Very Rare more frequent with other dissociatives One user reported a case of hyperthermia increased body temperature which could have been dangerous, with a rise in body temperature to F 38 C. The individual in question also had a cold at the time, so part of this might have been a result of existing illness. In the case of serious hyperthermia there is an immediate need to lower body temperature.
Sponge baths with cool water and drinking cold liquids are the safest way, although a few physicians have recommended ice-water baths for severe cases. Whenever body temperature nears F 40 C you should get medical attention. Temperatures at or above F 41 C will probably cause permanent brain damage. There is a condition that occurs sometimes with volatile anaesthetics called Malignant Hyperthermia , which is often fatal and seems to involve genetic susceptibility.
Malignant Hyperthermia can raise temperature to F 44 C and is obviously a different sort of threat than the one or two degree temperature rise from dissociatives. I have never heard of it occurring with any dissociative anaesthetic use or not. DXM itself typically raises blood pressure slightly although a few people experience a drop in blood pressure.
Take care combining DXM with stimulants or physical exertion. There is always a chance of hypertensive crisis and hemorrhage, and it's not always easy to predict. If in doubt consult a physician, since drugs which lower blood pressure aren't commonly available, and must be used with considerable care. Avoid DXM if you have an existing high blood pressure condition.
Non-DXM PCP use has been cited as a cause of rhabdomyolysis, a condition where muscle cells break down, and myoglobin and other bits and pieces of muscle cells leak out into the bloodstream. To put it simply, they don't belong there, and the body doesn't know what do with them. They end up essentially clogging the kidneys, which shut down. This can also occur with a variety of stimulant drugs, including amphetamine and MDMA ecstasy.
Nobody's really quite sure why this happens, although some believe it to be a combination of repeated or excessive muscle cell activation, dehydration, and high body temperature not surprisingly, most MDMA-induced rhabdomyolysis takes place at raves. This is of course a serious condition, but hasn't to my knowledge ever occurred from DXM. It's not always fatal, but if enough muscle tissue is destroyed, it can be. Needless to say, medical intervention is required.
I have received anecdotal evidence from one person who complained of prolonged illness days following DXM use, during which she did not produce urine, followed by about three hours of bloody urine. Needless to say she didn't repeat the experience. I haven't a clue if this could have been rhabdomyolysis and she didn't consult a physician at the time , but obviously something was amiss with the kidneys.
Incidentally, this occurred after years of DXM use. Non-DXM One of the risks of high doses of dissociatives, and in fact the proposed mechanism for overdose fatalities, is respiratory depression The two medically recorded deaths due to DXM overdose one of which was a suicide were attributed to this. The real danger of respiratory depression other than death of course is hypoxia insufficient oxygen and subsequent brain damage. DXM does, of course, protect the brain from hypoxic damage, so hypoxia with DXM is probably safer than an equivalent degree of hypoxia with opiates, but there's still no need to put your brain at risk.
In the grand scheme of things hypoxia is just one risk among many for brain damage with regular use of high-dose DXM, but the actual data from DXM users shows that brain damage is extremely rare. A lot of people worry about respiratory depression because of a feeling of shortness of breath that often accompanies DXM intoxication. This may be a consequence of the brain "taking over" breathing from conscious control, as well as impaired perception of the breathing process.
If you're really worried, stop taking DXM. I suppose you could rig up an oxygen mask, but if you're enough of a hardcore psychonaut to consider that you probably don't need my help. Phentermine, fenfulramine, and phen-fen can also cause serotonin syndrome when combined with DXM. DXM induces a release of serotonin, and while it has never been demonstrated to cause serotonin syndrome by itself, it has been shown to do so in combination with other serotonergics Serotonin syndrome is indicated by a combination of three sets of symptoms: Changes in Mental Status hypomania confusion agitation Autonomic Dysfunction diarrhea low-grade fever diaphoresis sweating shivering Neuromuscular Abnormalities myoclonus sudden, brief muscle spasms hyperreflexia exagerrated reflexes ataxia incoordination and clumsiness Yes, there is some overlap e.
More serious symptoms can include rhabdomyolysis basically, your muscle cells break open and leak muscle-cell-parts into your bloodstream, poisoning you , coma, and death. Serotonin syndrome deaths are rare, however. Treatment of serotonin syndrome requires medical intervention, and consists of supporting measures to treat the symptoms, and possibly antiserotonergic drugs. Benzodiazepines such as Valium TM have also been used with considerable success The astute among you will notice that many of these "symptoms" are characteristics of DXM intoxication.
In fact, many serotonergic drugs can cause these symptoms. The question is whether or not the symptoms become severe and numerous. At least one symptom from each of the three categories is generally required for a diagnosis of serotonin syndrome. Once again, if in doubt, see a doctor. And avoid using DXM in combination with any antidepressant.
Theoretical It is possible to have a major allergic reaction to DXM or to one of the inert ingredients typically tartrazine. An antihistamine is the obvious solution. If you are allergic to aspirin you may be allergic to tartrazine, and in any case it is a good idea to try DXM at a very low dosage first to rule out allergic reactions to any of the ingredients found in cough syrups. You should also repeat the low-dose test every time you try a new syrup, gelcap, or other DXM formulation.
I have never heard of a serious case of DXM-induced histamine release but it is a possibility. Again, an antihistamine should help, but if things continue to get worse, get medical help. You want to avoid this. Obviously, nobody should be experimenting at this level without a sober assistant. If this happens, seek medical assistance. While I cannot vouch for the efficacy or safety of this procedure, I have been told that one can maintain the airway by grabbing the person's tongue and holding it out of his or her mouth until motor function is regained or the ambulance comes.
Don't try to insert anything into the person's mouth; it could slip and make the problem worse. Prolonged, regular use of DXM has some definite risks. Generally speaking the most common is mania, which has been reported in people using large amounts of DXM especially to self-medicate depression , , , This is probably a combined effect of dopamine reuptake inhibiton, downstream effects of NMDA blockade, and possibly sigma receptors see Section One user who had formerly used the antidepressant bupropion Wellbutrin TM reported a similar but somewhat stronger antidepressant effect from DXM, though with greater adverse side effects.
This section may also apply in the case of drug "binges" using DXM continuously of more than one day. This is to my knowledge much more common with other drugs than DXM, since it does tend to induce a fairly significant hangover after awhile if for no other reason than the cough syrup is hard on your stomach. The most serious adverse effects are all related to brain damage. This is a well documented risk of PCP in humans and has been shown with all dissociatives in animal models!
The good news is this doesn't happen at human recreational dosage; the bad news is the animal models may not predict the effects of regular use at lower dosages. This time I have tried to organize by categories representing the degree of seriousness of the adverse effects: Permanent brain damage Onley's Lesions named after a researcher named Olney, appropriately enough are a particular type of damage observed from NMDA antagonists dissociatives.
Damage occurs primarily to the posterior cingulate and retrosplenial cortex , and to a lesser extent the entorhinal cortex, dentate gyrus, and olfactory regions The posterior cingulate may be involved in evaluating one's own behaviour , verbal and auditory memory , spatial memory and cognition , and language, notably metaphor comprehension The retrosplenial cortex may be involved in novelty encoding and learning, memory, and emotional behaviour The hippocampus and adjacent areas are well known to be deeply involved in intermediate-term memory and forming relationships between sensory data, and damage to the hippocampal formation causes amnesia both in humans and animals.
Full detail on Olney's lesions is given below; see Section 6. On the other hand, these are functions that, according to all human research, recovers after occasional use of dissociatives. There is considerable documentation of PCP users suffering deficits in language especially finding words , memory, cognitive skills, and motor skills which may be a result of PCP's peculiar toxic effects on the cerebellum not shared by other dissociatives.
Perhaps most disturbingly, this damage also includes the ability to form emotional ties and recognize emotions in others, and an increase in flattened affect outward emotionality. PC has been well studied, and an on-line review is available Some of the papers cited in this source are, in my opinion, a bit dated, but it provides a good starting point for understanding what can occur with long-term high-dosage use of dissociatives.
