Dextromethorphan recreational use and poisoning – the social and psychological background

Abstract

Background. dextromethorphan (dXM) is a widely used over-the-counter antitussive drug. in supratherapeutic doses, it exerts psychoactive effects. Use of dXM seems very common among people seeking 'illegal or legal highs'. Objectives. the aim of the study is to assess the social and psychological features of dXM users. Material and methods. data on dXM poisoning (n = 103; adults and youths) in lodz Province from January 2011 to March 2015 were obtained. Furthermore, analyses of the psychological or psychiatric examination of patients were performed. the symptoms of acute intoxication and ingested doses were reported to evaluate the course and possible tolerance. Results. recreational dXM poisoning was the main reason for the admission of the majority of patients (53%). this phenomenon was observed mainly in the group of adolescents and young adults. the average dose ranged from 5 up to 120 pills of 15 mg each. coadministration with alcohol was reported in 45% of patients. clinical presentation included predominantly balance disorders, psychomotor retardation and agitation. there was a difference in psychosocial risk factors between genders: living alone and relationship problems were significantly more frequent in females. Conclusions. our study highlights gender differences in psychosocial risk factors for dXM use, a potential role of the family environment, substance addiction, and organic diseases in the development of dXM dependence. SummaryISSN 1734-3402, eISSN 2449-8580 this is an open access article distributed under the terms of the creative commons attribution-noncommercial-sharealike 4.0 international (cc by-nc-sa 4.0). license (http://creativecommons.org/licenses/by-nc-sa/4.0/). Koziarska-rościszewska M, Piątek a, Kobza-sindlewska K, Krakowiak M, winnicka r, Krakowiak a. dextromethorphan recreational use and poisoning -the social and psychological background. Fam Med Prim Care Rev 2018; 20(2): 139-143, doi: https://

A mixed-methods systematic review of the prevalence, reasons, associated harms and risk-reduction interventions of over-the-counter (OTC) medicines misuse, abuse and dependence in adults

“…Other risk factors implicated in OTC medicines problematic use collectively involved behavioural, cultural, socioeconomic and health factors. For instance, socioeconomic factors such as personal and relationship problems, living alone, childhood experiences of a negative divorce process, unemployment and low self-esteem, low educational level and occupation were correlated to dextromethorphan abuse and codeine dependence [ 40 , 42 , 45 ]. Low health status such as impaired visual acuity, long-standing diseases requiring polypharmacy use and advanced age were associated with the increased risk of misusing OTC medicines among the elderly [ 46 ].…”

“…However, in the developed countries, abuse of OTC medicines was associated with illicit drug use and alcohol dependency [ 11 , 35 , 36 , 50 ]. Concomitant abuse of OTC medicines with other prescription medicines was reported in some studies [ 31 , 42 , 51 ]. For instance, most individuals who were abusing the OTC loperamide took simultaneously prescription medicines, primarily the antidepressants benzodiazepines, according to the European Medicines Agency [ 31 ].…”

“…Cardiovascular events such as QTC-prolongation, ventricular dysrhythmias were distinctive of loperamide abuse and dependence in patients presented in hospital with toxicity symptoms [ 32 ]. Harms related to dextromethorphan abuse included balance disorders, psychomotor retardation and agitation in individuals admitted to hospital for DXM poising [ 30 , 42 ]. Social harms were mainly experienced by codeine dependents and commonly include; deteriorated family relationships, inability to continue employment, loss of children, spouses and family homes [ 51 ].…”

“…paracetamol or ibuprofen. Correspondingly, the poisoning was high in individuals who abused medicines such as DXM to potentiate the effect of alcohol and other illicit substances [ 42 ].…”

“…Individuals who were dependent on codeine-based analgesics and loperamide attributed their dependence to the avoidance of acute opioid withdrawal symptoms and, in some cases, to harm themselves or commit suicide [18,32,[38][39][40][41]. Dextromethorphan was mostly abused for recreational purposes, to commit suicide and obtain a mind-altering effect [19,42,43], while sedative antihistamines were abused for improving sleep and relaxation [19,35,44]. Other risk factors implicated in OTC medicines problematic use collectively involved behavioural, cultural, socioeconomic and health factors.…”