DXM to control opiate tolerance: do you do it?

[dugwylor]

Quick written poll: who uses DXM to control tolerance, as seen in trials such as the experimental drug DextroMorph, an equal combination of DXM and morphine (though that ratio isn't ideal)?

If you do, do you do it every time? How much do you use? Do you find it works in minimizing tolerance buildup? Any tolerance "reversion" as some people have claimed? Also, anyone used ultra-low-dose naltrexone (as in ~10mcg) for similar purposes?

I use 30mg DXM about 30 minutes before any opiate dose, except when taking tramadol, as that combination can cause serotonin problems. It manages tolerance pretty well, though I've reduced my dose lately, so it's hard to tell in the last few weeks. I'm stepping back up again today and will do a highly-subjective field test to see if I experience about the same euphoria from the (roughly equal) doses I was taking 6 months ago, when I first hopped on the DXM train. Also taking 600mg cimetidine as I did back then. Will report back.

[EleusisII]

Well, wouldn't the effect of DXM and cimetidine just be because of potentiation?
I tried cimetidine, got fuck all from it, besides getting really itchy one time, So I've pretty much given up on that junkie-fairy tale. Note that Cimetidine THEORETICALLY works, because it messes with your liver enzymes. (I believe the it's the CYP420 enzyme to be specidic...) Not all opiates get processed through that enzyme, so it doesn't work an all opiates. Works best on hydrocodone, if I'm not mistaken.

Regarding ultra low dose naloxone, a US company (Pain Therapeutics Inc) is releasing a ER formulation of oxycodone containing a tiny dose of naloxone for that specidic purpose. To slow down, or completely eliminate tolerance. So that should really be a pretty surefire and scientifically proven way of slowing down tolerance. Not to mention a pretty good time to buy stocks in said company. ;)

[Paregoric Kid]

I doubt it does much for tolerance, at least not for long. though I do use it as a potentiator whenever I have my hands on it. it works as a cyp2d6 inhibitor like tagamet or grapefruit, and the NMDA potentiation would be similar to how the isomers of methadone and other synthetics work. don't expect to control you tolerance for long with dxm though.

[dugwylor]

From http://www.ncbi.nlm.nih.gov/pubmed/7708410:

"Tolerance to the antinociceptive (analgesic) effect of morphine, a mu-opioid agonist, was developed in male CD-1 mice as assessed by a shift to the right of the analgesic (tail-flick) dose-response curves and an increase in the ED50 values. Administration of dextromethorphan at 30 mg/kg s.c., but not saline, 30 min prior to an escalating 3 times per day (t.i.d.) morphine dosing schedule prevented a 5-fold increase in the morphine ED50 value observed on treatment day 4. Concurrent administration of dextromethorphan at 12 mg/kg/24 h by s.c. infusion prevented the 6-fold increase in the morphine ED50 value that was observed in control mice that received morphine at 30 mg/kg/24 h by s.c. infusion. Implantation of two 25 mg morphine pellets resulted in a 10-fold increase in the morphine ED50 value on treatment day 4. Administration of dextromethorphan at 30 mg/kg s.c. t.i.d., but not saline, resulted in a reversal of morphine tolerance with the almost complete return of the morphine ED50 value to the control (opioid naive) value. These results demonstrate that dextromethorphan, an NMDA receptor antagonist can modulate morphine (mu-receptor)-mediated tolerance."


I've had good results with it for the past six months, so I'm inclined to believe that it can actually work for long periods of time. Unsure about it inhibiting CYP2D6 (haven't heard that until now), though.

When I went back to the dose of 6 months ago, it was utterly amazing. Pure bliss. It's as though for the past 2 months I'd forgotten how good it can be when it's good. I just repeated the experience today, after my usual tramadol day in-between break (alone which shouldn't account for lack of tolerance development), and all signs point to it being just as successful...


Also, re: naltrexone and a company combining it with an opiate as a patented sort of combination, the same thing was done with DXM in DextroMorph. It's legit! :D

[I-Nod]

Very interesting DugWylor!! So what exactly was your dosing schedule during those 6 mths? I mean, was you still partaking in opiates as you were before?

To think I could save a ton of money by buying some cough syrup every so often... wth am I thinking? Best of luck with your experiment... hope it's a total success, man.

[DCBA]

For me it kinda doesnt work. Maybe for someone with low tolerance it will make a small diference, but i agree with Paregoric Kid (http://forum.opiophile.org/member.php?u=2), methadone is also an NMDA antagonist and altough is takes more time for get adicted you still get addicted, and get tolerant to the effects.

[simfromstoke]

is this what all you guys are on about taking before you have some gear??

[I-Nod]

is this what all you guys are on about taking before you have some gear??

Yessir, that's the stuff.

[dugwylor]

Very interesting DugWylor!! So what exactly was your dosing schedule during those 6 mths? I mean, was you still partaking in opiates as you were before?