Some speculate the damage is caused by hypertensive strokes or hemorrhages, although it is worth noting that this speculation was made prior to the knowledge of Olney's lesions. Studies with PCP show that this sort of damage sometimes does resolve though sometimes after months or years. And users of ketamine seem to show considerably less damage than users of equivalent amounts of PCP pers. Even more skepticism is warranted since one popular method for making PCP involves a precursor chemical which, when heated, releases cyanide gas Samples of street-grade PCP show that many contain a fair amount of this precursor the sloppiness of drug chemists is probably the biggest reason to avoid synthetic drugs.
Still, I have received a few anecdotal reports of DXM-induced degradation of mental performance that are consistent with this type of damage. To be precise, I have received eight first-hand reports of this over the past five years, and have read about one other. Three of the eight seemed to show permanent damage; in the other five, it resolved after several months and may have been due to depression. There have been numerous second-hand stories "I heard from this ex-girlfriend about this guy who drank a bottle of cough syrup and his brain melted and ran out his nose" , but I don't necessarily consider them accurate.
The published account involved a year-old insurance salesman who consumed mg DXM, mg guaifenesin, and 3 mg alcohol, about once per week. The researchers suggested a concurrent diagnosis of temporal lobe epilepsy on the basis of extreme religiosity andexcessive note-writing although I've known more than one who experienced this from DXM.
His condition continued to deteriorate after ceasing DXM use. One former user told me of his experiences following use of mg DXM twice to three times a week for 3 months, and then four to five times a week for another three months. After quitting DXM, he experienced uncontrolled shaking of muscles and severe muscle fatigue for three years, and permanent difficulties in forming complex thoughts into words.
He described the latter as "trying to make a complicated sentence out of alphabet soup". Of the first-hand accounts, three involved concurrent use of other drugs, in all cases stimulants pseudoephedrine in one, amphetamines in the other two , and in one case DXM and amphetamine also PCP, ketamine, and MDMA. Of the four cases not involving other drugs, all four used in excess of mg per week, three using over mg per week, and all four for a period of at least six months.
To make matters even more complicated, I've also spoken to at least twelve other people who have used in excess of mg per week for a period of one year or more, without obvious evidence of lasting impairment. One was formally tested and showed no significant impairment. A few of them remarked that there was a recovery period of several months to two years during which they felt "burned out". So how do you avoid this sort of damage? Well, the obvious way is, don't do DXM.
However, people regularly use drugs which can and often do cause brain damage including alcohol, cocaine, amphetamines, and depressants , so I have a sneaking suspicion not everyone is going to drop that bottle of Tussin and walk away from the medicine cabinet. Keep doses as low as necessary to meet your objectives, using meditation, sensory deprivation, theta stimulation, etc.
And since I mentioned it, don't use DXM without a set objective and goal. It is not a casual psychedelic which should be taken just to relieve boredom; that's why the Goddess gave is marijuana and mushrooms wait, I can't say that Okay, fly to somewhere where it's legal and then smoke marijuana. Don't break the law.
But more importantly, don't use DXM so often that it becomes damaging. Besides, like any other psychedelic it loses its magick when used too often. If you have already spent the last five years drinking gallons of cough syrup, maybe now is the time to stop, wait a year or so, and then decide whether you want to continue. More practical advice for psychonauts and the hardcore is given below, in Section 6. Permanent brain damage PCP has been repeatedly blamed for causing cerebro-vascular accidents CVAs such as hemorrhages and strokes, with numerous papers referring to this a good review is provided in Most of the research suggesting CVA damage from PCP came out during the initial PCP epidemic, when it was obvious that people were being hurt but there wasn't much time to figure out why, and the research was somewhat rushed.
Nobody at the time knew any mechanism for NMDA antagonist neurotoxicity and it wasn't considered as a possible culprit. Many people who used PCP were polydrug abusers and mixed it with amphetamines, cocaine, or other stimulants, a practice which is much more likely to result in hypertensive CVAs Much of this research was funded during the early years of the War on Drugs, and other research from this time is known to be biased. Still, the concensus among everyone this researcher included is that PCP, especially street-grade, is bad stuff, and while one hit isn't likely to fry your brain, continued use might.
Whether this is due to Olney's lesions or CVAs is to some degree a moot point. The symptoms of a CVA can include sudden often intense headaches, slurred speech, ataxia, confusion, numbness or loss of muscle control to parts of the body, and abnormal pupil responses. That some of these are also symptoms of DXM intoxication complicates matters for physicians, so make sure if you do see a doctor you tell her or him about your DXM use and what it does.
There is, I think, enough data to show that PCP is possible of inducing CVAs, at least in those with underlying hypertension and who go on "binges". Perhaps with increasing recreational use of ketamine the issue will be resolved. If you use any drug regularly you should seriously consider donating your body to science when you die, since it really will help us in our understanding of the actual dangers of drugs.
Not that a solid knowledge of the dangers of alcohol and tobacco stop anyone from using them, mind you. I know of one person who developed a severe headache during an extended DXM trip, which lasted for several days. This person experienced no loss of mental ability, but hasn't had an MRI a type of brain scan either and isn't likely to since they don't come cheap. So who knows, it could have happened. If it makes you any happier, a DXM-induced CVA is probably healthier than one induced by stimulants, since the secondary quinolinic acid induced damage see Section 4.
Still, that's small comfort when you risk irreversible brain damage. Permanent Brain Damage Some have suggested that chronic NMDA blockade may be a mechanism for Alzheimer's disease , though this could be due to advanced stages of Olney's lesions. There is also a remote possibility of toxicity to 5HT serotonin neurons due to induced overactivity, similar to that resulting from MDMA This has, however, never been observed with any dissociative.
Excitotoxic rebound is a process by which brain cells, accustomed to a lower level of activity, essentially "burn themselves out" when a depressant drug is removed. Alcohol, benzodiazepines tranquilizers, e. It is possible that regular use of DXM could lead to an upregulation i. Recent research suggests that NMDA receptors do not upregulate with blockade, so excitotoxic rebound probably isn't a major factor to worry about.
Psychological disorder As stated above, mania has been documented from regular use of DXM , , , There may be biological susceptibility to it. One of the problems with mania is that, unlike depression, manic patients are often unaware that they are suffering from a psychological disorder. In all recorded cases, mania went away when DXM use was discontinued. Psychological disorder In addition to mania, DXM can also induce depression, although depression is more often associated with DXM withdrawal.
In a few cases, depression can occur even during DXM intoxication. This can range from mild dysphoria to suicide attempts, and there have been a few anecdotal reports unverified, at least by me of actual suicides among heavy DXM users. There is also a published case of a successful suicide attempt by DXM, although it is not known if DXM-induced depression had anything to do with it.
There is some research right now indicating that dissociatives may actually have antidepressant effects , , , , , but other research casts doubt on this , It seems that in animal models, dissociatives can act like antidepressants on some tests, but not necessarily others. What may be happening is that, by inhibiting memory and overall cognitive function, the dissociative is producing identical results in the test models but for a completely different reason.
Others suggest that dissociative depression occurs primarily when tolerance is reached and as a result of withdrawal, or because of a perception of significant mental impairment and the fear that it might be permanent. Withdrawal does improve cognitive abilities Whatever the reason, it does seem to be a real risk of long-term use. If you start finding yourself hostile or depressed, or your friends start mentioning it, lay off the DXM for a few months and see a mental health professional.
Psychological disorder A few regular users of DXM have reported to me that, after a year or so of constant use, they developed regular, violent ideations, and would tend to respond in anger to any perceived threat. A few others have noticed a paranoia while using DXM regularly. Two may have exhibited antisocial behaviour but to my knowledge no formal tests have been done and in one of these cases I suspect the individual wasn't terribly social to begin with.
