Why I'm enamored with drinking cough medicine part 1

I figured DXM warranted a long post of its own. This is a long post in 2 parts. Part 1 is about the nature of DXM and why it is so special and fascinating to me. Part 2 is trip reports and my personal anecdotes.

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-Part 1-

DXM is not my favorite drug. It is incredibly uncomfortable and strange, physically and psychologically. It is however, by FAR the most fascinating thing I have ever explored, and that keeps me coming back for more. The experiences are emotionally neutral or dysphoric, but it is absurdly interesting and deep, from the different plateaus, to the enzyme inhibition interactions one can do, to the fabled "Pleateau Sigma". There are drugs I love, that make me feel euphoric, confident, in tune with myself, insightful, smarter, comfortable. DXM does none of these things, it is in a league of its own in terms of effects. If I were to rank every drug I've done by how much I liked it, DXM wouldn't even be on the list, it would be off to the side on its own list, picking through the dirt and looking for bugs, it is that strange and unique. I am upset that DXM has earned a reputation of something high schoolers take in lieu of a "real drug", because DXM is realer, deeper, and more intense than almost everything I have taken. It is so immensely powerful, and truly the strangest and most interesting hallucinogen that exists. 

"
and on the baking sands, certainly not made of sand at all
the dome above seeps its hot and heavy breath through a thousand apertures
That one looks appealing
i'm sitting on my bed, I have to stop thinking the furniture is my roommates, because there's already one of each of them in the room
or it's yesterday, or maybe tomorrow, or maybe in a dream, but not today, or right now, and I feel like a tangle of shelves ambling down the street, I don't think there's anything else out here
or i didn't know this was 15 days later when a sheet of ice has severed us and no matter how much I do not shut up the permafrost advances
or the warm and indistinguishable time when you are curled up in my bed
you peruse dreams with the feathery antennae of a moth with a subconscious grin at the corner of your mouth
"
" well ok you were still wondering, I haven't been clear, I'm sorry I'm a bit messed up, ok, so it begins
someone is sitting on a metal stool, saying 'bleakness' over and over again,
two to four benadryl march past first, the pink pills are paid no mind yet
the air is buzzing as the first dirt bitter cherry poison lurching worm pulse of syrup oozes down reluctantly, 
hey bub, I don't like you, and you don't like me, lets go to the dextroverse together
it reaches the drain, clings on with all its might'no, I don't want to!'
but succumbs, shivers down in drip drops, each the gelatinous spawn of wretched eels, hagfish and toads, each hatching into a 
thrashing, slimy goo, whipping their slippery tails until they have filled the space to bursting, with room only to writhe and twitch
that fellow, he chants 'bleakness' louder, faster, with anxious gumption
repeat ad nauseam, 
until you've emptied a whole bottle of store brand robitussin
really now, you say you're bored
its ok, I am too,
all I said before, that's what comes after really, yes, thats it,
its confusing and sickening,
I feel like death and out of sorts for days
"

I first did DXM when I was 17, soon after I got out of the psych hospital for the first time. My first attempts were with triple C's (Don't do that, more on that later). I was wary of the potential harm they could cause so I began with very low doses. My first experiences felt wobbly and cartoony, with closed eye visuals and some bodily distortion but not much else. I was soon after prescribed SSRI's, very dangerous to combine with DXM. Thus, I did not take them for a long while. The next time I took them was as a freshman in college, first combined with pscyhedelics, and then by itself a few times. This was all with the gelcaps, I had yet to explore the dark dark world of syrup yet. I found it somewhat boring and didn't delve in again until spring of 2015, when I had become extremely depressed. I decided to play around with it some more, testing combos and high doses. My last experience with gelcaps imbued them with a disturbing feeling of a bunch of slimy little things distending my stomach. I opted for the syrup, which I was able to throw back with relative ease.

I noticed the effects were unlike they ever had been... After some research, I learned that it was an interaction with my newly prescribed antidepressant, Bupropion. I found myself having totally unique drug experiences, unlike any psychedelic or dissociative, or anything really, and unlike other people's DXM experiences. "Dex", as I had affectionately named it, had become something unique to me, it was now something I could claim ownership and identity from. So how does this work? What can you combine with DXM to get an interesting experience?

Well, time for some real drug nerd shit. All of this is based on the metabolism of DXM once it enters your body. The metabolism of DXM is unlike any other psychoactive drug and is in part responsible for its completely unique effects.
I drew a handy diagram just for this purpose, It is pretty rudimentary and doesn't include many stages of the metabolism process/inactive or other compounds, and may not be entirely accurate in the physical depictions of the actions of these substances, but it gets the basic point across I think.

some drug nerd shit

In words, the basic metabolism of DXM is thus: Dextromethorphan is ingested and is processed in the liver. It is metabolized by a series of enzymes from the Cytochrome 450 family, namely Cytochrome 450 2D6 (CYP2D6) and Cytochrome 450 3A4 (CYP3A4). Once in the liver, these act on DXM simultaneously. With healthy enzymes, the effects of this are pretty constant. CYP2D6 metabolizes DXM into the active metabolite Dextrorphan (DXO) and CYP3A4 metabolizes it into 3-Methoxymorphan (3MM). Now is the strange part-The pathways of the metabolites then get switched, with Dextrorphan being taken up by CYP3A4 and 3MM being taken up by CYP2D6. After this second metabolism, both leave us with the final product of 3-Hydroxymorphinan (3HM). The majority of it is metabolized into DXO, which then enters the bloodstream and crosses the blood-brain barrier. Unmetabolized DXM, 3MM, and 3HM exist in much smaller proportions.

