolkit
That'd honestly be my guess as well regarding street fentanyl where most end users don't actually know what the potency is, what other downers it might be cut with, or even which analogue of fentanyl it is. In a lot of cases it's not fent at all but some newer, weirder opioid RC. It's hard to say how much of a role having DXM in your system would have on an overdose here because it's just another wildly confounding variable among way too many.
Given the very wide array of receptors DXM is known to bind with, I'd say it's probably not worth the risk to use DXM in these situations where you don't actually know exactly what drugs you're taking in what quantity. Maybe there are directly lethal interactions happening with some of the nastier analogues, but it might also be the case that DXM is indirectly mediating opioid effects and pushing what may have been a near lethal overdose over the edge.
With less deadly legit pharma opioids like Hydrocodone, Oxycodone, or Morphine (not IV), I wouldn't worry too much about it. Especially if you have a large tolerance to begin with and you're not being excessive with the dosing. The tolerance reduction and potentiation may even be an easy means of stopping your dose of full agonists from spiraling out of control like it typically does in the development of opioid addiction. And with partial agonists like Kratom and Buprenorphine, I'm not sure there is any danger at all. My maintenance dose of Buprenorphine is already near the ceiling dose and I was breathing just fine on my last 3rd plateau DXM trip.
That said, taking more extreme caution can't hurt.
But also yeah, DXM is a very good tool when you run out of opioids and have to go through withdrawal. It's funny you mention it because I did actually get kind of fucked by the pharmacy last time I picked up my prescription. For some reason they were still out of stock for a whole three days after I ran out despite taking my dose as prescribed and calling to ask for the refill a whole week ahead of time. Buprenorphine has a long ass half-life, so I wasn't feeling too bad by the end, but I was definitely getting very uncomfortable at an increasing rate. It was that point I just threw down a bunch of DXM tablets on a whim to take my mind off it, kind of expecting to just sorta distract myself from the withdrawal, and two hours into a second plateau dose I realized the symptoms had become miraculously unnoticeable.
Then the next day I got my Buprenorphine, dosed it during the DXM afterglow, and once again experienced a miracle when it felt almost like my first experiences with full agonists all those years ago. The only thing missing was the sleepiness and nodding.
Yeah, absolutely no danger with kratom. Love kratom and dextro. But I think you hit the nail on the head. Dextro takes opiate cases that were right on the edge and pushes the over with the tolerance rollback. It's different for people who are physically dependent on opiates, but if you're not then your tolerance isn't consistent enough to even know what a safe dose of opiates is, even with clean product.
DXM+Kratom took me through full fent withdrawal almost comfortably, it's amazing. Seriously, if you start tapering, dextro that shit.
This was a fun read, thanks for penning out. Drugs aren't really my thing outside of the rare bit of booze or endorphins, but it is cool seeing a description.
In smaller doses you get an intoxicating alcohol-like high without any of the downsides like hangovers, liver damage, or obvious loss of motor control
Mine ended up with me feeling like I drank wayyy too much alcohol and I was fighting the entire time to stand up and almost passing out while my vision was dark as shit so I just ended up trying to sleep it off while my head was a rollercoaster
I tried looking online and no idea what happened
I'm 100% confident I bought only DXM HBr too :/
Any ideas?
What was the dosage?
Getting back into DXM after a few years, I was surprised to find out I didn't know that DXM dosing is very dependent on body weight, kind of like alcohol is for some reason. My weight had changed a lot since I had last used, so I needed to take that into account to accurately dose for the different plateaus.
And since DXM is a drug with plateaus: the effects as perceived by the user change massively and discretely with increasing dosage. The popular model involves four plateaus and there's a recommended DXM dose to body weight ratio for each. Example: You're on a first plateau dose for some light intoxication and you're using DXM like a social drug. Doses ranging from 1.5mg/kg to 2.5mg/kg all give you just about that effect in various degrees of potency. But once you get above 2.5mg/kg things suddenly change and start getting weird in a way you wouldn't have extrapolated from the lower grade high.
That then happens again at 7.5mg/kg where you enter the third plateau. I personally don't enjoy going much higher than that, too much more and the psychedelic trip aspect of it starts to become too dominant and I run the risk of a panic attack. At 15mg/kg you're probably just about reaching ego death, and anymore than 20mg/kg is where DXM is rumored to become physiologically dangerous on its own.
I use this site as a reference for exact numbers: https://dxm.tripsit.me/