My hunch is DXM may actually be more pleasant to antisocial personalities because it seems to impair perception of social cues, reduce stress related to social situations, and generally reduce inhibitions. It may be that antisocial personalities just happen to like DXM more than others, who don't enjoy being cut off from interpersonal interactions and social behaviour or who find such interaction to be more unpleasant than most. It is possible that violent ideations coupled with psychotic breaks could result in violent behaviour; this is a well known side effect of PCP, and can have such extreme consequences as parents trying to kill their children However, these cases are not nearly so common as they are made out to be Also, one paper on PCP found that violence was correlated with personality and background, and not everyone was susceptible The only person who reported this with whom I've communicated after he stopped using DXM told me that these symptoms went away after about three months.
If you use it regularly, your memory will be impaired. No big secret here; if you smoke weed all the time you probably won't have much of an attention span either. Still, don't forget that it can take awhile up to a month or so for memory to come back to normal after discontinuing DXM. And since DXM inhibits encoding of memories, keep in mind that you may not have coherent memories from times when you used DXM, even for days after the experience.
This is nothing new to alcoholics, of course, but it isn't exactly fun in either case, and years from now you may find yourself regretting not having remembered the times when you regularly used DXM. Temporary Mental Impairment While on high doses of DXM most people remark on impaired language skills, especially being unable to find the correct word.
With regular use of DXM, many people have noticed that their "inner narratives" become more and more abstract and pre-linguistic, and that they find it more and more difficult to convert concepts into language. Some of this may be due to the fact that the mental states induced by DXM don't really have terms, but I have little doubt that there is some transient and possibly permanent inhibition of language skills.
Although in all cases I've known of except for those listed above under Section 6. One person remarked that it felt as if the skills had been somewhat forgotten due to lack of use, since DXM tended to make him think in terms of pure concepts rather than language, and that as soon as he started using language in his inner narratives, the skills came back. Perhaps like muscles, mental skills must be used regularly to stay in shape. Physical Toxicity Before you get any stupid ideas, the weight comes back after you stop using DXM and typically you end up worse off than before similar to speed in this respect.
I wouldn't mention it, but I've spoken with someone who used heroin for the weight loss somehow I think this person's going to get the Darwin Award. Now that I've hopefully dissuaded everyone, here's the skinny so to speak. Regular use of DXM can induce weight loss, typically about 10 to 20 pounds 4. Part of this weight loss is probably due to a drop in appetite, since it inhibits appetite for food as well as most other physical appetites and since one is often nauseous from drinking cough syrup.
Part of it may be due to a stimulant effect, or an increase in metabolic rate. Regardless of the reason, it is temporary. Miscellaneous At high enough doses, DXM, like any other dissociative, can cause loss of muscle control, but that's not what I'm referring to. With regular use of DXM, some people have noticed extreme weakness and muscle tremor, like that found during exhaustion with weightlifting.
Exactly is going on is beyond my knowledge; it may be related to blood glucose everyone who mentioned this was a regular user of cough syrup , it may be neuromuscular in nature, or it may be a result of exhaustion from muscle rigidity. This is idle speculation, however. Regardless of the cause, this sort of problem is probably your body's way of telling you to lay off the drugs. Miscellaneous Anything can become psychologically addictive: Generally speaking though one can distinguish a point at which one's habits become self- destructive, and at this point it's generally safe to say psychological addiction has occurred.
There is much talk when discussing any drug about the difference between psychological and physical addictions. At the extremes, this isn't so difficult to understand. People who use alcohol regularly eventually require alcohol for their brains to function normally, and are considered to be physically addicted. In the middle is a grey area. Is caffeine physically addictive? With regular use, the brain does adjust to it, and there is a well-defined set of withdrawal symptoms, but people don't generally think of caffeine as being physically addictive.
The same holds true for nicotine, which some rate as the most addictive drug known to man. More recently, psychological addiction has come to be understood as the desire or need to take a drug especially when there are serious consequences to doing so , whether out of enjoyment of the drug primary psychological addiction or out of a desire to avoid the negative effects of withdrawal secondary psychological addiction.
There are documented accounts of DXM users who continued to use DXM in spite of adverse consequences , and I have received about two dozen reports of people whose use of DXM caused them significant trouble. Everyone I was able to follow up on had discontinued use, although some experienced relapses into use. This follows the patterns of PCP users , Based on this I would say that DXM is habit-forming or psychologically addictive. Well, it's hard to tell; any rating of addictiveness is definitely subject to bias.
Personally, I'd say it's more addictive than marijuana, and probably about as addictive as or slightly less than alcohol, in those susceptible to dissociative addiction. There does seem to be some sort of factor or factors which are involved, since many people can use large amounts of DXM without ever developing a habit. Whether these factors are a part of personality or biology is beyond my knowledge. Psychological addiction is not itself a threat, although there can be economic and social consequences to it.
After all, not everyone likes being around someone who is high all the time, and it does impair your ability to hold down a job, go to school, and interact with your loved ones when used to excess. More importantly, however, regular DXM use may bring about long-lasting or even permanent mental impairment. Miscellaneous Tolerance and physical addiction are two different things, although some would argue that the first is a necessary condition for the second. Tolerance occurs where increasing doses of a drug are required to maintain a given level of a drug's effect.
One can become tolerant to many drugs, whether they affect the mind or not; some examples are caffeine, alcohol, stimulants, depressants, opiates, nicotine, nasal decongestant sprays, and aspirin and related NSAIDs. Physical addiction is generally viewed as a condition where the drug is needed for normal function of the body or brain. Tolerance to the effects of drugs can occur without physical addiction, e. However, in the case of psychoactive drugs, tolerance and physical addiction usually go hand in hand.
The big exception to this is the psychedelics. They do induce tolerance, some would argue extremely rapid tolerance called tachyphylaxis , since a second dose of a dissociative a few hours after coming down off the first doesn't seem to induce the same level of effects. This may be related to alcohol tachyphylaxis, since many of the behavioural effects of alcohol may be a result of direct or indirect NMDA blockade. To sum it up, DXM does seem to induce tolerance and I would guess it is cross-tolerant with PCP and ketamine, but nobody's ever tested that , but there does not seem to be an appreciable withdrawal symptom beyond drug craving Some might disagree, pointing out a definite set of withdrawal symptoms from dissociatives including restlessness, dysphoria, depression, and flattened affect, but these may just be an effect of long-term use itself that persists for some time after discontinuing the drug.
Psychological Disorder DXM, like other psychedelics and for that matter any intense experience can induce psychotic breaks which can be long-lasting. Personal susceptibility seems to be involved here, and some people may have latent mental problems which are triggered by DXM. I definitely would advise against DXM use if you have a history or family history of mental illness, especially schizophrenia, depressive disorders, or antisocial personality traits.
The threat for this sort of thing goes up as use becomes more regular, and some have noted that DXM made them a little bit crazy when they were using it regularly. One person with whom I spoke didn't think this was such a bad thing, but none of the others enjoyed it much. This isn't a particularly common problem, but shouldn't be ignored either.
You never know if you're susceptible to a psychotic break until you have one, and coming to your senses in a padded room probably isn't the best trip in the world. Treatment includes antipsychotic drugs and in rare cases electroshock Some research has linked sigma receptors to schizophrenia , and chronic use of NMDA antagonists has been shown to upregulate increase the number or activity of dopamine receptors This could theoretically mean that DXM could trigger schizophrenia or mania in susceptible individuals.
Physical Toxicity I have found no evidence of damage to the liver, kidney, or pancreas from DXM in medical research, however, there are potential mechanisms for it. DXM itself is metabolized fairly easily; it's the inactive ingredients and some of the more unlikely side effects one has to worry about. Drinking cough syrup dumps glucose into your bloodstream, and doing this repeatedly on an empty stomach probably puts a load on your pancreas and stomach, adrenal glands, and probably other parts of your body as well.
True, that's their job, but one can overwork any organ. A few long-term users of DXM have reported that after years of use they became intolerant to any amount of sugar on an empty stomach. There's also the possibility of damage to the liver, especially if the enzymes inhibited by DXM cytochromes PD6, 3A4, and 3A5 are also involved in metabolizing something else, and that something else ends up being metabolized by another enzyme into something dangerous.