A diagram showing the convoluted metabolism pathways

The only chemicals of interest here are DXM and DXO, as 3MM and 3HM are poorly studied and as of now considered to not have much effect in the effects. The experience is a combination of both DXM and DXO acting on your receptors concurrently (mainly NMDA and Sigma), in different ration (usually more DXO). A person can play with these ratios by inhibiting the two enzymes involved. White grapefruit juice (the active chemical is Bergamottin) is a potent inhibitor of CYP3A4. There are many inhibitors of CYP2D6, many of which are anticholinergics, which have the added benefit of calming down nausea, and depending on whether you're into it or not, add deliriant effects into the mix. The most potent CYP2D6 inhibitor is Bupropion (wellbutrin), what I happen to be prescribed :3.

Inhibiting CYP3A4 inhibits the second metabolism of DXO to 3HM, and this could be considered true potentiation, as you end up with an even higher ratio of DXO to the other metabolites, allowing you to get more out of it. Inhibiting CYP2D6 inhibits the metabolism of DXM to DXM, leaving you with a higher ratio of DXM to other metabolites. more on this in a bit,

Anyways,

A normal DXM experience is a pretty high ratio of DXO to DXM. What are the effects of this?
Most of the pleasant effects of DXM are a result of DXO. DXO is an extremely potent NMDA receptor antagonist, (other NMDA agonists include Ketamine, MXE, PCP, etc etc). Thus, you get the typical dissociative effects, euphoria, it manifests in warmth and body high.

DXM is more active on the sigma receptors, and gives you the mental aspects of the trip-hallucinations, psychedelia, speediness and sensory distortions. 

So if I am on bupropion, that means that a lot of DXM is going unconverted! I end up with a high ratio DXM trip. This accounts for the unique effects I have felt.

Most describe a mostly DXM trip as unpleasant, and they certainly are almost like deliriants, with vivid hallucinations and a sort of disturbing weirdness to them. I personally enjoy them, but I have yet to try actual deliriants :\ (soooooooooooon)

My first diagram shows the action of various inhibitors on potentiating DXM. One to note is Chlorpheniramine, CPM, the other active ingredient on Coricidin Cough and Cold (triple C's). This is a non-competitive ligand for CYP2D6, meaning that if other things are being metabolized by CYP2D6, it will just kinda turn away and stay unmetabolized (for the record Bupropion is similar...). Most other inhibitors are more competitive with being metabolized. What sets CPM apart is that it is pretty toxic, and when a lot of it goes unmetabolized there is a toxic buildup in the liver, which can cause death. This is why almot all of the deaths attributed to DXM were from triple C's

Also, what is this fabled "plateau sigma" i mentioned earlier? Well, this is the most interesting part, this is like a cheat code, a glitch in the fabric of reality. By spacing out several doses of DXM across an entire day, (about 200-300 mg every 3 hours or so about 3 times in a day), one can attain a state called Plateau sigma. Plateau sigma is the farthest you can get. It is described as insanity beyond insanity, or is simply just described as being purely inexplicable. Vivid open eyed hallucinations and entity contact occurs. There is no ego death, but rather the ego begins to exist in a way that is truly incomprehensible. Information processing stops following any rules of association or causality, and one's mind truly becomes subject to chaos. It is described as being very mentally and physically taxing and leaving people feeling out of sorts for days after. Most describe the experience as being unpleasant.

Chart showing the ratio of metabolites when redosing (Courtesy of erowid.org)

So how does this happen? Well when you repeatedly dose yourself with DXM, you are disabling and stressing your enzymes, making less of them available each time. Eventually, they are all so occupied that there are none to metabolize DXM anymore, which then passes through the entire process unscathed and goes straight to your brain. Thus the sigma experience is a DXM-heavy experience. While one can effectively inhibit enzymes with other chemicals, the sigma experience only comes from inhibition through a DXM overload. No one knows why this is. Maybe has something to do with 3MM and 3HM being active after all? But anyways, this means that with my medications I am getting predominantly DXM experiences, I guess you could call it Sigma-lite. I love it.

"
"hello, and 
welcome to my house!
the walls are grey the doors are grey the windows are grey the ceiling is grey the stairs are grey oh heck even the disarray of hands in the living room is grey, has gone grey
Maybe its more like taupe hm,
I digress, You're grey!
It took 6 hours and a whole bottle of delsym to do all this grey, but I'm not particularly proud, ive have done better things with my time
'This is getting weird' you say to me
'Yeah, it is' I say to you
I want to smile at you, at you, each tooth uniform and perfect rectangles, 90 degree corners to the very atoms
but instead I say, 
'Come and sit, there isn't really much to do'
'ok'
'care for some water?'
'oh, do you have some?'
'oh'
"..."
'why doesn't anyone come by anymore?'
you shift uncomfortably, your eyes are struggling for a spot on the drywall to fix your gaze on 
'...'
'I get the impression that some people think I'm crazy'
your expression is so stoic that it must hurt
'...'
'so yeah'
'...'
'How was your day?'
'ok'
'ok'
'...'
'I have paper and pencil, would you like to make a picture?'
You pull your phone out of your pocket and furiously ripple the walls with radio waves, each profane arcane and spat with venom
I don't know if you notice, you probably do, but, when each one crashes onto me, you may observe that like a nest of vitreous spiders, they scuttle up my torso
and come to whisper themselves into me
'do you want to leave?'
I say
'yes'
you say
'yes, ok'
'yes, ok'
After you're gone, the door welds shut, I did not even look out the peephole to make sure you got outside safe, that's it 
"