If you want to learn about the use of DXM for opiate withdrawal, you’ve come to the right place. I’ve been researching and writing about natural and medication-based opiate withdrawal remedies for years, and I recently learned about DXM’s ability to positively affect the withdrawal syndrome.
Research has shown that individuals using DXM for opiate withdrawal have experienced a significant reduction of symptoms.
After reading a ton of literature from different sources and watching many YouTube videos on DXM, I can see both the benefits and potential dangers of using DXM for opiate withdrawal. The purpose of this article is to provide you with accurate and helpful information regarding the use of DXM in the treatment of opiate withdrawal.
Table of Contents
What Is DXM?
Dextromethorphan (DXM) is an antitussive (cough suppressant) drug found in over 125 over-the-counter cough and cold medications, including Robitussin, Coricidin, and Vicks. The DXM dosage for cough relief is 10-30 mg every 4-8 hours, with a maximum dose of 120 mg/day.
DXM was originally developed to replace codeine phosphate as a cough suppressant, and it was approved by the FDA in 1958 as an over-the-counter antitussive. Codeine was a powerful cough suppressant, however, it had a few undesirable attributes, namely sedation and opioid dependence.
Unfortunately, DXM was also found to have negative aspects associated with it. At high doses above the therapeutic level, DXM and it’s major metabolite, dextrorphan, act as an NMDA receptor antagonist, thus producing effects similar to the dissociative hallucinogenic states created by drugs such as phencyclidine (PCP) and ketamine.
High doses of DXM are now commonly used (mostly by teenagers and young adults) for recreational use. “Robotripping” has become the main drug culture term used for this altered state of consciousness. The name is derived from the common cough syrup brand Robitussin, as well as the trippy state induced by taking high doses of DXM.
Common experiences of a DXM trip include:
- Separation of mind and body
- Feelings of supreme balance and strength
- Intense dreamlike states
- Sensory deprivation
Note: Individuals under the influence of DXM are also known for their distinct “robo-walk”. Brain-motor coordination is affected, leading to a robotic-like movement of arms and legs, which many have described as trying to walk in zero gravity and struggling for one’s feet to touch the ground.
The 4 Plateaus Of DXM
As dosages of DXM increase, the effects change and are commonly referred to as plateaus, of which there are four. At the low end of the spectrum (first plateau), DXM produces an excitatory state of pleasure similar to stimulants such as cocaine. The sound of music becomes increasingly pleasant, as auditory stimulation is greatly enhanced.
In midrange doses of DXM (2nd plateau), sensory perception, memory, and brain-motor coordination are affected. Psychotomimetic (psychotic-like) effects can become present. At this stage sight and sound can take on a dream-like characteristic, and one begins to feel increasingly detached from the outside world. I saw a YouTube video where a kid described his DXM trip “like being in a box that was separated from reality.”
As doses of DXM are further increased (3rd and 4th plateaus), the effects become less “recreational” than the lower plateaus and are more spiritual, introspective, and shamanic. There are increasing gaps in sensory input, or “cut-offs”. Instead of the usual awareness of one’s body and environment, there is now awareness of nothing. This “white-out” can lead to a total loss of self-awareness, and at very high doses, the incapacity for speech and movement.
DXM exhibits different effects as the dose is increased due to the various stages of receptor action and receptor saturation.
Pharmacology of the DXM experience can be defined as follows:
- Low doses (1.2-2.5 mg/kg) – 1st Plateau: PCP1 mediated NMDA blockade; PCP2 mediated increase in dopaminergic tone.
- Medium doses (2.5-15 mg/kg) – 2nd & 3rd Plateaus: PCP1 mediated blockade; sigma agonism.
- Large doses (>15 mg/kg) – 4th Plateau: PCP1 mediated NMDA blockade.
Note: If you want to see and hear some DXM effects, click on the links below. I’ve never done DXM, but after watching videos of people on it, I now have a much better idea of what it might be like. Also, I listened to some songs that a guy recorded while he was robotripping…very creative and entertaining!
Why Does DXM Help With Opiate Withdrawal?
A review study from 2004 done in Germany concludes that three main mechanisms are responsible for opioid tolerance and the withdrawal syndrome dependence, which are upregulation of adenyl cyclase and nitric oxide synthetase and activation of NMDA receptors. Consequently, the use of alpha-2 agonists (e.g., clonidine) and NMDA antagonists (e.g., dextromethorphan, ketamine) can minimize the tolerance phenomenon and decrease the withdrawal symptoms.
DXM For Opiate Withdrawal Studies
In a study from 1990, 48 heroin addicts going through acute opiate withdrawal were separated into two groups. The first group received 4 mg chlorpromazine every hour, and 10 mg diazepam every 6 hours. The second group received 15 mg of dextromethorphan instead of chlorpromazine.
All withdrawal symptoms except perspiration and emesis (vomiting) were significantly less in the dextromethorphan group.
