Misplaced Pages

#533466

76-691: Dextromethorphan , or DXM , a common active ingredient found in many over-the-counter cough suppressant cold medicines, is used as a recreational drug and entheogen for its dissociative effects. Street names include Brownies , Dextro , Drix , Gel , Groove , Lean , Mega-perls , Poor man's ecstasy , Poor man's PCP, Red devils , Robo , Rojo , Rome , Skittles , Sizzurp , Triple Cs, Sky and Velvet . It has almost no psychoactive effects at medically recommended doses. However, dextromethorphan has powerful dissociative and euphoric properties when administered in doses well above those considered therapeutic for cough suppression. Recreational use of DXM

152-645: A benzodiazepine , or is suspected or known to use opioids nonmedically. Prescribing naloxone should be accompanied by standard education that includes preventing, identifying, and responding to an overdose; rescue breathing; and calling emergency services. Distribution of naloxone to individuals likely to encounter people who overdose is one aspect of harm reduction strategies. However, with opioids that have longer half-lives, respiratory depression returns after naloxone has worn off; therefore, adequate dosing and continuous monitoring may be necessary. Naloxone can also be used as an antidote in overdose of clonidine ,

228-448: A fast heart rate , and sweating. To prevent this, small doses every few minutes can be given until the desired effect is reached. In those with previous heart disease or taking medications that negatively affect the heart, further heart problems have occurred. It appears to be safe in pregnancy, after having been given to a limited number of women. Naloxone is a non-selective and competitive opioid receptor antagonist . It reverses

304-511: A 1   ml ampoule of naloxone in the US is estimated to be significantly higher than in most other countries. Take-home naloxone programs for people who use opioids is under way in many North American cities. CDC estimates that the US programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its use prevented 10,000 opioid overdose deaths by 2014. In Australia, some forms of naloxone are available "over

380-442: A dangerous rise in blood pressure and heart rate. CNS depressants such as alcohol will have a combined depressant effect, which can cause a decreased respiratory 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 could possibly cause serotonin syndrome , an excess of serotonergic activity in

456-438: A dose is given, the child should be monitored for at least 24 hours. For children with low blood pressure due to septic shock , naloxone safety and effectiveness are not established. For patients 65 years and older, it is unclear if there is a difference in response. However, older people often have decreased liver and kidney function that may lead to an increased level of naloxone in their body. In hospital settings, naloxone

532-421: A dose of 2   mg and 85% with 4   mg, and an estimated half-life of occupancy disappearance of approximately 100   minutes (1.67   hours). When administered parenterally (non-orally or non-rectally, e.g., intravenously or by injection), as is most common, naloxone has a rapid distribution throughout the body. The mean serum half-life has been shown to range from 30 to 81 minutes, shorter than

608-508: A medication that lowers blood pressure. Clonidine overdoses are of special relevance for children, in whom even small doses can cause significant harm. However, there is controversy regarding naloxone's efficacy in treating the symptoms of clonidine overdose, namely slow heart rate , low blood pressure , and confusion/somnolence . Case reports that used doses of 0.1   mg/kg (maximum of 2   mg/dose) repeated every 1–2 minutes (10   mg total dose) have shown inconsistent benefit. As

684-404: A medium for conveying the active ingredient is usually called the vehicle . For example, petrolatum and mineral oil are common vehicles. The term 'inactive' should not, however, be misconstrued as meaning inert . The dosage form for a pharmaceutical contains the active pharmaceutical ingredient, which is the drug substance itself, and excipients, which are the ingredients of the tablet, or

760-478: A more physically addictive μ-opioid class antitussive, be made available as an alternative to dextromethorphan. No legal distinction currently exists in the United States between medical and recreational use, sale, or purchase. Some states and store chains have implemented restrictions, such as requiring signatures for DXM sale, limiting quantities allowable for purchase, and requiring that purchasers be over

836-962: A paper by Gosselin estimated that the lethal dose is between 50 and 500 mg/kg. Doses as high as 15–20 mg/kg are taken by some recreational users. A single case study suggests that the antidote to dextromethorphan overdose is naloxone , 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. Dextromethorphan has not been shown to cause vacuolization in animals, also known as Olney's lesions , despite early speculation that it might, due to similarities with ketamine. In rats, 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