This is the sort of thing one has to worry about when inhibiting liver enzymes, and it does occasionally cause problems; as an example, DXM will compete for the enzyme which degrades the prescription antihistamine terfenadine Seldane TM. It may happen that the new metabolite of something is a cell toxin and will wreck your liver; this is a proposed mechanism for acetaminophen toxicity. If you are worried, there are blood tests which can assess liver function.
Finally, I received anecdotal evidence from one person about potential kidney damage. This person had used DXM numerous times without problem until once after a year of regular use when, while using during a flu, experienced kidney dysfunction and bloody urine. Years later when trying DXM again, the effect repeated itself, with kidney pain, lack of urine production, and a few days later when her kidneys started to produce urine again , blood in the urine.
Needless to say if this happens to you, it's a good sign you should stop. Physical Toxicity Although some authors have suggested the possibility of DXM-induced bromism , actual blood tests have revealed little danger to occasional users, even with large doses of DXM Daily use might lead to a dangerous buildup. Notable symptoms of bromide poisoning include headache, irritation, slurred speech, psychosis, weight loss, hallucinations, and an acne-like rash.
Bromism can cause irreversible brain damage. In addition to directly testing bromide ion content of the blood, bromism can be detected by increased anion gap. Chronic use of NMDA antagonists seems to modify alcohol tolerance; this is based mostly on anecdotal evidence and theory, but it appears to be a very real phenomenon. If true, then it is important to note that the GABA receptor effects of alcohol may NOT be changed; in practical terms, you might be a lot drunker than you feel, and this could possibly lead to alcohol poisoning.
Be careful, and limit yourself to as little alcohol as possible when using DXM. A recent paper supports the ability of DXM to affect alcohol tolerance 53 although this paper was concerned with a different effect, i. At least one user has reported that very long-term regular use of DXM recreationally can lead to a constant hacking dry cough.
I have not been able either to confirm or to disprove this. Regular Use Considered There are obvious societal consequences to regularly using a drug which can significantly alter or impair function, and though I shouldn't need to bring this up, I'd better do so anyway. One user of DXM who sent me email reported that he had lost his job, his wife, and his friends because his regular use of DXM made him unable to function in society.
He seemed happy, and perhaps he found his own curious form of nirvana, but if he had been given the choice before using DXM with foreknowledge of the consequences he might have chosen differently. I realize that most people go through irresponsible phases where they don't really care about the consequences of their actions. Now, I truly believe that, as long as those consequences don't involve the physical harm to others, that's your business.
Someone who cares about you has every right to try to talk you out of it, but ultimately, it's your life, and all too often people see any behaviour they don't understand or like as self-destructive. I've known racists who believed that associating with members of other races was self-destructive, and that certainly doesn't make it true. However, before doing anything that may change your outlook on life significantly, ask yourself if you are ready for the changes that may occur, for the loss of those things you now consider significant.
Ideally one would consider this before making any big decision in life, regardless of whether it is marraige, divorce, taking a new job, becoming a Tibetan monk, joining the French Foreign Legion, or doing too many drugs. Remember though, that regular use of DXM may cause long-lasting, even permanent changes in consciousness, mental ability, and personality. Don't jump into the deep end without knowing how to swim and knowing what's waiting for you down there.
Dissociatives seriously affect fetal brain development , and reduce the number of axons pruned during brain development up to and including early childhood This results in disrupted network formation , which leads to impaired spatial learning and may increase the chance of seizures. To sum this up in non-scientific terms, kids whose parents used dissociatives during pregnancy run a high chance of brain damage and possibly epilepsy.
When NMDA antagonists were first studied they seemed like a dream come true: However, it seems that nature never gives something for nothing, and here too there was another side to the coin. The dream ended when Olney et al. Further research showed that other indicators of damage were present, such as proliferation of microglia and induction of a protein called HSP70 Heat-Shock Protein 70 , PCP causes additional damage to the cerebellum and other areas, possibly due to its unique pharmacology Drugs which bind to the polyamine site on the NMDA receptor evidently do not cause Olney's lesions , although nobody is quite sure why.
Curiously, NAN may be worse in females than in males Trying to tie everything together is a little like trying to solve a crime with only circumstantial evidence; there are clues, but nobody's been able to watch the criminal in action. Here is what current research seems to indicate, pieced together into a coherent whole. A simplified explanation is given below.
Dissociative anaesthetics activate neurons in the posterior cingulate cortex PC and retrosplenial cortex RC in lab animals and presumably humans , , There is also secondary, "downstream" activation of neurons in the entorhinal cortex, dentate gyrus of the hippocampus, and olfactory regions There are two theories for why this happens; either one, both, or neither could be true.
The other theory is that the PC and RC are less affected by NMDA blockade than the hippocampus and related areas , and that these formations serve as feedback to the hippocampus and surrounding networks. As these limbic networks are inhibited, the PC and RC increase their output to compensate, resulting in overactivity Regardless of the mechanism, or whether the mechanism is none of the above, the overactivity seems to cause intracellular organelles notably mitochondria and endoplasmic reticulum to malfunction , , The mitochondria probably lose their proton gradient and allow their innards to spill into the surrounding cell material, where they cause all sorts of trouble, possibly including forming free radicals which cause further damage to the cell.
Another possibility is that the free radicals come first, and they cause damage to the mitochondria and other organelles. Mitochondrial damage can occur within 15 minutes of the drug dose, the endoplasmic reticulum is damaged 30 minutes, and in both cases gets worse as time progresses The cell responds to this damage with a protein called HSP This "heat shock" protein is made and activated when something such as overheating, thus the name "heat shock protein" or HSP is causing a cell to malfunction so badly as to be in danger of self-destructing, and its job is to turn the cell off until repairs can be made Hopefully, the cell will get a lot of rest about 24 hours until it goes back to normal.
At this point the problem is still reversible and the brain cells have not been permanently damaged At this point, surrounding support cells called microglia are activated and come in and eat the cell probably under the theory that if an infectious organism caused the cell death, it'd better be destroyed before the infection can spread , Then, scientists come along, freeze the brain, and slice it up into thin slivers.
During the fixing process , the disrupted intracellular organelles expand to form vacuoles, the HSP70 shows up with tests designed to look for it, and the dead cells and proliferating microglia show up on microscope slides. The scientists take pictures, publish papers, thank their lucky stars that they aren't the rats who just took ten times the human anaesthetic dose of dizocilpine, and go home and fix martinis, smoke cigarettes, eat fast food, and engage in other sanctioned risk-taking behaviour that's a joke A layman's explanation of the above: Support cells come in to clean up the mess, and you're left with permanent brain damage.
Here are some of the reported dosages applicable for different dissociatives. Obviously there are still a lot of questions to be answered. The most important for human users of dissociatives is whether this type of damage can occur at recreational levels, and if so, what can be done about it. Let's review the evidence both for and against Olney's lesions in human users of dissociatives. First, the evidence for. The posterior cingulate and retrosplenial cortex PC and RC are involved in skills which seem to be impaired in regular users of dissociatives.
Olney's lesions occur at doses several times the recreational dose, but that's at one dose of the drug; repeated doses of lower amounts may cause the same damage. Olney's lesions are also only generally visible when large numbers of cells are destroyed, and they're significant enough to be visible under the microscope. Finally, conditions which increase the likelihood of Olney's lesions, such as less than ideal blood circulation to the brain, large amounts of glucose like that found in cough syrup , concurrent use of stimulants, physical stress, hypertension, and the like, are all commonly found in drug users, who don't tend to be the healthiest lot this is a generalization, of course.
On the other hand, Onley's lesions have never been found at human recreational levels, and DXM has received little attention. Ketamine users, some of whom have used ketamine for many years, don't typically show mental impairment. Even the few DXM users who do show impairment typically return to normal after staying off DXM for several months, and at least one paper suggests the mental impairment from dissociatives may be caused by depression, not brain damage Weighing the two sides I personally believe that moderate use of dissociatives is probably no harder on your brain cells than moderate use of alcohol or amphetamines I said moderate use, not some five day fry-yer-brain speedfreak binge , and that if you use DXM sparingly e.
