WSNIA - The Educator

INFORMATION ♦ EDUCATION ♦ ENFORCEMENT

THE EDUCATOR - Summer 2003

Over the Counter Drug Abuse: Dextromethorphan (DM) as a Hallucinogen

Submitted by Lieutenant Donald J. Mac Neil (ret), Glendale PD

Periodically, law enforcement discovers a new offbeat drug use trend that defies conventional drug abuser wisdom. The newest discovery involves the use of the common cough suppressant Dextromethorphan as a drug of abuse. Dextromethorphan. known as “DM,” is a common over- the-counter medicine that is used to suppress cough. DM is an added ingredient in dozens of cold medicines, the best known of these compounds being Robitussin DM. Most concoctions consist of DM in modest amounts with other ingredients that deal with the symptoms that arise out of infection with a cold or the flu. Dextromethorphan has always had a small, hard core group of abusers. Just ask anyone who works in a drug treatment center. They see this type of abuser from time to time.

Dextromethorphan is a drug that bears a very close structural chemistry resemblance to the potent opiate levorphanol. Because of this relationship, DM can be a frequent source of false positive drug tests for opiates. Despite the chemical similarity to a powerful opiate, DM does not necessarily work in the central nervous system as an opiate. Instead, Dextromethorphan can act more like a hallucinogen. DM seems to be an agonist for receptors that are associated with the serotonin regulatory system in the brain. Medical warnings for adverse reactions counsel medical professionals to guard against “serotonin syndrome.”

DM’s serotonergic work doesn’t diminish its role as a cough suppressant. Opiates are potent agents at inhibiting the normal chemical processing of transmitters in the cough center. Dextromethorphan masquerades enough as an opiate (due to structural similarity to levorphanol), that it can be a rather decent cough suppressant. The drug’s ability to impact cough is not why it is abused by drug users however. Further, it is very unlikely that someone who is taking DM for the purpose of suppressing cough is likely to become someone addicted to it.

DM is a medication that pain management doctors suggest to their patients from time to time. DM is available in highly concentrated over-the-counter syrup that is sold under the trade name of Delsym. This particular medicine is nearly 100 percent Dextromethorphan. As a result, excessive consumption of this medication can give a user a significant serotonergic effect. The end result? A near hallucinogenic high. Dr. Edward Lataille, the director of western region Salvation Army adult rehabilitation centers, has seen Dextromethorphan addicts on a number of occasions. Dr. Lataille characterizes the abuser as someone who presents like an LSD user. Dr. Lataille described the most recent DM addict admission to one of the Salvation Army’s adult rehabilitation centers as being “crazier than a bed bug.”

A Dextromethorphan user or addict will present in the field as someone who fits the seven-step profile of a DAR hallucinogen user. DM can cause a fiery red skin rash as well the standard hallucinogenic symptoms. Because of DM’s antitussive (cough suppressant) effects, moderate doses of 90 milligrams may cause some sedation. At doses above 90 mgs, users will tend to present as hallucinogen abusers. The standard DM dose is 30 mgs.

Tolerance does develop to DM use. As a result of tolerance, DM addicts may drink a complete large volumes of Delsym or Robitussin like compounds that contain the medication to you. The abuse of Dextromethorphan is of particular concern to probation officers, parole officers and drug court personnel. Since offenders in surveillance programs are searching for ways to beat drug tests, DM provides a very legitimate alternative drug. If agents see bizarre behavior and symptoms being exhibited by a client/suspect, but drug tests return negative. Officers should consider the use of a DAR or DRE exam. A properly conducted exam will uncover hallucinogen symptoms and provide a sound hunch that it’s Dextromethorphan that’s aboard.

Lieutenant Donald J. Mac Neil (ret), Glendale PD is a lifetime member of Region III and Al Steward Award Winner. Mr. Mac Neil is a senior criminal justice consultant for Medtox Laboratories Inc. and the Salvation Army Adult Re habilitation Center Command System.