The Hidden World of Dextromethorphan Abusers| in-depth reporting
Collection/Su Zihan Li Qinhua
Editor/Liu Mi
When dextromethorphan arrives, an abuser throws the package away, pulls the tablet out and puts it in a small box
After taking a dozen white round pills, Xiaoya lay on the bed in her bedroom, listening to her favorite songs while waiting for the effects to appear.
Before long, all she had to do was close her eyes and she would enter "another world": a world where time was stretched out, where all fatigue and negativity disappeared, and where she seemed to be in the picture of the lyrics, a green train passing through endless green wheat fields, standing beside the tracks, wearing a red scarf.
This medicine, called dextromethorphan, is a central cough suppressant suitable for colds, acute and chronic bronchitis and other diseases. When used in excess, it can cause euphoria and hallucinations. So some young people use it as a condiment for life, and when they're bored or in a bad mood, it's taken out, and when the seasoning's over, it's put aside.
This gift, which seems easy to obtain, comes with a price. Repeated, heavy use of dextromethorphan for non-medical purposes may lead to addiction. * Side effects quickly appeared on them, including convulsions, shock, and even cardiovascular and cerebrovascular problems, impaired neurological function...
Even with the help of a professional doctor, quitting addiction is still a difficult task. Some people compare themselves to being "slaves" of dextromethorphan, trapped here and unable to escape.
Xiaoya's first overdose of dextromethorphan was one night this summer. She described the feeling when she woke up the next day as if she had obtained a "new life", breaking through a layer of hazy membrane separated from the world,"long-lost sunshine health, I feel like a normal person again..."
Despite sleeping just over five hours the night before, she felt completely untired. Making breakfast, playing games, helping her mother at noon and doing housework in the afternoon, she was full of energy, once dull senses became sharp, and all colors in her sight were bright.
Such a "good" state was rare for Xiaoya at that time. Over the past few years, due to conflicts between her parents, the rapid pace of high school learning, and alienated interpersonal relationships, she has been depressed every day, and once escaped stress by self-harm. She had asked her parents several times to see a psychiatrist, but for various reasons she had not been able to do so.
Knowing that dextromethorphan's "effect" is in Weibo, Xiaoya saw someone saying that this drug "can treat depression." Half a month later, in a state crash, she bought three boxes of 72 tablets of dextromethorphan at one time.
After arrival, she swallowed 10 pills with Coke, feeling dizzy at that time, as if she was awake dreaming. But for the next two days, she felt "like a new person" and did not feel any negative emotions.
In fact, dextromethorphan does not have the effect of treating mental illness. It is a central antitussive drug, developed by a Swiss company in 1950s, produced and marketed in China in 1990. It is often used clinically to treat cough caused by upper respiratory tract infection and acute and chronic bronchitis. The dosage for adults is usually 1 to 2 tablets each time, 3 to 4 times a day.
Some of the "side effects" come from overdoses. A study has shown that high doses of dextromethorphan have effects similar to hallucinogens. For a person weighing 150 jin, ingestion of 100 to 200 mg of dextromethorphan will bring agitation and euphoria, and when intake reaches 200 to 500 mg, it will cause exaggerated auditory and visual feelings, hallucinations and imbalances. At 500 to 1000 mg, people may experience visual and auditory disturbances, altered consciousness, unresponsiveness, mania, panic, and partial dissociation.
One adolescent respondent described the world created by high doses of dextromethorphan as "an unrealistic utopia."
Lei Zeyu, 31, first came into contact with dextromethorphan at the age of 21. Since then, he has been abusing it intermittently for six or seven years. Until now, he has not completely quit. He takes medicine three or five times a year, about 120 tablets each time.
He has a regular habit of taking all his pills in three separate doses within an hour. With the increase of dosage and the change of efficacy, Lei Zeyu's "Utopia" was divided into three stages.
The first half hour after taking the first dose, he will feel top-heavy. The middle part lasts for a few hours. His attention and reflexes are greatly improved. His vision and hearing are enlarged. His vision becomes clear. He can hear the cat moving around the living room or jumping here and there. He also remembers a lot of things from the past, and hallucinations occur at this stage. Later on, his vision becomes blurred, his reflexes slow, and sometimes he has cramps and sees tendons throbbing in his forearms and thighs, a phase that lasts for hours.
Similar to Xiaoya's situation, Lei Zeyu remained in good condition for a few days after overdose of dextromethorphan. But the medicine wears off, so what happens then? For many abusers, the answer is simple: just take another pill.
