Wednesday, January 8, 2014
What Everyone Needs to Know
The irony is, that I wish dextromethorphan didn't exist. Whatever the medical examiner eventually decides, I know it was dextromethorphan that killed my son.
If you're lucky enough to be like I was a few short years ago, you're likely to wonder, "What's dextromethorphan?" You might even imagine it was illegal or hard to obtain. You may feel like you don't need to worry about it at this point in your life. But whether you have children or grandchildren, or simply have kids that you care about, this is my educational course.
I usually keep some over the counter cold medicine around, and I'm willing to bet most people do. Maybe just the few pills left from the last round with a cough, but a partial box at least. Check the ingredients. If your medicine is designed to deal with a cough in any way, its active ingredients probably include dextromethorphan -- probably aboout 30 mg in a recommended dosage, which may be a couple of pills or a measure of liquid.
Yes, most of us have it, take it, buy it over the counter and keep it around the house. If we went to take a dose and that partial box was gone, would we really be certain that we hadn't taken it? If we found a few empty pill packets in the trash or while cleaning our teen's room, would we react like we would if we found a roach, a bong, or a bag of suspicious powder? Probably not. I know I didn't.
Once our better cough medicines were laced with codeine to quiet the hacking, although the last time I got it I had to sign for it and I'm not even sure it's available any more. Once codeine's more dangerous properties came to light, it became virtually impossible to get. That mean pharmaceutical companies, seeking ways to help us with our ills, had to have a new cough suppressant. Along came our new friend, dextromethorphan.
However the same agencies that eventually recognized the dangers and addictive properties of codeine have failed to recognize that a product designed to take its place carries the many of the same risks. It sits untended on the shelves of pharmacies, grocery stores, department stores, and even dollar stores. That's despite the efforts of StopMedicineAbuse.org and groups like them. Although you may have to present identification proving you are over 18 to make a purchase, there's nothing to keep a 13-year-old from slipping a small box into a pocket other than good shoplifting surveillance -- a fact that made dollar stores Ethan's favorite target until he racked up enough arrests for shoplifting that he could not get a job and feared incarceration.
The author of one of many pages dedicated to recreational, or as he terms it ritual use of dextromethorphan (erowid.org) writes that he discovered the drug through an accidental overdose by taking twice the recommended liquid dosage for a cold. That was in 1995 and he began to explore the use of the drug and publish his findings on the internet. There is a Facebook page called dextromethorphan hbr on which DXM abusers share their tips for how much to take and sometimes their writings while on a trip.
No, despite the fact that you may not know, that I didn't know, and that the police officer who arrested Ethan for shoplifting once did not know, there is a lot of information to be had about how to abuse dextromethorphan. There are multiple pages and blogs describing the misuse of dextromethorphan (as well as virtually any other substance you might care to learn about). You don't need an accidental overdose to find out you can get high on cough medicine, just an internet connection or a curious friend who has already done the research.
What does it do? I've asked.
Scientifically, when taken in excess dextromethorphan produces a dissociative or psychedelic effect. The effect is similar to the illegal drugs PCP and ketamine. Someone who takes dextromethorphan may experience hallucinations and strong feelings of euphoria. The effect typically lasts about the same length of time as the normal cough-suppressant effect of the medication, so a 12-hour cough suppressant will produce dissociative effects that last 12 hours in high doses. An increased dose does not cause longer-lasting effects, but it will cause stronger effects.
Ask someone who has used the drug, and you may get a better idea. I've talked to some of Ethan's friends who once used with him and these are the answers I've gotten.
"We used to think it was almost like giving us the knowledge of good and evil...like we suddenly knew everything. Everything we saw was a sign to us. It didn't take much for me to get high. I would only take about 4 pills, (not sure about dosage), and I felt like I was gliding when I walked. My eyes felt like they were widened, literally and mentally. I was never hungry, so I didn't eat much. This made me lose weight. I felt like I could stay awake for days and when I was coming down, I wanted to sleep it out. I found myself stumbling from time to time and stuttering while taking this drug. It made me feel warm. I could feel my body and heart slow down. I was always ready to get out and do something, yet at the same time, I was content with just sitting around because I could be with my thoughts and questions."
"I don't understand a lot about how far Ethan went with it. The way the drug works is if you take a little bit you just get high. the more taken, the more reality you lose. It changed me. The drug took something from me I'll never get back, or so I think. I'm not perfect, by far, but it's the worst drug I've ever taken in terms of effects. Even now, I'm paranoid because of it. There's something about me that will never be the same. It's something I like to hide in my past and don't like to talk about, but I want to help you understand how powerful of a grip it can have and had on Ethan."
A 39-year-old user on the Facebook page told me this: "So for me, at 24... I had 720 and went catatonic. Laid in bed. I felt paper thin and infinitely wide. Sensory matrix distortion. Tired. Like sleep. Now, I could have 1000mg in a 12 hour period and feel normal enough to walk, talk...not drive. I know NO study of longterm use. Honestly, in 2013 since March I have used an average of at least 240 / day... at night or in the morning. I will use it around people who are stressful or jerks because I can tune them out. Like family who will seem like total asses (partly because I am irritable etc) then on dm I see a lovable side and my pain doesn't get to take 1st place... I win. It's the drug I regret the least. Alcohol kills more, causes men to cheat, drivers to crash.(Although earlier in this tale he told about crashing his car) Adding caffeine to dm makes my heart race, so I dont. Benedryll helps a little at 25-75mg to sedate. Bededryll ALONE is like dm. I don't feel damaged after 290 straight days. So I wrote poetry n shit and read it to some girls in a bar crying. They were touched. Dm has helped my writing probably like drugs help rock stars..."