In fact, I've never known anyone to suffer lasting impairment even after going through a few months of weekly DXM use at upper plateaus. But I could be wrong! Mild brain damage has a nasty way of showing up years later when you've forgotten about the stupid things you did when you were young. Although our understanding is far from complete, and mine is considerably worse than that, I'll try to put together the published results into a coherent whole.
The posterior cingulate cortex is the posterior rear part of the cingulate cortex, a section of the cerebral cortex interconnected with the limbic areas. The front part of the cingulate cortex is called, appropriately enough, the anterior cingulate cortex. Like most areas of the brain, the boundaries of the cingulate cortex are somewhat indistinct. There are differences between the posterior and anterior cingulate cortex beyond the obvious one of location ; notably, the anterior cingulate cortex has fewer pyramidal neurons than the posterior cingulate, and in the anterior cingulate these neurons have more complex connections This entire area may relay information between the hippocampus and other limbic systems and other areas of the brain There is a lot of disconnected research that points towards possible purposes for the posterior cingulate cortex.
The right hemisphere posterior cingulate is activated in comprehension of metaphors , and the left in associative learning Story comprehension seems to use the posterior cingulate In late Alzheimer's disease the posterior cingulate may be subject to atrophy , It is activated during anxiety and in OCD Obsessive-Compulsive Disorder but deactivated during phobic fear It has been suggested that the cingulate cortex in general may be involved in evaluating posterior and acting on anterior one's own behaviour and spatial orientation This is, in my opinion, the most comprehensive view of the existing research.
To put it simply, the job of the posterior cingulate cortex might be to evaluate and consider where you are and what you're doing. Since dissociatives tend to interfere with the ability to evaluate one's own behaviour, it may be that the posterior cingulate is a part of a self-evaluation system. Another paper analyzed the network properties of the posterior cingulate, and suggested that neural output from the hippocampus that was in sync with the theta rhythm would pass through the posterior cingulate cortex in preference to other routes.
What makes this so interesting is that the flanging or strobing effects of DXM seem to occur at theta rhythm, which may be a consequence of DXM's effects on the posterior cingulate. There was considerably less information published on the retrosplenial cortex. One paper found that it was activated during the encoding of novel situations Another suggests that the circuitry between the retrosplenial cortex and hippocampus is an important path by which the hippocampus affects learning, memory, and emotional behaviour.
Numerous papers suggest it has a role in visual processing. Hopefully I'll be able to fill this area in with more information as my knowledge of and the amount of published information on these two areas of the brain increase. Until then, make what you will of the rather sparse information I have provided. Well the best thing I can tell you is, stay away from drugs that might give you brain damage, whether it's DXM, alcohol, stimulants, benzodiazepines, PCP, or glue.
If marijuana were legal I'd say smoke as much as you want keep in mind that the smoke isn't terribly good for your lungs though , since there have been numerous studies which have shown no neurotoxic effect from marijuana. But since marijuana ain't legal, Realistically, I know many of you are going to keep using DXM, especially since it obviously doesn't impair everyone who uses it even in large amounts. People regularly make choices to engage in risk-taking behaviour, whether it's rock climbing, driving too fast or without a seat belt , eating red meat, not exercising, or taking drugs.
Ultimately that's your choice. Society has made many drugs illegal, and many argue that if drugs were legalized that would give them an aura of legitimacy and safety, but it's legal to sit around and watch TV all day, eat nothing but cheeseburgers, bathe only once a month, and hit yourself on the head with a hammer, and even as a child I never believed that legality made any of these a good idea. So here are some practical suggestions based on research into Olney's lesions, which may work, may do nothing at all, or may make it worse.
It's up to you to decide, but keep in mind that tomorrow it may turn out that any one of these is helping to fry your brain. Avoid stimulants of any kind with DXM, especially yohimbine. Alpha 2 agonists seem to prevent Olney's lesions ; yohimbine, an alpha 2 antagonist, could instead make the problem much, much worse. Make sure you are in good physical condition, with low blood pressure and low cholesterol.
The ability of brain cells to recover from metabolic insults is vastly improved if cerebral blood circulation is in good shape. Consider Coenzyme Q10 supplementation. One paper suggested that Q10 might be useful in some types of neural lesions It has been suggested that, as a mitochondrial energy substrate, it may prevent brain cells from "running out of fuel". Consider a very mild CNS depressant, like a glass of wine or a beer.
I wouldn't go much beyond this, since combining DXM with too much alcohol can lead to severe nausea. A benzodiazepine is probably overkill. Use gelcaps or capsules instead of syrups, which contain glucose; the presence of high glucose levels seems to make things worse. Limit use of DXM extract, which doesn't contain bromide ions, or use it in conjunction with a little alcohol. Or maybe not; the research isn't conclusive on this yet.
Regularly monitor your mental skills and have others monitor them as well. Make each DXM trip count so you don't feel the urge to reattempt an unfulfilling trip experience. From one viewpoint, of course, anything can be addictive -- television, chocolate, masturbation, self-mutilation, etc. So in that sense, yes, DXM can be addictive. Somewhat more relevant are the degree to which DXM is addictive, and how such addiction manifests itself.
The quick answer is, DXM can be addictive if you use too much, too often. The traditional distinction made with respect to addiction is between physical addiction and psychological addiction. As examples, alcohol is physically addictive, whereas marijuana is psychologically addictive. Unfortunately this distinction has its problems - not the least of which is that since the brain is a physical construct, any addiction is in some sense "physical.
Tolerance is a process by which the body and brain adjust to a drug so that the dosage must be increased to achieve the same effect some drugs, such as nitrous oxide, exhibit reverse tolerance , becoming more potent the more often they are used. Note that it is possible to become tolerant to a drug without being psychologically addicted; in fact, some people lose the desire to use a drug when tolerance takes away its more interesting effects. There is considerable evidence based on personal reports that tolerance to DXM's more interesting dissociative effects builds quickly.
This is a result of upregulation or sensitization of NMDA receptors, as well as possible changes in other receptors and systems indirectly affected by DXM. Some people seem to be immune to tolerance to dissociatives including DXM lucky them. Usually it takes several doses before tolerance is noticeable, although a few people have noted tolerance after just one dose. Larger doses will lead to quicker tolerance.
Once tolerance has built, it takes at least three weeks before receptors will reregulate to normal levels. To avoid this problem, it is probably best to dose only once a week at most. Also, some people believe that receptors which are upregulated or downregulated for long periods of time may tend to stay that way. The practical upshot is you should take a month off every now and then a good idea with any drug, incidentally.
Interestingly, the first plateau music euphoria effect also seems to disappear with repeated use of DXM. It's also one of the last effects to come back. This may be due to downregulation of dopamine receptors rather than upregulation of NMDA receptors. The practical upshot is, don't do DXM all the time. Again, some people are luckily immune to this tolerance effect. For information on withdrawal and withdrawal symptoms, refer to the next section.
Psychological addiction to DXM has been noted a few times, and can theoretically lead to physical addiction. Generally, though, dissociatives aren't considered particularly habit-forming, since they tend to have such "heavy" effects. Low-dose DXM might be an exception due to its moderate to strong stimulant effect; in practicality, it's probably too hard to consistently hit the first plateau. There are exceptions, some of them notable. Needless to say, after maintaining this dose long enough, he had become addicted, although the authors consider it a "psychological" addiction, with withdrawal symptoms such as dysphoria, depression, and anxiety.
Most people who use DXM have noticed little or no addiction, and only mild tolerance don't let that scare you; remember that coffee produces both tolerance and withdrawal symptoms. A few unfortunate people have developed problems with DXM. Unfortunately, at this point, there may be withdrawal problems see the next section. If this happens to you, seek medical assistance. Withdrawal from occasional DXM use is almost certainly not dangerous, and in fact any "symptoms" felt are probably just "jonesing" - the same sort of withdrawal "symptoms" felt with marijuana, television, sex, etc.
