DRUGS OF CONCERN (DXM, Kratom, Saliva Divinorum)

Drugs of Concern

Even though some substances are not currently controlled by
the Controlled Substances Act, they pose risks to individuals
who abuse them. The following section describes these drugs of concern and their associated risks.

I. DXM

WHAT IS DXM?
DXM is a cough suppressor found in more than 120
over-the-counter (OTC) cold medications, either alone
or in combination with other drugs such as analgesics
(e.g., acetaminophen), antihistamines (e.g., chlorpheniramine),
decongestants (e.g., pseudoephedrine), and/ or expectorants (e.g., guaifenesin). The typical adult dose for cough is 15 or 30 mg taken three to four times daily. The cough-suppressing effects of DXM persist for 5 to 6 hours after ingestion. When taken as directed, side effects are
rarely observed.

WHAT IS ITS ORIGIN?
DXM users can obtain the drug at almost any pharmacy
or supermarket, seeking out the products with the highest
concentration of the drug from among all the OTC
cough and cold remedies that contain it. DXM products
and powder can also be purchased on the Internet.

What are common street names?
Common street names include:
CCC, Dex, DXM, Poor Man’s PCP, Robo, Rojo, Skittles,
Triple C, and Velvet

What does it look like?
DXM can come in the form of:
Cough syrup, tablets, capsules, or powder

How is it abused?
DXM is abused in high doses to experience euphoria and
visual and auditory hallucinations. Users take various amounts
depending on their body weight and the effect they are attempting
to achieve. Some users ingest 250 to 1,500 milligrams in a
single dosage, far more than the recommended therapeutic
dosages described above.

Illicit use of DXM is referred to on the street as “Robo-t ripping,”
“skittling,” or “dexing.” The first two terms are derived
from the products that are most commonly abused, Robitussin
and Coricidin HBP. DXM abuse has traditionally involved drinking
large volumes of the OTC liquid cough preparations. More
recently, however, abuse of tablet and gel capsule preparations
has increased.

These newer, high-dose DXM products have particular appeal
for users. They are much easier to consume, eliminate the need
to drink large volumes of unpleasant-tasting syrup, and are
easily portable and concealed, allowing an abuser to continue to
abuse DXM throughout the day, whether at school or work.

DXM powder, sold over the Internet, is also a source of DXM for
abuse. (The powdered form of DXM poses additional risks to
the user due to the uncertainty of composition and dose.)
DXM is also distributed in illicitly manufactured tablets containing only DXM or mixed with other drugs such as pseudoephedrine and/
or methamphetamine.

DXM is abused by individuals of all ages, but its abuse by
teenagers and young adults is of particular concern. This abuse
is fueled by DXM’s OTC availability and extensive “how to”
abuse information on various websites.

What is its effect on the mind?
Some of the many psychoactive effects associated with highdose
DXM include:
Confusion, inappropriate laughter, agitation, paranoia, and
hallucinations
Other sensory changes, including the feeling of floating and
changes in hearing and touch
Long-term abuse of DXM is associated with severe psychological
dependence.

Abusers of DXM describe the following four dose-dependent “plateaus”:

PLATEAU    DOSE (MG)    BEHAVIORAL EFFECTS
1st                   100 – 200        Mild stimulation
2nd                 200 – 400       Euphoria and hallucinations
3rd                  300 – 600       Distorted visual perceptions
Loss of motor coordination
4th                  500 – 1500     Out-of-body sensations

What is its effect on the body?
DXM intoxication involves:
Over-excitability, lethargy, loss of coordination, slurred speech,
sweating, hypertension, and involuntary spasmodic movement
of the eyeballs

The use of high doses of DXM in combination with alcohol or
other drugs is particularly dangerous, and deaths have been
reported. Approximately 5-10 percent of Caucasians are poor
DXM metabolizers and at increased risk for overdoses and
deaths.

DXM taken with antidepressants can be life threatening.
OTC products that contain DXM often contain other ingredients
such as acetaminophen, chlorpheniramine, and guaifenesin that
have their own effects, such as:
Liver damage, rapid heart rate, lack of coordination,
vomiting, seizures, and coma

To circumvent the many side effects associated with these other
ingredients, a simple chemical extraction procedure has been
developed and published on the Internet that removes most of
these other ingredients in cough syrup.

What are its overdose effects?
DXM overdose can be treated in an emergency room setting and
generally does not result in severe medical consequences or death.
Most DXM-related deaths are caused by ingesting the drug in
combination with other drugs. DXM-related deaths also occur from
impairment of the senses, which can lead to accidents.