Lei Zeyu will prepare lime flavored coke and mints before taking dextromethorphan
circulation
Taking drugs, immersing themselves in the utopia of high-dose drug creation, the effects disappearing, taking drugs again... in this way, many people fall into the Mobius loop of DM abuse.
The next step in abuse may be drug dependence. A specific mental and physical state resulting from the abuse of a dependence-inducing psychoactive drug, characterized by intense craving for the drug and compulsive seeking behavior.
After about three months of DM abuse, Lei Zeyu found himself unable to live without it. In the years when he was most heavily medicated, he took at least 120 pills every three or four days. When talking to others, as soon as you talk about this medicine, you will have the idea of "wanting to eat"."It's okay if you don't mention it. As long as you talk about this thing, it seems to remind you."
Encounter unhappy things or physical discomfort, may become the abuse of dextromethorphan reasons,"I regard it as a spiritual pillar, suddenly encounter some very collapse things, want to be happy, the first time will think of it." More often than not, he doesn't need a reason to take the medicine, and if he doesn't take it, he will feel sick.
* This is also the addiction mechanism common to all addictive substances.
Over time, people tend to develop drug tolerance. To avoid withdrawal symptoms and get the desired euphoria, some people choose to increase their doses. Xu said this creates a vicious cycle, making it harder for users to quit the drug.
Chen Meng, a 36-year-old Cantonese, is in this cycle. Over the past 12 years, his dosage has gradually increased from 12 tablets of dextromethorphan to 120 tablets.
Dextromethorphan was not the first drug Chen Meng abused. After dropping out of school in the second semester of junior high school, he started drinking federal cough syrup, an addictive cough water containing codeine, under the guidance of several friends he met in Internet cafes. At age 21, because he had "no feelings" from drinking three bottles of federal a day, he and his friends added the same addictive central analgesic tramadol to the cough syrup.
Tramadol required a prescription to purchase. In order to buy medicine, Chen Meng repeatedly stole the doctor's uncle's blank prescription, stamped his uncle's name, went to know the pharmacy prescribed medicine. Because to help a few friends buy medicine together, the clerk will ask why buy so much, he always confidently replied: "cure cancer."
Two years later, his uncle discovered that he had stolen the prescription. A friend suggested that tramadol could be replaced with dextromethorphan, which is not only cheap, but also does not require a prescription. Many pharmacies sell it.
The first time he took dextromethorphan, Chen Meng used 1 tablet (12 tablets per tablet) with 1 bottle of federal. For the next month, he took three bottles of federal and one tablet of dextromethorphan daily.
Tolerance appeared shortly afterwards. When 12 tablets no longer gave Chen Meng a "feel," the amount of dextromethorphan was increased to 2 tablets a day.
Later, as federal prices continued to rise, Chen Meng gradually could not afford the cost of three bottles a day. To get the same effect, he increased the dose of dextromethorphan again.
When Chen Meng was 28 years old, the federal price had reached more than 100 yuan per bottle. Since then, he has stopped drinking cough syrup and maintained the state of eating 3 tablets of medicine every day. He knew he was addicted to dextromethorphan, but what he didn't know was how much effort it would take to break out of the vicious circle.
out of control
According to the package insert of a domestic brand of dextromethorphan hydrobromide tablets, overdose of this drug may cause mental confusion, excitement, tension, irritability, confusion, bronchospasm, respiratory depression and other symptoms, depending on the degree of poisoning, symptoms may vary.
Chen Meng has more than once experienced a state of delirium after overdose, which he calls "fragmentation.""People are awake, but you don't know what you're doing... completely like a fool. You won't remember what you did at that time."
On the day of the first fragment, Chen Meng took 2 tablets of dextromethorphan in the morning, 1 tablet at noon due to disappearance of the drug effect, and 1 tablet near work in the afternoon, equivalent to taking 48 tablets in more than ten hours.
At that time, his drug resistance was not so strong. After taking three tablets, his body had already reacted differently from before. During his work, a colleague asked him a very simple question. He understood the other party's meaning and had an answer in his mind, but the words stuck on his lips and he could not say it. He could only respond with "uh-uh-uh."
Chen Meng found that his whole body was numb and lost the feeling of everything around him, but he still took another tablet of medicine and then rode his electric bike home.
A few hours later, he woke up and saw a lot of blood flowing from his thigh. He tried to remember how he fell like this, where he fell, why he didn't treat his wound at that time, but he couldn't remember anything."That was the closest I came to death."