At this point it's a matter of willpower more than anything else. Once tolerance has built, withdrawal has the potential to cause more serious problems. Mild tolerance to DXM is probably no more dangerous than mild tolerance to alcohol tolerance at the level of "being able to hold your liquor". Withdrawal may produce boredom and mild anxiety, but rarely anything more troubling than that. One person reported a curious withdrawal effect which has also been noted upon cessation of SSRI antidepressant therapy.
Whenever moving his eyes, or upon any sudden change in sensory input, he experienced a sudden, momentary dizziness and altered consciousness. Ginkgo biloba, exercise, and sleep were reported to all help with this. Beyond the mild tolerance level, things could get rapidly worse. There is evidence that significant NMDA upregulation can lead to and many of the symptoms of opiate withdrawal may occur via a similar mechanism , The good news is, studies generally haven't found any significant evidence of brain damage from heroin withdrawal, so withdrawal from DXM probably wouldn't be much trouble.
The bad news is, heroin withdrawal isn't particularly enjoyable. Interestingly, one person who developed addiction and tolerance to DXM also compared the withdrawal symptoms to those of heroin although DXM never produced any of the positive effects of opiates in this individual. These symptoms included watery eyes, stuffy nose, gooseflesh, muscle spasms, increased pain sensitivity, nausea, anxiety, and depression. Furthermore, the individual eventually began to develop some of these symptoms even while using DXM.
This is definitely something to avoid. If you happen to develop a significant degree of tolerance to DXM, it might be a good idea not to quit "cold turkey" all at once. Build down slowly over a few weeks, and avoid all other drugs in the mean time. This should prevent any excitotoxic rebound. On the other hand, given the research from Olney et al see Section 6. Some research casts doubt upon upregulation of NMDA receptors with blockade, and if so, then there may be no danger to quitting DXM completely without tapering down.
To be honest, there is evidence on both sides, and the best advice I can give you is not to get into this situation in the first place. If you do manage to develop a DXM addiction, I wish you the best of luck, and I think your best course of action would be to see a physician. Since most medical authorities are ignorant of DXM's psychoactive potential, it would probably be advisable to treat it as an addiction to any other dissociative ketamine or PCP.
This is very dangerous! It is vital that you quit using DXM as quickly as possible if you are using it on a daily basis. If you have access to mental health services I strongly suggest you seek them out. Many areas provide financial assistance for uninsured or low-income patients. DXM addiction can be treated like addiction to any other dissociative, i. Unfortunately, many physicians and psychiatrists are not generally up-to-date on dissociative addiction, so you may need to look around.
The biggest problem with DXM addiction is rebound depression. Many casual DXM users have noticed a slight depression during the hangover phase. With regular use, however, the brain becomes tolerant to certain aspects of the DXM experience probably a reregulation of serotonin receptors due to the DXM-induced serotonin release. To compensate for the depression which can be severe many people turn back to DXM. Unfortunately, dissociatives make poor antidepressants, since they have numerous side effects.
Incidentally, keep in mind that dissociative-induced depression is often severe enough to result in impaired mental functioning. Many cases of dissociative "brain damage" turn out not to be permanent after all, but only the consequences of major depression. If you choose to kick the habit on your own, or if you have no other choice, you have two options: Build-down means that you slowly taper off DXM use in the hope that your brain will readjust as you do so, and thus avoid the potentially severe depression of sudden withdrawal.
Cold turkey withdrawal the term comes from the gooseflesh of heroin withdrawal means stopping suddenly. Furthermore, another of DXM's metabolites - 3-methoxymorphinan - can also block this enzyme, so that taking divided doses leads to more DXM and less DXO than taking a combined dose of the same amount. DXM, however, can alter the thought processes, leading to highly abnormal, psychosis-like mental states. It is possible that DXM, via sigma activation, may induce a mental state similar to that of schizophrenia.
Whether or not this is fun to you is, of course, up to you. DXM seems to exhibit at least four definable plateaus based solely on dosage, and an additional plateau is notable from a specific dosing regimen see below, Section 5. I previously listed three plateaus; then four; now I'm listing five although "Plateau Sigma" doesn't occur at dosages higher than the fourth plateau.
Not everyone notes distinction between the first and second plateaus, or between the third and fourth plateaus. Others suggest that each effect of DXM has a dosage level at which it starts, and in some cases a dosage level at which its effects are no longer noticeable being overpowered by other effects. Some people will disagree with this classification method, but I think this is the best way to represent DXM's effects. Both the third and fourth plateaus have significant dissociative characteristics, much like ketamine.
The most important thing to keep in mind is that the effects in different plateaus are often very different. For example, on the first plateau, DXM tends to have a stimulant effect. Upon reaching the second plateau, however, the stimulant effect may no longer be present. The beginning of the comedown off of a DXM trip can come abruptly. Often, the user will know when it's starting to end by noticing the return of normal sensory processing.
Coming down from there may take a significant amount of time. A second DXM trip too soon after coming down is not a good idea due to the potential for side effects and psychotic episodes Wait at least three days and preferrably two weeks between each DXM trip. The following table can be used as a general guideline for the plateaus. These dosages are as DXM hydrobromide. Dosage will vary considerably from person to person, by as much as 5 times!
I have included a new category in this table: This is a combination of suggested dosage guidelines from Usenet, and may more accurately represent the plateau dosage of DXM in regular users the original plateau levels were based mostly on occasional users. Additionally, the lower two plateaus are considered together, as are the upper two plateaus.
The lower two plateaus share many features and some of these will be considered here. A generalization would be that the lower two plateaus are more "recreational" than the upper plateaus. Specifically, they have considerably less hangover, do not generally involve serious disruption or breakdown of sensory processing, and are more similar to other intoxicants. It tends to intensify emotional responses and feelings of meaning from external events. At the lower plateaus there is usually enough motor control to be able to engage in physical activites although, like MDMA and MDA there are reasons why you may not want to, including dehydration and overheating.
Most find sensory input is still understandable, although there are peculiar changes which will be discussed below notably flanging. At the lower plateaus it is still possible to interact extensively with the outside world, and one can watch and follow reasonably complex plots in movies, and have complex conversations.
Although DXM is in many ways not a good "casual" drug most people have used it without adverse effect at the lower plateaus. Interestingly, many people who have use DXM at the upper plateaus eventually find that the lower plateaus no longer offer much enjoyment. There are a lot of potential reasons for this see Section 7. The first plateau is probably the hardest to hit; many people "overshoot" it. Please keep in mind that these effects listed are general effects, and that individual results may vary considerably.
A general narrative of the first plateau can be constructed. At about 30 minutes to 1 hour after dosing, an "alert" sensation is noticeable; this is simply a feeling that is unique for individual and signals the begin of altered consciousness. The experience has only a vaguely "drug-like" character for about 10 minutes, after which restlessness and slight stimulant effect are noticeable. After another 10 minutes or so, movement and position sense are altered; those with motion sickness begin to notice nausea.
Gravity starts to feel weird, and one may bounce around a lot. Emotions may start to become intensified. There is a slight feeling of dissociation from reality, but overall the experience is slightly intoxicating, with intensified emotions and sense of importance from everyday events. This effect peaks and then slowly subsides until it is unnoticeable. A first plateau trip usually takes between 20 and 40 minutes to start on an empty stomach , peaks about 1. Gel capsules take up to 1 hour additional to dissolve.
Hangovers are very rare from this plateau, but if they do occur, they tend to consist mainly of lethargy. The primary effects of the first plateau are general euphoria, euphoria specifically linked to music and motion, slight disturbances in balance, moderate stimulation, and very slight intoxication. The intoxication and balance disturbances are similar to that induced by alcohol, but much weaker and without the mental confusion; there is little if any mental sluggishness or confusion with a first plateau trip.
Some people have difficulty hitting the first plateau. It can take several trials; as a general guideline, if you notice double vision, you've gone way too far. A lot of the more pleasurable first plateau effects, in particular the music euphoria, are set and setting dependent. Being in good physical condition, avoiding excessive caffeine, and being in a good mood are all important factors in achieving a good first plateau dose.