When Ethan was using, he lost weight and he was delusional. Sometimes what he said would pass for a really good imagination and sometimes it really didn't make sense. Often his behavior fit with the typical teen withdrawal -- he'd rather play video games alone than hang with the family sort of thing -- but sometimes his isolation went a step further. I didn't know what I was dealing with and what the symptoms could be.
From talking with his best friend I've found the extreme emotional spikes -- particularly rage -- are also common from teens/adults who are using regularly and at high amounts.
Anyone using dextromethorphan may also have trouble driving because the effects at low levels mimic alcohol, however if they are stopped by law enforcement, they can easily pass a roadside breath test. I know Ethan left my house high one day and was pulled over and passed a test. He also wrecked once while in the process of consuming the pills he preferred -- not just a double dose, but a pack or more at a time -- and frequently had minor accidents where he probably misjudged distances and struck trees, ditches, etc. When he died there was a pending lawsuit in the local courts from a collision where the other driver decided he needed money. He was without a license from blacking out while driving, striking a parked car and then going over an embankment. A toxicologist in the courtroom the day of his trial said he had a lethal dose of the medication in his system.
Aside from the psychological issues, and those associated with any addiction, there are physical risks as well. Some studies have shown there is a danger of developing brain lesions called Olney's lesions. These brain lesions affect memory, learning, and emotions. In some cases, the person will develop psychosis or epilepsy. Severe dextromethorphan abuse can lead to permanent lesions that cause permanent irreparable damage to the brain.
Ethan began having tremors and seizures more than three years ago. Sometimes the seizures were focal in that he could not completely focus or control his body and other times they were grand mal, in which he would fall in the posture we typically associate with a seizure. Although by that point I had learned that the drug would cause seizures, I also, naively, assumed once the seizures began that he would have enough sense to stop. He didn't. Had I known better the side effects, his gaunt face and continued rages would have told me that despite our regular doctor's visits to seek help for the seizures, he was still slowly killing himself. And it wasn't sense, it was addiction although many programs still don't recognize an addiction to dextromethorphan.
I didn't have a good grasp of the mechanics of addiction and still don't completely understand. However another article written by a former addict gave me some understanding. The drug of choice takes over the pleasure centers of the brain so that nothing else really gives an addict pleasure. The things you think of as good times are meaningless to them, even when they are physically with you. His writing is scientific, because he went on to become a neuroscientist, but does help explain what happens.
“... when drugs (or booze, sex, or gambling) are nowhere to be found, when the horizon is empty of their promise, the humming motor of the orbitofrontal cortex sputters to a halt. Orbitofrontal cells go dormant and dopamine just stops. Like a religious fundamentalist, the addict’s brain has only two stable states: rapture and disinterest. Addictive drugs convert the brain to recognize only one face of God, to thrill to only one suitor.” The addict’s world narrows. Dopamine becomes “specialized, stilted, inaccessible through the ordinary pleasures and pursuits of life, but gushing suddenly when anything associated with the drug comes into awareness…. I wish this were just an exercise in biological reductionism, or neuro-scientific chauvinism, but it’s not. It’s the way things really work.”
If I've scared you enough about the dangers of dextromethorphan, you may wonder what you can do. I don't have all the answers, but I do have recommendations:
Get as educated as possible. Do searches on the internet or even Facebook and don't settle for the science pages, but look at the addict's pages as well (although heaven knows they probably won't call themselves addicts). Learn the slang, the symptoms of abuse, the dangers of misuse. Be aware that most of the scientific sites seem to be out of date. There are not a lot of studies and it is wrongly assumed that young teen males are the most at-risk. That isn't necessarily true.
Talk to the young people in your life about the danger. Because it is not an illegal drug, most people wrongly assume it is safe even at dosages that exceed the recommendations.
Be careful with your attitude toward medication. Do your kids see you take double the recommended doses of anything? Like when your headache doesn't go away? If you take medication, follow the directions and make sure your children understand why. When you give medicine to your kids, do the same.
Consider keeping all medication under lock and key and explain that it is for the safety of everyone. You don't have to make your children feel you don't trust them. Maybe you have company with younger children sometimes, maybe you can blame it on protecting expensive prescriptions from thieves. You can come up with a way to manage the medicine in your house.
Watch not only your child's behavior, but that of his/her friends who may easily pave the way for your child if they get into trouble. If you're concerned tell your child that random drug tests are going to be part of your life. They could be the price for something they want to have or do, the risk of choosing friends you don't like, or you can point to someone else's loss and tell them you just want to feel better. Heck, blame me. Whatever it takes. Also be aware that dextromethorphan won't show up on standard tests but will show up on tests for PCPs and opiods. Yes, it's likely to create some tension, but it gives your kid a good excuse to say "no" when offered a little something and that tension is nothing compared to living with a kid on drugs. There will also be some expense, but compare that to seeking treatment for addiction, or perhaps the cost of burying a child.
Get involved in trying to get more people informed and laws changed. Visit StopMedicineAbuse.org or the organization's Facebook page and become a part of the movement to make a difference for our children and those not yet at risk. That means petitions, contacting congress and working to get laws changed so that this drug, at least, loses its illusion of safety and easy access.