SECTION 10

#1732798234534

912-606: A second chance to get help". Emergency Medical Service Providers (EMS) routinely administer naloxone, except where basic Emergency Medical Technicians are prohibited by policy or by state law. In efforts to encourage citizens to seek help for possible opioid overdoses, many states have adopted Good Samaritan laws that provide immunity against certain criminal liabilities for anybody who, in good faith, seeks emergency medical care for either themselves or someone around them who may be experiencing an opioid overdose. States including Vermont and Virginia have developed programs that mandate

988-435: A sensation of unpleasant tingling, not unlike a mild "electric shock". Dextromethorphan's effects have been divided into four plateaus. Also, a marked difference is seen between dextromethorphan hydrobromide, contained in most cough suppressant preparations, and dextromethorphan polistirex, contained in the brand name preparation Delsym. Polistirex is a polymer that is bonded to the dextromethorphan that requires more time for

1064-402: A sense of human agency (that is, something that a person combines with other substances), whereas the natural products present in plants were not added by any human agency but rather occurred naturally ("a plant doesn't have ingredients"). In contrast with the active ingredients, the inactive ingredients are usually called excipients in pharmaceutical contexts. The main excipient that serves as

1140-414: Is a lipophilic compound that acts as a non-selective and competitive opioid receptor antagonist . The pharmacologically active isomer of naloxone is (−)-naloxone. Naloxone's binding affinity is highest for the μ-opioid receptor (MOR), then the δ-opioid receptor (DOR), and lowest for the κ-opioid receptor (KOR); naloxone has negligible affinity for the nociceptin receptor . If naloxone

1216-543: Is a Schedule III controlled substance and is placed in the same list as benzodiazepines and the majority of barbiturates . In December 2021, the National Medical Products Administration reclassified all oral single-component dextromethorphan to prescription drugs due to potential abuse. The authorities also mandated manufacturers to remove statements like "no addiction or tolerance with long-term use" from their instructions. Despite

1292-525: Is administered in the absence of concomitant opioid use, no functional pharmacological activity occurs, except the inability of the body to combat pain naturally. In contrast to direct opiate agonists, which elicit opiate withdrawal symptoms when discontinued in opiate-tolerant people, no evidence indicates the development of tolerance or dependence on naloxone. The mechanism of action is not completely understood, but studies suggest it functions to produce withdrawal symptoms by competing for opioid receptors within

1368-656: Is categorized depending on how much MG of DXM is ingested, each featuring varying or more intense effects. The defined number of plateaus vary depending on source, but the generally agreed-upon number is 4 or 5. Owing to its recreational use, 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 York and Alabama , 21 in Mississippi ) or older to purchase them. Some retailers also give out printed recommendations about

1444-488: Is excreted in breast milk is unknown, however, it is not orally bioavailable and therefore is unlikely to affect a breastfeeding infant. Naloxone can be used on infants who were exposed to intrauterine opiates administered to mothers during delivery. However, there is insufficient evidence for the use of naloxone to lower cardiorespiratory and neurological depression in these infants. Infants exposed to high concentrations of opiates during pregnancy may have CNS damage in

1520-527: Is increasing the distribution points for naloxone kits at all emergency rooms, and various pharmacies and clinics province-wide. All Edmonton Police Service and Calgary Police Service patrol cars carry an emergency single-use naloxone syringe kit. Some Royal Canadian Mounted Police patrol vehicles also carry the drug, occasionally in excess to help distribute naloxone among users and concerned family/friends. Nurses, paramedics, medical technicians, and emergency medical responders can also prescribe and distribute

1596-417: Is injected intravenously , with an onset of 1–2 minutes and a duration of up to 45 minutes. Naloxone can also be administered via intramuscular or subcutaneous injection . The onset of naloxone provided through this route is 2 to 5 minutes with a duration of around 30–120min. Naloxone administered intramuscularly are provided through pre-filled syringes, vials, and auto-injector. A hand-held auto-injector

SECTION 20

#1732798234534

1672-423: Is its United States Adopted Name and British Approved Name (Modified) . The patent has expired and it is available as a generic medication . Several formulations use patented dispensers (spray mechanisms or autoinjectors), and patent disputes over the generic forms of the nasal spray were litigated between 2016 and 2020, when a judge ruled in favor of Teva, the generic manufacturer. Teva announced entry of