Positive first plateau experiences are one of the first to go with regular use. Part of this seems to be tolerance which builds quickly and lasts for considerable time. Another part seems to be a familiarity with the first plateau experience; after awhile it no longer seems quite so profound or interesting. Some have suggested changing set and setting as a way of regaining the more interesting aspects of the first plateau.
The best known, and probably the most responsible for first plateau use of DXM, is the effect upon hearing specifically upon music. Sounds may seem "richer" or "deeper", and music in particular is affected the difference between listening to music on DXM versus sober has been compared to the difference between music in a concert hall versus on a cheap radio. In addition to the change in the nature of hearing itself, music can bring a sense of euphoria, often quite intense.
In comparison to the positive effects on music reported by some users of cannabis, the DXM music effect is usually characterized as much "speedier". The type of music with which this effect most strongly occurs will tend to vary from person to person. Rave music is one of the most commonly affected, possibly due to the regular beat at higher plateaus especially, much of DXM's sensory effects seem beat or rhythm related.
Really, though, the strongest indicator of personal response to a given piece of music seems to be 1 that the user enjoys it, and 2 that it has an "intense" or thematic quality. Not everyone notices this effect. Some notice the opposite -- DXM makes music seem less impacting, and bass tends to be attenuated, leaving everything sounding "tinny" and distant. There does not seem to be any factor predicting whether DXM will improve or degrade the musical experience.
Visual effects are not particularly strong at this plateau. If present, they usually consist of motion trails as if afterimages of each "frame" of vision were not clearing quickly enough. There may be some deterioration of stereoscopic vision and thus depth perception. Colors may seem slightly more vivid. Some have remarked that peripheral vision seems to be degraded.
Taste and touch do not seem to be appreciably affected, although some users have reported that taste is enhanced and mildly euphoria-linked. Others have reported the same effect for touch. The sense of smell, on the other hand, is improved for some; in fact, some find scents so overpowering that they cannot remain around scented items. Balance and body position sense can be significantly affected, ranging from a mild disturbance some call it "sea legs" to a near total loss of position and balance sense generally this only happens on upper plateaus.
The changes seem to relate to an anesthesia of the body senses in particular. The effect like the other sensory DXM effects can be euphoric; some users like to roll around, do cartwheels, dance, march, whatever. People who are very susceptible to motion sickness seem to report nausea, but most do not. Overall some have described these effects as like free-fall. Language is the most strongly affected, although these effects are usually limited to occasional word and syllable repetition especially in already-repeated syllables, e.
Some users report that they feel more creative and capable of non-linear thought on DXM, and this seems to be maximized on the first and second plateaus. Whether this is, in fact, true, or just seems true because of the drug, I have no idea; to my knowledge there are no studies on this. Another cognitive characteristic that occasionally occurs at the first plateau but more commonly at the second is that things can seem much more interesting, or at least much less dull and boring, than they usually are.
There may be an overall increase in approach-related behavior. Many DXM users report a moderate to strong stimulant effect at the first plateau, which disappears at higher dosages. This seems to be enhanced by caffeine. One user reported being able to stay up for 48 hours by maintaining a first plateau level. Note that I don't recommend this. Another characteristic of first and second plateau trips is a lowering of inhibitions related to conversation and to a lesser degree to behaviour.
Many people find they can discuss painful or embarrassing topics without difficulty. This is usually described as a very positive effect, and those who have experienced it often state that they feel more comfortable with themselves after the trip. Some have reported a strengthening of friendships due to this effect. It's interesting that as the third plateau is approached, recall and discussion of such topics seems to become more and more "mandatory".
A few people seem to have problems identifying abnormal behaviour, and some have gotten themselves into awkward social situations by saying or, rarely, doing exactly what they mean. Dissociatives do seem to inhibit the ability to unconsciously recognize and act based upon social constructs. My personal feeling based on some observation is that if you are consciously aware of your behaviour you are not likely to have problems; it is those who act primarily out of instinctual adherence to social rules that tend to behave somewhat bizarrely.
Mood enhancement is the most regular emotional effect of the first plateau; many people find themselves fairly bouncy and happy, occasionally euphoric. Unlike many drugs, there is not usually much "let-down" when the trip ends. Fear is rare at the first plateau. There may be a sense of energy or drive. The effects upon libido evidently tend to vary from person to person. Some people report an increase in sex drive; others find that playing, physical contact, music, etc.
The effects on sexual performance itself are not very strong at the first plateau, though males may have some difficulty in achieving orgasm. When orgasm does occur, it is often accompanied by extreme muscle tension and profuse sweating. Note that there may be problems with hypertension from sex on DXM. Users tend to walk and move in specific ways varying somewhat from person to person characterized by large, fluid movements.
In fact, it may be difficult to perform small or abrupt motion. Motor tasks initiated may continue beyond their targets this can range from fun to distracting. To an outside observer, this can seem quite strange, especially the changes in gait. It is possible, however, to move normally. These changes may be related to euphoria- linking of body kinetic sense see Sensory Effects, above which would make large and sweeping motions more enjoyable. It is also possible that something more directly involved in the planning and carrying out of complex motor tasks may be at work, and that the euphoria is simply a general phenomenon which is not directly connected to the alterations in motor skills.
Some have suggested that impaired processing of vestibular signals i. Activity of DXM in the cerebellum may also contribute. Most of the effects probably come from a general deterioration of short-term memory. Working memory the "train of thought" can become stuck in repetitive thoughts; other times it can be very easy to become distracted. Recall of events prior to the trip does not seem to be degraded. Also probably because of the deterioration of short-term memory, it may be easy to lose track of time.
The sections on memory discuss only memory effects during the acute effects of DXM ingestion and are not describing any lasting aftereffects. The most profound is that DXM begins to take on a heavier "stoning" characteristic, and senses and cognitive function are affected accordingly. Closed-eye hallucinations start for some people on the second plateau.
Some of the first plateau effects, e. Second plateau trips usually take between 30 and 60 minutes to start on an empty stomach , peak about 2 to 3 hours later, and last about 6 hours. Again, gel capsules take up to 1 hour additional to dissolve. Hangovers are not common with lower second plateau trips, but some people experience them. A general narrative of the second plateau: The trip beings identically to the first plateau trip, although the alert and early effects may be noticed earlier.
After passing to the music and motion euphoria stage, the first plateau sensations begin to be overshadowed by disruptions in sensory processing, as sensory input begins to get "choppy". Both sight and sound take on a dreamlike characteristic and one begins to feel increasingly detatched from the outside world. There may be bursts of sensory deprivation where the outside world seems to go away, but overall one maintains contact somewhat incoherent with the outside world.
After a few hours of an overall "stoned" feeling, the sensations begin to subside. A slight hangover consisting of lethargy may be noted the next day. Flanging, also called phlanging, phasing, stop-action, framing, strobing, etc. There does not seem to be any loss of sensory content; instead, it is as if the ability to keep sensory input time-continuous were disturbed. The best analogy from other drugs may be the effects of nitrous oxide upon sound.
An interesting and probably associated sensory phenomenon is that it seems as if one is aware of several temporal stages of sensory processing all at once. In other words, a sentence may be heard not sound for sound or word for word, but all at once this is difficult to describe. Similarly, visual images may be jumbled together with previous images. This may be due to an excessive persistence of sensory buffering.
Vision in particular is changed on this plateau. Depth perception is often lost, and the ability to keep both eyes focused on the same thing is diminished leading to slight double vision. This is most noticeable in people without a dominant eye. Sound, as already mentioned, tends to be flanged. With the sense of touch, there is not necessarily flanging so much as a noticeable delay between the stimulus and recognition of it. Pain especially tends to be somewhat dissociated. Taste is usually simply dulled.
Many people report a vastly improved sense of smell though some report that it is dulled as well. The sense of balance is severely disrupted, as is body position and kinetic sense. Keep in mind that dissociation of pain and the disruption of body sense together make physical exertion somewhat risky, as it is possible to over-exert and not notice. Closed-eye hallucinations tend to begin at the second plateau and in fact are the reason I distinguish this from the first plateau.
