Parachuting of water-extracted dextromethorphan [abstract] Abstract uri icon
  • Introduction: Dextromethorphan (DXM) is the active ingredient in many over-the-counter antitussives. There have been reports of recreational ingestion of this drug since its introduction in the late 1950s, and this phenomenon, in teenagers especially, has been increasing. Reports of use with special extraction techniques are exceedingly rare, and water extraction specifically has not been reported. We report a 17-year-old boy who became symptomatic after exposure to DXM that he had concentrated by a water extraction technique he learned about via forums on the Internet.
    Case report: A previously healthy 17-year-old boy was brought in for evaluation from school after being found stumbling around with slurred speech, and reported dizziness. Upon questioning in the emergency department (ED), the patient admitted to DXM abuse. He had found a method on the Internet to extract the drug from the liquid of Delsym® (DXM polistirex) and used it to make purified powdered DXM. He wrapped that powder in a tissue and swallowed it in an attempt to get high. Physical exam revealed altered mental status and hypertension. The patient was monitored in the ED, and symptoms resolved in several hours.
    Case discussion: DXM and its main metabolite, dextrorphan, cause a hallucinogenic high through NMDA receptor antagonism, serotonin and dopamine reuptake inhibition, and opioid receptor agonism. DXM polistirex uses the Pennkinetic™ delivery system, which allows DXM hydrobromide (HBr) to be released over time. When water is added and the mixture is shaken and allowed to settle, the DXM HBr separates from the liquid. This is a simple method in comparison to the previously reported 1-phase acid/base extraction resulting in “Crystal Dex” powder and the 2-phase acid/base extraction resulting in the “DXemon juice” liquid. By extracting the powder, abusers can easily yield purified/concentrated forms of DXM, making it easy to consume large amounts of DXM. Toxicologists should be aware of this method, and the subsequent possibility of larger than usual
    DXM ingestions.
    Conclusion: The creation and ingestion of water-extracted powdered DXM illustrates a drug-concentrating technique found on the Internet that poison center providers and toxicologists should be aware of.

  • publication date
  • 2010
  • Research
  • Drugs and Drug Therapy
  • Emergency Medicine
  • Poisoning
  • Substance Abuse
  • Additional Document Info
  • 48
  • issue
  • 6