In 2003, a 14-year-old boy in Colorado who abused DXM died
when he was hit by two cars as he attempted to cross a highway.
State law enforcement investigators suspect that the drug
affected the boy’s depth perception and caused him to misjudge
the distance and speed of the oncoming vehicles.

Which drugs cause similar effects?
Depending on the dose, DXM can have effects similar to
marijuana or ecstasy. In high doses its out-of-body effects are
similar to those of ketamine or PCP.

What is its legal status in the United States?
DXM is a legally marketed cough suppressant that is neither
a controlled substance nor a regulated chemical under the
Controlled Substances Act.

II. KRATOM

WHAT IS KRATOM?
Kratom is a tropical tree native to Southeast Asia. Consumption
of its leaves produces both stimulant effects
(in low doses) and sedative effects (in high doses), and
can lead to psychotic symptoms, and psychological and
physiological dependence. The psychoactive ingredient
is found in the leaves from the kratom tree. These leaves
are subsequently crushed and then smoked, brewed with
tea, or placed into gel capsules.

Kratom has a long history of use in Southeast Asia, where it is commonly known as thang, kakuam, thom, ketum, and biak. In the U.S., the abuse of kratom has increased markedly in recent years.

How is it abused?
Mostly abused by oral ingestion in the form of a tablet, capsule, or
extract. Kratom leaves may also be dried or powdered and ingested
as a tea, or the kratom leaf may be chewed.

What are the effects?
At low doses, kratom produces stimulant effects with users
reporting increased alertness, physical energy, and talkativeness.
At high doses, users experience sedative effects. Kratom
consumption can lead to addiction.

Several cases of psychosis resulting from use of kratom have
been reported, where individuals addicted to kratom exhibited
psychotic symptoms, including hallucinations, delusion,
and confusion.

What does it do to your body?
Kratom’s effects on the body include nausea, itching, sweating,
dry mouth, constipation, increased urination, tachycardia,
vomiting, drowsiness, and loss of appetite.

Users of kratom have also experienced anorexia, weight loss, insomnia, hepatotoxicity, seizure, and hallucinations.

What is its legal status?
Kratom is not controlled under the Federal Controlled Substances
Act; however, there may be some state regulations or
prohibitions against the possession and use of kratom. The FDA
has not approved Kratom for any medical use. In addition, DEA
has listed kratom as a Drug and Chemical of Concern.

III. SALIVA DIVINORUM

WHAT IS SALVIA DIVINORUM?
Salvia divinorum is a perennial herb in the mint family that
is abused for its hallucinogenic effects.

WHAT IS ITS ORIGIN?
Salvia is native to certain areas of the Sierra Mazaleca
region of Oaxaca, Mexico. It is one of several plants that
are used by Mazatec Indians for ritual divination. Salvia
divinorum plants can be grown successfully outside of
this region. They can be grown indoors and outdoors,
especially in humid semitropical climates.

What are common street names?
Common street names include:
Maria Pastora, Sally-D, and Salvia

What does it look like?
The plant has spade-shaped variegated green leaves that look
similar to mint. The plants themselves grow to more than three
feet high, have large green leaves, hollow square stems, and
white flowers with purple calyces.

How is it abused?
Salvia can be chewed, smoked, or vaporized.

What is its effect on the mind?
Psychic effects include perceptions of bright lights, vivid
colors, shapes, and body movement, as well as body or object
distortions. Salvia divinorum may also cause fear and panic,
uncontrollable laughter, a sense of overlapping realities, and
hallucinations.

Salvinorin A is believed to be the ingredient responsible for the
psychoactive effects of Salvia divinorum.

What is its effect on the body?
Adverse physical effects may include:
Loss of coordination, dizziness, and slurred speech

Which drugs cause similar effects?
When Salvia divinorum is chewed or smoked, the hallucinogenic
effects elicited are similar to those induced by other Scheduled
hallucinogenic substances.

What is its legal status in the United States?
Neither Salvia divinorum nor its active constituent Salvinorin A
has an approved medical use in the United States. Salvia is not
controlled under the Controlled Substances Act. Salvia divinorum
is, however, controlled by a number of states.

Since Salvia is not controlled by the CSA, some online botanical companies and drug promotional sites have advertised Salvia as a legal alternative to other plant hallucinogens like mescaline.

SOURCE: A DEA Resource Guide 2017 Edition