Usually these are not "true" hallucinations, but instead are considerable enhancement of imagination, up to fully eidetic imagery i. This is especially powerful with memories; some users are able to re-experience past events, or "simulate" future events, as if actually there, interacting with the environment I call this the "Holodeck Effect". Many users report this to be quite useful for introspection. Actual hallucinations, if they do exist, tend to be abstract and cartoon-like.
There seems to be an emphasis on linear structures - long, thin lines, or long queues of simple objects. There may also be Lilliputian hallucinations everything seems either way too big or way too small, or both. Some people find considerable similarity with fever hallucinations; this can be unpleasant. Your experiences throughout the day will influence the hallucinations you see and the imagery you can create.
For example, if you have spent the day playing DOOM TM , your hallucinations are likely to involve scenes and elements from the game. Eidetic imagery works a little different - you can conjure up images, but they are likely to have a "DOOM TM -esque" feel to them bitmapped textures, ugly walls, etc. This is an interesting effect, and my hunch is that DXM hallucinations and imagery may be very dependent upon what's already stored in intermediate term memory.
So it might be worth planning the events of the day with your trip objectives in mind. This may also be possible to some extent during the trip itself; e. On the other hand the content of one's thoughts may become increasingly abstract as the outside world is ignored. An interesting cognitive effect that is pronounced at the upper second through the third plateau is a change in self-referential thinking. Self-referential thoughts or ideas e. Thoughts can, in fact, get quite abstract, sometimes to the point of seeming meaningless to other observers.
Quite a few people have reported some sort of self-referential or abstracting aspect to thoughts, such as a "self-creating and self-invoking meme" that consists of the concept of itself. Another example is abstracting the concept of abstraction and abstracting that, and so on and so on. There may be an overall blurring together of cause and effect, and causality may become an alien concept I've spoken to more than one quantum physics student who enjoyed DXM.
Language becomes difficult, partly due to cognitive changes as in the first plateau , and partly due to difficulty in coordinating the mouth and tongue motions. There may also be a direct effect on the language-producing centers of the brain. Interpreting spoken language is difficult due to sensory flanging. However, thinking in language is still fairly easy. The curious detachment from painful or embarrassing topics of conversation that occurs at the first plateau continues and is much stronger at this plateau.
Again, this is generally viewed as a positive event, although if you're not prepared to encounter and possibly discuss your deepest, darkest secrets, you might want to avoid higher doses until you're comfortable with DXM. Another major defining characteristic of the second plateau as well as closed-eye hallucinations and flanging may be the motivational aspect. Repetitive, mundane, boring tasks suddenly become doable, and if one can avoid distraction may be easily accomplished, even if they take hours.
There may be a considerable behavioural stimulant effect remaining at the second plateau without other feelings characteristic of stimulants. The euphoria from the first plateau continues but diminishes as dosage across the second plateau increases. Some users find themselves contorting their limbs into rigid positions and in some cases with general muscle rigidity , others may extend and stretch themselves.
These effects are not always immediately apparent; when they are, the user usually reports that it just "feels right" to be in that position. It is still possible to override this. Another accentuation of first-plateau motion effects that sometimes occurs is that the large, sweeping motions, once initiated, may continue for considerable time looking somewhat like a cross between modern dance and Huntington's disease.
Again, it just "feels right" to do. Possibly because of the changes in memory, it may be very difficult to get bored, even with repetitive tasks. At this plateau, a lot of time may get lost, and the more mundane aspects of the trip are easily forgotten after it is over. In some senses it seems to be "programmed", in that the content of the experience, although varying from individual to individual, does not change much from one trip to another.
Overall these experiences are probably the crossing of a threshold in dissociation. The hypothesis is this although it is by no means proven. Generally speaking, sensory input competes with "feedback" input from the brain you've probably noticed this from being deep in thought and not noticing what is going on around you. As sensory input becomes sufficiently inhibited, networks where sensory and feedback information are combined and reconciled begin to gain a larger and larger proportion of their input from internal feedback sources.
Eventually, there is enough attenuation of sensory input and probably intermediate-term memory as well that the feedback loop becomes "free-running", leading to internal states or models, if you prefer that are increasingly detatched from the outside world. During this time, people generally report that they can experience the process or they can discuss, relate, write about it; it does not seem possible to experience it while attempting to maintain contact with the body in any way. Unfortunately, memory of the experience is often impaired, so one gets the feeling of having taken an incredible ride without remembering it.
Fortunately, the threshold experience may repeat itself throughout upper plateau trips see Section 8. If you want a very rough model for the threshold experience, get a video camera and a television, and feed the output of the camera into the TV. Point the video camera at the TV, turn on the date display on the camera to provide some sort of "sensory input" , and turn the brightness down on the TV.
Adjust the zoom on the camera to roughly include the entire TV screen. As you increase the brightness on the TV, however, something interesting begins to happen. Eventually, the feedback becomes self-sustaining, and you can get extremely complex, self-reinforcing patterns which take hold and maintain themselves. The entire picture begins to turn into abstract blobs and colors. As you adjust the zoom, you will find a stable point where you can wave your hand in front of the screen and the effects of this "sensory input" will ripple through the system, mutating constantly but never really leaving.
This also makes a fascinating trip toy, by the way. Overall there are some common features to most people's threshold experiences. The first is a sensation that has been described as the opening of nasal passages, being full of helium, losing one's body, or having one's heart stop beating. The actual effect is most likely a sudden cutoff of sensory input from within the body - everything from all the little aches and pains to the awareness of one's own heartbeat go away.
This can be very disturbing if a naive user interprets it as heart failure! The second transitional effect is a temporary loss of all sensory input this does not always occur , as if one were in a sensory deprivation tank. This is often accompanied by severe Lilliputian hallucinations, probably because there is no internal size reference since the rest of the universe has just gone away.
One person reported feeling as if he shrunk down to the size of a proton, and the rest of the world were light-years away. This transitional phase often repeats itself between the third and the fourth plateaus. Most people who use DXM for psychonautical exploration or spiritual work do so at the upper plateaus. The upper plateaus generally take more out of the user, with more frequent hangovers and moments of dysphoria. Unlike the lower plateaus, most upper plateau experiences do not lend themselves to moving around much.
Most people find it better to find someplace comfortable and stay there. Trying to move too much can induce nausea in some people. Keep in mind that a third plateau trip can be terrifying to people who are not psychologically comfortable and prepared. Because the third plateau is so individually variant, I don't feel comfortable in trying to come up with a narrative.
More complex images, especially images that are not sharply defined, are difficult if not impossible to recognize. Vision, when possible, has a very dream-like quality to it. Simple sounds are still understandable, and one can usually comprehend language, although it may be necessary for the speaker to phrase it in a complex rhythm see Section 5. Music euphoria is rare. Touch and taste are subject to considerable anesthesia, and pain especially may be completely dissociated it's still there, it just doesn't seem to apply.
Body position, kinetic, and balance senses are similarly disrupted. Some people continue to report an enhanced sense of smell on the third plateau; in a few people almost all smells are overpowering, and subtle elements of scents may be recognizable. This can affect taste, and ordinary foods or drinks can take on peculiar tastes as previously unknown odors are noticed. Even the type of container can affect the smell, with faint scents from paper cups, plastic, and even metal noticeable.
Hallucinations may continue, although they tend to be more abstract and "pre-sensory" rather than being predominantly visual. Oftentimes there is an overall sensation of being surrounded by "grey-ness", which brightens to white light as the dosage increases. There do seem to be more frequent moments of "virtual world" experiences, where one can construct an imaginary sensorium with the eyes closed.
At the third plateau, the flanging of sensory input occurs both on a raw level sounds, images and on higher levels words, phrases, faces, etc. This is, to my knowledge, unique to DXM. Flanging may slow down and speed up, leading to periods of lucidity alternating with periods of semi-consciousness.