1748-471: Is more potent than its "parent molecule" dextromethorphan, it likely works in combination with dextromethorphan to produce hallucinogenic effects due to only a small percentage of dextromethorphan being metabolized into dextrorphan. As NMDA receptor antagonists, dextrorphan and dextromethorphan inhibit the excitatory amino acid and neurotransmitter glutamate in the brain. This can effectively slow, or even shut down certain neural pathways, preventing areas of

1824-488: Is not physically dependent on opioids were to inject the buprenorphine/naloxone combination, then the effects of the buprenorphine may at most be slightly lessened, but the individual would still be expected to experience euphoric effects. A 2003 meta-analysis of existing research showed naloxone to improve blood flow in patients with shock , including septic , cardiogenic, hemorrhagic, or spinal shock, but could not determine if this reduced patient deaths. Whether naloxone

1900-547: Is often combined with acetaminophen (paracetamol, APAP) to relieve pain; however, to achieve DXM's dissociative effects, the maximum daily therapeutic dose of 4000 mg of APAP is often exceeded, potentially causing acute or chronic liver failure , making abuse and subsequent tolerance of products which contain both DXM and APAP potentially fatal. An online essay first published in 1995 entitled "The DXM FAQ" described dextromethorphan's potential for recreational use, and classified its effects into so-called plateaus. Each plateau

1976-503: Is often combined with a number of oral or sublingual opioid preparations, including buprenorphine and pentazocine , so that when swallowed or taken sublingually, only the non-naloxone opioid has an effect. However, if the combination is injected (such as by dissolving a pill or sublingual strip in water), the naloxone is believed to block the effect of the other opioid. This combination is used in an effort to prevent non-medical use. However, SAMHSA 's clinical guidelines state that if

2052-423: Is often standardized to the hypericin that is now known not to be the "active ingredient" for antidepressant use. Other companies standardize to hyperforin or both, ignoring some 24 known additional possible active constituents. Many herbalists believe that the active ingredient in a plant is the plant itself. Naloxone Naloxone is an opioid antagonist : a medication used to reverse or reduce

2128-448: Is pocket-sized and can be used in non-medical settings such as in the home. It is designed for use by laypersons, including family members and caregivers of opioid users at-risk for an opioid emergency, such as an overdose. According to the FDA's National Drug Code Directory, a generic version of the auto-injector began to be marketed at the end of 2019. Narcan nasal spray was approved in

2204-599: Is sometimes referred to in slang form as "robo-tripping" or "skittling", whose prefix derives from the Robitussin brand name, or "Triple Cs", which derives from the Coricidin brand whose tablets are printed with "CC+C" for "Coricidin Cough and Cold". However, this brand presents additional danger when used at recreational doses due to the presence of chlorpheniramine (antihistamine). In over-the-counter formulations, DXM

2280-410: Is the only country in the world that makes single-component dextromethorphan illegal even by prescription and violators may be prosecuted by law. Indonesian National Narcotic Bureau has even threatened to revoke pharmacies' and drug stores' licenses if they still stock dextromethorphan, and will notify the police for criminal prosecution. As a result of this regulation, 130 drugs have been withdrawn from

2356-401: Is unclear. It is included as a part of emergency overdose response kits distributed to heroin and other opioid drug users, and to emergency responders. This has been shown to reduce rates of deaths due to overdose. A prescription for naloxone is recommended if a person is on a high dose of opioid (>100   mg of morphine equivalence/day), is prescribed any dose of opioid accompanied by

Recreational use of dextromethorphan - Misplaced Pages Continue

2432-651: The Hepu County People's Court sentenced one defendant to 7 months in prison, while the Yanchi County People's Court sentenced a pharmacy owner to 6 months, both for drug trafficking involving dextromethorphan. After previously being available over the counter, the National Agency of Drug and Food Control of Republic of Indonesia (BPOM-RI) now prohibits single-component dextromethorphan drug sales with or without prescription. Indonesia

2508-417: 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, decline in ability to learn, abnormalities in some aspects of visual processing, and deficits of abstract language comprehension. In 2004, however, White retracted

2584-508: The CNS and peripheral nervous system . Dextromethorphan is primarily a sigma receptor agonist and an SNRI , and dextromethorphan's effects as a dissociative hallucinogen may be attributed partially to dextrorphan (DXO), a metabolite produced when dextromethorphan is metabolized by the body. Both dextrorphan and dextromethorphan are NMDA receptor antagonists , alike other dissociative hallucinogens such as ketamine and PCP. Although dextrorphan