According to the study:
The results are considered to be supporting evidence for the hypothesis emphasizing the blockade of NMDA receptors by opiates in opiate addiction. Furthermore, the decrease caused by non-opioid NMDA antagonists in the responsiveness of NMDA receptors appears very promising for the treatment of opiate addicts.”
In a clinical study from 2013 in Iran, 60 patients going through opiate withdrawal were divided into two groups.
Group 1 received 0.4–1.2 mg clonidine per day in three divided doses according to the patient’s tolerance, 1 mg clonazepam every eight hours, and 500 mg acetaminophen every six hours.
The second group received the same protocol mentioned above, with the addition of 75 mg dextromethorphan every six hours.
Results showed that dextromethorphan added to the clonidine regimen has a better efficacy compared to clonidine alone ameliorating opiate withdrawal symptoms.
According to the study:
Dextromethorphan, as a NMDA antagonist, is effective in the relief of withdrawal symptoms. Hence it is very useful in increasing the efficacy of clonidine and reducing the need for opioid agonists. Added dextromethorphan to clonidine resulted in symptom reduction as soon as the second day of admission while patients experienced very few side effects.”
DXM For Opiate Withdrawal Dosage
According to the studies mentioned above, the patients were given either 15 mg DXM per hour (360 mg/24 hours), or 75 mg DXM every six hours (300 mg/24 hours). This dosing protocol would appear to put the user in the 1st plateau, so one wouldn’t have to worry about the psychotomimetic effects of the upper plateaus.
Note: Everyone is biochemically unique, so there is no way to be certain how each individual will respond to DXM.
Dopaminergic (activated or transmitted by dopamine) effects of DXM are most prominent in the 1st plateau, making it ideal for the treatment of opiate withdrawal.
DXM blocks the reuptake of dopamine by its action at the PCP2 receptor site. Increased synaptic dopamine in the VTA and nucleus accumbens produces euphorigenic (feelings of well-being/euphoria) & reinforcing effects. DXM in this dose range produces an invigorating state of pleasure similar to stimulants such as cocaine.
Where To Purchase DXM For Opiate Withdrawal
The safest way to use DXM for opiate withdrawal is to get a product that lists dextromethorphan HBr as the only active ingredient…something like Robitussin Lingering Cold Long-Acting Coughgels, which has 15 mg in each liquid-filled capsule.
Do to the need for dosages above the antitussive level, using products with DXM in combination with other drugs can be dangerous and potentially fatal.
Here is a list of some other common drugs added in with DXM in many over-the-counter cough/cold medications:
- Guaifenesin – Expectorant
- Pseudoephedrine HCl – Nasal decongestant
- Acetaminophen – Pain reliever
- Chlorpheniramine Maleate – Antihistamine
Note: Large dosages of acetaminophen can cause liver damage; large dosages of chlorpheniramine can cause increased heart rate, lack of coordination, seizures, and coma; and large dosages of guaifenesin can cause vomiting.
Potential Dangers Of Using DXM For Opiate Withdrawal
DXM is a very powerful drug. Many teenagers and other individuals have ended up in the hospital or even died as a result of taking very large doses of DXM. I watched some YouTube videos where kids were taking 1,000 mg or more, and they couldn’t even talk. I would be very afraid to be in this state of mind.
To be quite blunt, this drug scares the shit out of me. While taking lower dosages for opiate withdrawal were shown to have good results in research studies, taking more to experience the dissociative hallucinogenic state can result in some serious side effects.
Apparently, about one third of people really enjoy the DXM tripping experience, another third hate it and never try it again, while the last third feel neutral about it. I can assure you I would be the one who freaks out and has a bad DXM trip. The thought of being even slightly dissociated from reality is a huge turn off for me.
Note: If you decide to use DXM for opiate withdrawal, make sure to use it safely by adhering to the contraindications.
Click on the link below for a complete list of DXM contraindications:
According to studies, dextromethorphan (DXM) appears to be a significant remedy for treating opiate withdrawal symptoms. However, due to it’s ability to produce effects similar to ketamine and PCP, it has the potential for abuse, and people have died from overdosing on DXM.
If you’re deciding whether or not to use DXM for opiate withdrawal, perhaps you might benefit from reading the following comment a reader left on another article:
I am at 46.5 hours now using Vit C chewable (sodium ascorbate), 2.5g 3 to 4x daily – it’s all I could get around my tiny town – loperamide 20mg 2x daily, clonidine 0.1mg 2 x daily and DXM 100 mg 1-2x daily. I have to say I don’t have any symptoms at all. I do not have any energy but that is about it. When I wake up in the morning I have watery eyes and sneeze and yawn, but within 30 min of my meds I feel fine. I slept 7 hours last night. NO RLS! Felt fine today. I’ve been eating toast and cereal and all bathroom functions are fine. I have to say I don’t feel quite like myself and I think it’s the DXM but I don’t have any cravings or withdrawals. I am coming off a huge habit which I tapered down to 120mg oxy and/or 32 mg hydromorphone daily.” – Shannon
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