To think I could save a ton of money by buying some cough syrup every so often... wth am I thinking? Best of luck with your experiment... hope it's a total success, man.
I understand it sounds a little ridiculous, but yep, essentially I continued my schedule as normal, with the exception of in the most recent 2 months having dropped my dose to be able to function a bit better. It's not an entirely rigorous schedule, though -- I do one day "on" and the next day "off," where "on" means (in the first 4 months, at least) enough to put me in the place capable of nodding if I were to lie down... and "off" means roughly 15-20% of the dose of the prior day, often with kratom or tramadol, done almost exclusively for maintenance... so of course that controls tolerance to some degree as well, in addition to making sure I can stay regular, with the help of a massive amount of fresh fruits and veggies!...

For me it kinda doesnt work. Maybe for someone with low tolerance it will make a small diference, but i agree with Paregoric Kid (http://forum.opiophile.org/member.php?u=2), methadone is also an NMDA antagonist and altough is takes more time for get adicted you still get addicted, and get tolerant to the effects.
This is what I remember reading about how naltrexone works to prevent tolerance buildup -- not sure if it's the same with DXM, though. Naltrexone has high binding affinity to kappa opioid receptors, from what I recall, and so when used in small enough doses, binds almost exclusively to the kappas. Meanwhile, your good opioids are left to bind to mu-1 and the blessed mu-2. This means you're not "wasting" good opioids with binding to kappa, going straight for the euphoric/analgesic mu receptors. But the real kicker is that kappa receptors are believed to be largely responsible for tolerance... so that hypothetically, your tolerance develops to the naltrexone rather than your opioid of choice! Hypothetically. Eventually, you require more and more naltrexone in order to manage the same level of tolerance control. However, as you're using it in such small amounts, this is insanely cheap in comparison to just increasing DOC -- one 50mg naltrexone pill should hypothetically a year or more. The trick is just measuring it out properly (possibly by getting it dissolved in solution, and ensuring it maintains well-distributed)... I have yet to try this, but as you can get naltrexone pretty easily, and 4 or 5 pills is <$50, it's on the list.

If DXM works the same (and as a person who's used it religiously for the last 6 or so months, I do believe that at the very least it works, even if not in this same way), then tolerance may be developed to the DXM rather than the DOC, requiring increasing amounts in order to maintain it. I don't think it's supposed to be any kind of miracle -- if you're banging 16mg hydromorphone twice a day it probably isn't going to do much for you, or not for long -- but I think it helps, honestly. I'll need to read up on the science behind it, though... I think that the methadone comparison isn't necessarily the best one because the done serves both purposes, whereas DXM and your DOC are administered separately.

[resorcinol]

I've never found DXM effective at slowing the development of or lowering opioid tolerance.

I'm extremely skeptical about the whole NMDA antagonists can slow amphetamine and opioid tolerance development idea.

What IS true though, is that a low dose NMDA antagonist dose along with an opioid dose is strongly potentiating (at least for me) particularly with regard to the overall "buzzed" feeling, which can make the euphoria seem stronger. They do this without adding heavy sedation like benzos do, which is a plus (but NMDA antagonists are harder to come by than benzos except DXM... not that there's anything wrong with DXM but lets face it, the preps it comes in taste nasty). DXM also competes with some opioids for CYP2D6, so you get some enzyme based potentiation too.

[Narkotikon]

I can't speak for controlling tolerance, but I will say that once I gained a physical dependence to opiates (2004), that DXM went out the window. I know DXM is a dissociative anesthetic and related to opiates, and may even be classified by some as a "technical" opiate, but to me it's not. I remember in 2001-2002 I'd walk to CVS and buy their BIG bottles of generic Robitussin (with just DXM - I"m a strong believer in that if you're going to do DXM, you just need to do it, fuck Coricedin Kids), and during that time, since I didn't have a car (DUI, totaled it, and also because mommy wouldn't get me another one until I graduated -- God, I'm a spoiled brat -- this is Maker's Mark talking btw), and I used to enjoy it.

Now, though, since I've found "real" opiates, even if it's only seeds at times, DXM just feels cold and "dirty" somehow to me. I do still feel like it's a "real" drug, I mean, I know what I"m talking about. I just think my brain / body can't handle it anymore. It feels cold, and dissociative, and like a shitty version of Ketamine, whereas true opiates feel warm, glowy, and euphoric. I used to lie on my dorm bed during junior year after my two-year hiatus from college and trip on DXM listening to the Deftone's White Pony album. Let me tell you, that album has SO MUCH MORE meaning when I got used to going to the student health center to get Tussionex.