2660-852: 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 (but does not act like an opiate), an exemption was necessary to keep it an uncontrolled substance. The Federal Analog Act does not apply to dextromethorphan because a new drug application has been filed for it. Active ingredient The similar terms active pharmaceutical ingredient (abbreviated as API ) and bulk active are also used in medicine. The term active substance may be used for natural products . Some medication products can contain more than one active ingredient. The traditional word for

2736-461: The US have carried naloxone for decades, law enforcement officers in many states throughout the country carry naloxone to reverse the effects of heroin overdoses when reaching the location before paramedics. As of 12 July 2015, law enforcement departments in 28 US states are allowed to or required to carry naloxone to quickly respond to opioid overdoses. Programs training fire personnel in opioid overdose response using naloxone have also shown promise in

2812-575: The US in 2015, and is the first FDA-approved nasal spray for emergency treatment or suspected overdose. It was developed in a partnership between LightLake Therapeutics and the National Institute on Drug Abuse . The approval process was fast-tracked. A generic version of the nasal spray was approved in the United States in 2019, though did not come to market until 2021. In 2021, the FDA approved Kloxxado, an 8   mg dose of intranasal naloxone developed by Hikma Pharmaceuticals . Citing

2888-648: The US, and efforts to integrate opioid fatality prevention into emergency response have grown due to the US overdose crisis . Following the use of the nasal spray device by police officers on Staten Island in New York, an additional 20,000 police officers will begin carrying naloxone in mid-2014. The state's Office of the Attorney General will provide US$ 1.2 million to supply nearly 20,000 kits. Police Commissioner William Bratton said: "Naloxone gives individuals

2964-412: The above issues. Misuse of multisymptom cold medications, rather than use of a cough suppressant whose sole active ingredient is dextromethorphan, carries significant risk of fatality or serious illness. Multisymptom cold medicines contain other active ingredients, such as paracetamol (acetaminophen), which can cause permanent bodily damage such as kidney failure or death if taken in quantities exceeding

3040-422: The action of pain-lowering endorphins the body produces naturally. These endorphins likely operate on the same opioid receptors that naloxone blocks. It is capable of blocking a placebo pain-lowering response, if the placebo is administered together with a hidden or blind injection of naloxone. Other studies have found that placebo alone can activate the body's μ-opioid endorphin system, delivering pain relief by

3116-493: The active ingredient may be either unknown or may require cofactors in order to achieve therapeutic goals. This leads to complications in labelling. One way manufacturers have attempted to indicate strength is to engage in standardization to a marker compound. Standardization has not been achieved yet, however, with different companies using different markers, or different levels of the same markers, or different methods of testing for marker compounds. For example, St John's wort

Recreational use of dextromethorphan - Misplaced Pages Continue

3192-438: The active pharmaceutical agent is pharmacon or pharmakon (from Greek : φάρμακον , adapted from pharmacos ) which originally denoted a magical substance or drug. The terms active constituent or active principle are often chosen when referring to the active substance of interest in a plant (such as salicylic acid in willow bark or arecoline in areca nuts ), since the word "ingredient" can be taken to connote

3268-460: 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 or possession, other than in Illinois. Cases of individuals being sentenced to time in prison and other penalties for selling pure dextromethorphan in this form have been reported, because of the incidental violation of more general laws for

3344-569: The article in which he made these claims. A formal survey of dextromethorphan users showed that more than half of users reported experience of these withdrawal symptoms individually for the first week after long-term/addictive dextromethorphan use: fatigue, apathy, flashbacks, and constipation. Over a quarter reported insomnia, nightmares, anhedonia, impaired memory, attention deficit, and decreased libido. Rarer side effects included panic attacks, impaired learning, tremor, jaundice, urticaria (hives), and myalgia. Medical DXM use has not been shown to cause

3420-585: The average half-life of some opiates, necessitating repeat dosing if opioid receptors must be stopped from triggering for an extended period. Naloxone is primarily metabolized by the liver. Its major metabolite is naloxone-3-glucuronide, which is excreted in the urine. For people with liver diseases such as alcoholic liver disease or hepatitis , naloxone usage has not been shown to increase serum liver enzyme levels. Naloxone has low systemic bioavailability when taken by mouth due to hepatic first-pass metabolism, but it does block opioid receptors that are located in