Director Xu Jie summarized the harm of overdose of dextromethorphan into two aspects: body and life. Physically, too much abuse at one time may cause acute poisoning symptoms, leading to limb convulsions, even shock coma, long-term abuse will cause cardiovascular and cerebrovascular problems and damage to liver, kidney and nerve function, people are prone to depression, anxiety, temper tantrums and emotional instability.
In life, after dextromethorphan addiction, people's social function will be impaired. Take adolescent patients as an example, the first thing affected is learning, their concentration will be difficult to concentrate, memory decline, resulting in reduced learning ability. At the same time, due to emotional instability, their relationships with classmates, teachers and family members may change. In addition, although dextromethorphan is cheaper than other addictive drugs, abuse is still a significant expense for financially unable adolescents, and some people will embark on the path of crime.
Lei Zeyu and Chen Meng both experienced the harm Director Xu Jie had mentioned. In the years when medicine was most fierce, Lei Zeyu often couldn't eat. He weighed only 110 jin at a height of 1 meter 78, and he became forgetful. Since last year, Chen Meng's physical problems concentrated outbreak, high blood pressure, tinnitus, dysuria, lower abdomen often feel cold,"like there is a piece of ice there."
When adverse reactions to overdose of dextromethorphan occur, some people choose to switch to another drug. He Jing, who lives in Northeast China, is one of them. Every time she took two or three pills, she would feel nausea, nausea, body stiffness, easy to forget what happened for a period of time. So six months after abusing dextromethorphan, she switched to the opioid analgesic Tylenol, when she was only 16.
Others decide to withdraw temporarily after adverse reactions occur. In mid-September this year, Xiaoya, who had just entered the first grade of junior college, experienced a "fragment" in school. That day, she took 30 tablets of dextromethorphan at a time. After eating, her brain was stuffy, she could not breathe, her heart was beating very fast, and her roommate's voice sounded like distorted electronic audio. In the past, she would only appear hallucinations when she closed her eyes. Now, she could "see" even with her eyes open.
Coincidentally, her mother came to school to deliver her goods. She was helped downstairs by her roommate and felt that everything around her was shaking. After meeting her mother teased her,"How weak ah," she forced a smile, dizzy back to the dormitory, lying on the bed.
When consciousness recovered, it was already zero point the next day. Lying in the dark dormitory, Xiaoya was very afraid."(At that time), what I thought was terrible. I was thinking about whether this time was too much. Then I decided to live a healthy life for a period of time and recuperate."
In November 2022, Chen Meng threw away all the dextromethorphan in hand.
self-rescue
At the age of 25, Chen Meng first tried to quit when he saw a friend in his circle die of overdose.
He adopted a gradual reduction method."I had to take 24 tablets (dextromethorphan) a day, but I reduced it to 12 tablets. I took them to do other things and let myself not think about it." After half a year, he failed, and the dosage increased instead of decreasing.
At 26, he tried to quit again. This time, he had several friends lock himself in and take turns delivering three meals a day.
At first he didn't think it was a difficult thing. However, as the withdrawal time extended, he began to have diarrhea, headaches, body discomfort, people also become manic, even in front of the tissue are not pleasing to the eye.
Chen Meng's physical and mental discomfort belongs to withdrawal symptoms. Yang Liang, the fifth executive director of the Chinese Association for the Prevention and Control of Drug Abuse, mentioned in his book Drug Dependence that once drug addicts stop taking drugs or suddenly reduce their doses, the body will have serious clinical symptoms of drug withdrawal or drug reduction, which is called "acute withdrawal symptoms" or "clinical withdrawal syndrome." Director Xu Jie believes that physical discomfort and psychological anxiety caused by drug withdrawal, namely withdrawal syndrome, is also a reason for addicts to take drugs again.
Chen Meng eventually failed to overcome drug addiction. After being locked up at home for a month, he asked his friend to let him go out. The other party couldn't bear to see him continue to suffer and agreed. After regaining his freedom, Chen Meng went straight to the drugstore to buy dextromethorphan and ate 24 tablets at a time."Because I haven't eaten it for a while, the effect will come up soon, and people will feel comfortable immediately."
Over the next ten years, he tried many times to reduce or quit his medication, each time failing, the longest of which lasted ten months.
There are many drug addicts like Chen Meng who want to save themselves. Some of them connected online, punching out their progress in posts titled "Day XX of withdrawal," cheering each other on, or setting up Group chats to share withdrawal experiences and monitor each other.