[dugwylor]

There's an old thread on this topic bustling around here somewhere, so I guess I thought a lot of people probably did use DXM for tolerance control. Here's the article + abstract:

http://cat.inist.fr/?aModele=afficheN&cpsidt=2499764

Oral administration of dextromethorphan prevents the development of morphine tolerance and dependence in rats

"Combined oral administration of morphine sulfate (MS) and the over-the-counter antitussive drug and N-methyl-D-aspartate receptor antagonist dextromethorphan (DM) prevented the development of tolerance to the antinociceptive effects of MS (15, 24, or 32 mg/kg) in rats. This combined oral treatment regimen also attenuated signs of naloxone-precipitated physical dependence on morphine in the same rats. A wide range of ratios of MS to DM (2 :1, 1 :1, and 1 :2) were effective for preventing the development of morphine tolerance and dependence. In addition, we provide evidence that under certain circumstances DM increases the acute antinociceptive effects of MS. All of these results indicate that oral treatment that combines DM with opiate analgesics may be a powerful approach for simultaneously preventing opiate tolerance and dependence and enhancing analgesia in humans."

Don't know if there have been serious human studies, though, except for perhaps where they were trying to market this with the DextroMorph 1:1 ratio combo. Don't think that ever went through. Either that or it could just be awaiting FDA approval. Personally, I'd rather the Dr. just give me a bottle of morphine sulfate and a bottle of cough syrup and tell me to take them mg for mg... (though in the study, many ratios were effective, suggesting that you may not need much DXM to control opiate tolerance.)

[pinn3d]

Here's my .02 on dxm and tolerance/potentiation.....


I remember reading about this years ago, back before I had a habit......This was when I would sporadically get some pain pills, usually vicodins, or percodans..... but I had no tolerance back then..

I remember trying on several occasions to take some DXM before I dosed my opiates, like 30-60 minutes before, 30-45 mg DXM.... and it NEVER worked.... It always seemed to nullify the effects of the opiates, like the two drugs were competing with eachother!!

Well, since I have gotten a habit, and the tolerance that comes with it, DXM works much better as a potentiator..... I rarely do it, but when I do, I only take 15-30 mg of DXM, about 30-45 mins before i take the opiates.... and there is definitley a little potentiation....It seems to lend itself to creating a more mellow, smoother high.... very comfortable indeed.... but it should be known that my tolerance is not really that high..... I eat pod grounds 2-3 times a day, but only take like 15-20 grams of pod grounds each dose.....

So I think it can help with tolerance, as it seems to somewhat potentiate the pods for me.... I used to love DXM... I would get the most cozy, laid back feeling... very physical... would make me want to sing, play guitar.... but after a while the trips just got too similar, nothing new, so I don't take big doses to 'trip' anymore....30 mg is PLENTY for me now......only once in a while--- mostly i stick w/ grapefruit juice.....

[reddragon3668]

DXM has always allowed me to decrease my dose with little discomfort.

[pinn3d]

Anyone notice these new 'warning's on DXM products nowadays?----- I pick up a bottle of cough gels every month or two to have some around for potentiating pods sometimes, and the last time I got some there was this warning thing--- Now they call the cough-gels "Adult" Robitussin too btw......LOL----It says 'Parents--- Learn more about teen medicine abuse--- www.stopmedicineabuse.org'...... I'm gonna have to check out that website....;)

But come on.... The company must know that kids take that shit to trip on--- and it's gotta be helping them in terms of sales...... Personally I wouldn't mind if they got rid of OTC DXM---- I don't need it much anymore.... but I loved it back in the day---- I remember the first time I took a big dose in high school and watched "Nirvana: Live Tonight Sold Out" .... it was incredible.....Kurt Cobain was a robotripper.......:D

[Thebane]

I just think my brain / body can't handle it anymore. It feels cold, and dissociative, and like a shitty version of Ketamine, whereas true opiates feel warm, glowy, and euphoric.

I agree, I took DXM for a little bit when nothing else was available and it seemed like a good time then. Now I take 50-100 mg to potentiate opiates and it feels like I'm more sensitive so I can feel pure DXM effects from it (I couldn't before when I took that much to potentiate opiates) and those effects are just uncomfortable - I feel hot, nervous, spaced out, etc. absolutely no good feelings from it. DXM just seems to lose its magic fast.

DXM has always allowed me to decrease my dose with little discomfort.

I swear DXM can help noticeably with kicking. It's not a cure obviously and it does have some annoyig side-effects at higher than therapeutic doses (but far below tripping), but it covers up a lot of opiate withdrawals for me, or at least takes my mind off them.

[OverDriven]

The only effect DXM has ever had with opiates in my experience is sometimes a small dose of DXM will significantly prolong the opiate (pods) high. Other times it has no effect on the length of the high. It's weird how it isn't consistent. Other than that, it's a useless drug IMO. Tripping on it is desperation to get fucked up...the trip is a confusing, unpleasant, heavy mindfuck and it has a sort of "creepy" feeling to it, while hallucinogens like shrooms are more awe inspiring and euphoric.

[asplinteredfawn]

I kicked a methadone habit for the first 15 days taking dxm. Helps a lot with the RLS stuff.

[Ickyuck]

... but it covers up a lot of opiate withdrawals for me, or at least takes my mind off them.

Yeah, I find it as a nice cover blankey for WD's and general wanton of opiates.