3496-903: The brain (a competitive antagonist, not a direct agonist), thereby preventing the action of both endogenous and xenobiotic opioids on these receptors without directly producing any effects itself. A single administration of naloxone at a relatively high dose of 2   mg by intravenous injection has been found to produce brain MOR blockade of 80% at 5   minutes, 47% at 2   hours, 44% at 4   hours, and 8% at 8   hours. A low dose (2   μg/kg) produced brain MOR blockade of 42% at 5   minutes, 36% at 2   hours, 33% at 4   hours, and 10% at 8   hours. Intranasal administration of naloxone via nasal spray has likewise been found to rapidly occupy brain MORs, with peak occupancy occurring at 20   minutes, peak occupancies of 67% at

3572-404: The brain from communicating with each other. This leaves the user feeling dissociated or disconnected, experienced as brain fog or derealization . Antitussive preparations containing dextromethorphan are legal to purchase from pharmacies in most countries, with some exceptions being UAE, France, and Sweden.. In Russia , dextromethorphan (commonly sold under the brand names Tussin+ and Glycodin)

3648-709: The case of naloxone, these orders are meant to facilitate naloxone distribution to people using opioids, and their family members and friends. Over 200 naloxone distribution programs utilize licensed prescribers to distribute the drug through such orders, or through the authority of pharmacists (as with California's legal provision, AB1535 ). Laws and policies in many US jurisdictions have been changed to allow wider distribution of naloxone. In addition to laws or regulations permitting distribution of medicine to at risk individuals and families, some 36 states have passed laws that provide naloxone prescribers with immunity against both civil and criminal liabilities. While paramedics in

3724-466: The combination of buprenorphine and naloxone is injected by a regular user of buprenorphine or buprenorphine/naloxone, then the buprenorphine would still produce an agonist effect but the naloxone would fail to produce an antagonist effect. This is because the amount of naloxone that would be required to block the buprenorphine after injection is much larger than the amount that is contained in buprenorphine/naloxone (Suboxone) pills and strips. If someone who

3800-497: The country, Health Canada proposed a change to make naloxone more widely available to Canadians in support of efforts to address the growing number of opioid overdoses. In March 2016, Health Canada did change the prescription status of naloxone, as "pharmacies are now able to proactively give out naloxone to those who might experience or witness an opioid overdose." In a survey of US laypersons in December 2021, most people believed

3876-527: The depression of the central nervous system and respiratory system caused by opioids. Naloxone was patented in 1961 and approved for opioid overdose in the United States in 1971. It is on the World Health Organization's List of Essential Medicines . Naloxone is useful in treating both acute opioid overdose and respiratory or mental depression due to opioids. Whether it is useful in those in cardiac arrest due to an opioid overdose

SECTION 50

#1732798234534

3952-427: The doses used throughout the literature vary, it is difficult to form a conclusion regarding the benefit of naloxone in this setting. The mechanism for naloxone's proposed benefit in clonidine overdose is unclear, but it has been suggested that endogenous opioid receptors mediate the sympathetic nervous system in the brain and elsewhere in the body. Naloxone is poorly absorbed when taken orally or sublingually, so it

4028-432: The drug. As of February 2016, pharmacies across Alberta and some other Canadian jurisdictions are allowed to distribute single-use take-home naloxone kits or prescribe the drug to people using opioids. Following Alberta Health Services, Health Canada reviewed the prescription-only status of naloxone, resulting in plans to remove it in 2016, making naloxone more accessible. Due to the rising number of drug deaths across

4104-477: The effects of opioids . For example, it is used to restore breathing after an opioid overdose . It is also known as Narcan. Effects begin within two minutes when given intravenously , five minutes when injected into a muscle , and ten minutes as a nasal spray . Naloxone blocks the effects of opioids for 30 to 90 minutes. Administration to opioid-dependent individuals may cause symptoms of opioid withdrawal , including restlessness, agitation, nausea, vomiting,

4180-621: The first generic nasal spray formulation in December 2021. Brand names of naloxone include Narcan, Kloxxado, Nalone, Evzio, Prenoxad Injection, Narcanti, Narcotan, and Zimhi, among others. Naloxone (Nyxoid) was approved for use in the European Union in September 2017. In the United States, some nasal naloxone are legally available without a prescription. As of 2019, officials in 29 states had issued standing orders to enable licensed pharmacists to provide naloxone to patients without

4256-420: The former of which is active at opioid receptors. The drug is highly lipophilic , allowing it to rapidly penetrate the brain and to achieve a far greater brain to serum ratio than that of morphine. Opioid antagonists related to naloxone include cyprodime , nalmefene , nalodeine , naloxol , and naltrexone . Naloxone was patented in 1961 by Mozes J. Lewenstein, Jack Fishman , and the company Sankyo . It

4332-914: The frequent need for multiple 4   mg doses of Narcan to successfully reverse overdose, packs of Kloxxado Nasal Spray contain two pre-packaged nasal spray devices, each containing 8   mg of naloxone. However, a wedge device (nasal atomizer) can also be attached to a syringe that may also be used to create a mist to deliver the drug to the nasal   mucosa . This is useful near facilities where many overdoses occur that already stock injectors. Administration of naloxone to somebody who has used opioids may cause rapid-onset opioid withdrawal . Naloxone has little to no effect if opioids are not present. In people with opioids in their system, it may cause increased sweating, nausea, restlessness, trembling, vomiting, flushing, and headache, and has in rare cases been associated with heart rhythm changes, seizures , and pulmonary edema . Naloxone has been shown to block

4408-434: The individual first visiting a prescriber. Prescribers working with harm reduction or low threshold treatment programs have also issued standing orders to enable these organizations to distribute naloxone to their clients. A standing order, also referred to as a "non-patient specific prescription" is written by a physician, nurse or other prescriber to authorize medicine distribution outside the doctor-patient relationship. In

4484-508: The intestine. Naloxone, also known as N-allylnoroxymorphone or as 17-allyl-4,5α-epoxy-3,14-dihydroxymorphinan-6-one, is a synthetic morphinan derivative and was derived from oxymorphone (14-hydroxydihydromorphinone), an opioid analgesic. Oxymorphone, in turn, was derived from morphine , an opioid analgesic and naturally occurring constituent of the opium poppy . Naloxone is a racemic mixture of two enantiomers , (–)-naloxone (levonaloxone) and (+)-naloxone (dextronaloxone), only

4560-443: The liquid in which the active agent is suspended, or other material that is pharmaceutically inert. Drugs are chosen primarily for their active ingredients. During formulation development, the excipients are chosen carefully so that the active ingredient can reach the target site in the body at the desired rate and extent. Patients often have difficulty identifying the active ingredients in their medication, as well as being unaware of

4636-514: The market, but drugs containing multicomponent dextromethorphan can be sold over the counter. In its official press release, the bureau also stated that dextromethorphan is often used as a substitute for marijuana, amphetamine, and heroin by drug abusers, and its use as an antitussive is less beneficial nowadays. The Director of Narcotics, Psychotropics, and Addictive Substances Control (NAPZA) BPOM-RI, Dr. Danardi Sosrosumihardjo, SpKJ, explains that dextromethorphan, morphine, and heroin are derived from

SECTION 60

#1732798234534

4712-540: The notion of an active ingredient. When patients are on multiple medications, active ingredients can interfere with each other, often resulting in severe or life-threatening complications. Many online services can help identify the active ingredient of most medications, such as the Medicines Database providing information on medications available in Australia. In phytopharmaceutical or herbal medicine ,

4788-718: The online sales ban, the drug can still be found on some niche e-commerce platforms in China and Twitter . In April 2024, the National Medical Products Administration announced that dextromethorphan, compound diphenoxylate tablets, nalfurafine , and lorcaserin are included in the second-class psychotropic drug catalog. The announcement took effect in July. In August, Xi'an police arrested a suspect and seized 23 boxes of dextromethorphan; in October,

4864-497: The past, although physical dependence is usually only seen in cases of heavy abuse. Due to dextromethorphan's selective serotonin reuptake inhibitor -like action, the sudden cessation of recreational dosing in tolerant individuals can result in mental and physical withdrawal symptoms similar to the withdrawal from SSRIs. These withdrawal effects can manifest as psychological effects, including depression, irritability, cravings, and as physical effects, including lethargy, body aches, and

4940-536: The potential for abuse with the purchase of products containing dextromethorphan. At high doses, dextromethorphan is classified as a dissociative general anesthetic and hallucinogen, similar to the controlled substances ketamine and phencyclidine (PCP). Also like those drugs, dextromethorphan is an NMDA receptor antagonist . It generally does not produce withdrawal symptoms characteristic of physical dependence -inducing substances, but cases of both psychological dependence and physical dependence have been reported in

5016-541: The prescription of naloxone when a prescription has exceeded a certain level of morphine milliequivalents per day as preventative measures against overdose. Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in North Carolina , and have been replicated in the US military. In Canada, naloxone single-use syringe kits are distributed and available at various clinics and emergency rooms. Alberta Health Services

5092-657: The recommended dose. Chlorphenamine and phenylephrine may also contribute to the harm. Sorbitol , 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 , an expectorant commonly accompanying dextromethorphan in cough preparations, can cause unpleasant symptoms including vomiting , nausea, kidney stones , and headache . Combining dextromethorphan with other substances can compound risks. Central nervous system (CNS) stimulants such as amphetamine and/or cocaine can cause

5168-625: The sale of legitimate drugs – such as resale of a medication without proper warning labels. Dextromethorphan was excluded from the Controlled Substances Act (CSA) of 1970 and was specifically excluded from the Single Convention on Narcotic Drugs . As of 2010, it was still excluded from U.S. Schedules of Controlled Substances ; however, officials have warned that it could still be added if increased abuse warrants its scheduling. The motivation behind its exclusion from

5244-776: The same receptor mechanism as morphine. Naloxone should be used with caution in people with cardiovascular disease as well as those that are currently taking medications that could have adverse effects on the cardiovascular system such as causing low blood pressure , fluid accumulation in the lungs (pulmonary edema), and abnormal heart rhythms . There have been reports of abrupt reversals with opioid antagonists leading to pulmonary edema and ventricular fibrillation . Use of naloxone to treat people who have been using opioids recreationally may cause acute opioid withdrawal with distressing physiological symptoms such as shivering, tachycardia and nausea; these in turn may lead to aggression and reluctance to receive further treatment. Naloxone

5320-466: The same tree, and states the effect of dextromethorphan to be equivalent to 1/100 of morphine and injected heroin. By contrast, the Deputy of Therapeutic Product and NAPZA Supervision BPOM-RI, Dra. Antonia Retno Tyas Utami, Apt. MEpid., states that dextromethorphan, being chemically similar to morphine, has a much more dangerous and direct effect to the central nervous system, thus causing mental breakdown in

5396-409: The scientifically supported idea that trained bystanders can reverse overdoses with naloxone. A survey of US naloxone prescription programs in 2010 revealed that 21 out of 48 programs reported challenges in obtaining naloxone in the months leading up to the survey, due mainly to either cost increases that outstripped allocated funding or the suppliers' inability to fill orders. The approximate cost of

5472-427: The setting of perinatal asphyxia . Naloxone has been studied to improve outcomes in this population, however the evidence is currently weak. Intravenous, intramuscular, or subcutaneous administration of naloxone can be given to children and neonates to reverse opiate effects. The American Academy of Pediatrics recommends only intravenous administration as the other two forms can cause unpredictable absorption. After

5548-430: The stomach to digest it, as it requires that an ion exchange 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,

5624-602: The user. She also claimed, without citing any prior scientific study or review, that unlike morphine users, dextromethorphan users cannot be rehabilitated. This claim is contradicted by numerous scientific studies which show that naloxone alone offers effective treatment and promising therapy results in treating dextromethorphan addiction and poisoning. Dra. Antonia Retno Tyas Utami also claimed high rates of dextromethorphan abuse - including fatalities - in Indonesia, and even more questionable, suggested that codeine , despite being

5700-460: Was a fiction spread by the police. Yet another is the claim that people have indulged in "yo-yoing", whereby they would take naloxone and opioids simultaneously to enjoy an extreme "high" and subsequent revival; the idea is scientifically nonsensical. Naloxone is its international nonproprietary name , British Approved Name , Dénomination Commune Française , Denominazione Comune Italiana , and Japanese Accepted Name , while naloxone hydrochloride

5776-446: Was approved for opioid use disorder treatment in the United States in 1971. Naloxone has been subject to much inaccurate media reporting and a number of urban legends about it have become prevalent. One such myth is that naloxone makes the recipient violent. Another is that events called "Lazarus parties" have taken place, in which people reportedly took fatal overdoses in anticipation of being treated with naloxone; in reality this

#533466