In a WeChat drug withdrawal group with more than 60 members, searching for the word "quit" will pop up nearly 900 chat records. Friends use nicknames to refer to the drugs they abuse,"512" for Tylenol, dextromethorphan for "Youmei" or "Meisha","compound" and "Anding" for compound tramadol and aminophenol tramadol respectively.
Although they had never met and their circumstances were different, the group of friends showed trust and solidarity. They talked about how they had been exposed to drugs, what reactions they had had to taking too much, what to do if they felt bad after stopping them, and what alternatives to use to survive withdrawal symptoms. Every time someone wants to give up, someone encourages them to "hang in there." In the face of drug dealers advertising in the group, they will not hesitate to ask the group owner to "kick people."
Li Yang once hid his identity and joined such Group chats to help these addicts. He is a clinician who has been engaged in drug research and development when he was a student, and has been exposed to drug psychiatry research and anti-drug related content.
Since 2020, Li Yang has popularized the design ideas, brain effects and withdrawal methods of dextromethorphan, tramadol and other drugs on platforms such as Zhihu, Tieba and Tianya Forum. He explained why he hid his profession."Often you say you're a doctor," he said."The first time [they] feel defensive, they think you'll report me, you'll call the police."
Li Yang can clearly feel that whether it is completely dependent on personal self-control to quit drugs, or in friends or netizens under the encouragement and supervision of withdrawal, the effect is not optimistic.
"In the post bar or in some other network channels, you can see a lot of people posting every day, the first day quit, the next day quit, the third day did not hold on and eat again", in the more than 20 dextromethorphan addicts who added him WeChat, only four or five people really successfully quit, the rest basically resumed eating.
It's not easy to wean yourself off dextromethorphan altogether. So with the intervention of a professional addiction doctor, will it be easier to quit drugs?
* Of the 11 symptoms, mild addiction is defined as 2 to 3 symptoms within 12 months, moderate as 4 to 5 symptoms, and severe as 6 or more symptoms.
Xu Jie will recommend hospitalization for people with relatively severe addiction. If the patient is underage, he will ask his parents to stay together."If the parents are not present, we generally do not allow him to leave the ward without medical escort, because it is very likely to communicate with the outside world after leaving the door, and we will be afraid of causing some influence."
Xu Jie said the impact, refers to the abuse of different drugs inpatients, may change each other after communication, and then contact new drugs. To avoid this, patients do not mix and cannot exchange contact information when discharged. At the same time, electronic products are prohibited during hospitalization to avoid contact with social circles that have made them addicted.
The treatment cycle is generally 1 to 3 months, including three stages: the first stage is detoxification treatment stage, to help patients physically break away from dependence on dextromethorphan, eliminate or reduce physical withdrawal symptoms; the second stage is rehabilitation stage, through the professional intervention of psychological teachers to make patients reduce mental dependence on dextromethorphan, control psychological craving; the third stage is social return stage, the purpose is to change the patient's lifestyle, prevent relapse after discharge.
When the toxin in the patient's body is exhausted, the psychological test results are good, and at the same time, through the three-way evaluation of the attending physician, the nurse in charge and the psychological teacher, it can be determined that he has successfully abstained from addiction and can be discharged from the hospital.
Unfortunately, discharge is often not the end point of withdrawal. * "This relapse rate is similar to heroin, very high." Xu Jie said.
Wang Juan, a national second-class psychological counselor with five years of experience in addiction research and intervention practice, believes that this is first and foremost related to the concept of addicts.
She had in-depth talks with a number of patients and found that many addicts, especially young people, always hold the view that "taking medicine is not a very serious matter" and do not feel that drug abuse is very harmful."(When discharged) He knows that (taking medicine) is not allowed by adults, doctors, and society, but he may not have some big changes in his behavior." That's one of the reasons they're eating again."
A few years ago, Lei Zeyu's brother accidentally discovered that he was abusing dextromethorphan and sent him to a drug rehabilitation center for nearly two months. During this period he received detoxification and psychotherapy, but each time the psychiatrist's words went in one ear and out the other. The experience didn't change his attitude toward substance abuse. A few days after leaving rehab, he went to a familiar drugstore to buy drugs.
WangJuan mentioned, From the physiological point of view, Drugs will have an impact on people's nervous system, To bring people in the routine life difficult to obtain euphoria,"It is functional in life, The drug taker is like that function, Not necessarily attached to drugs", This is also unable to successfully quit medicine reasons.
In interviews, many respondents showed indifference to questions such as "Are you worried or afraid of side effects?"
A senior high school girl started abusing dextromethorphan about a year ago. Before taking medicine for the first time, she had seen someone say in the post bar,"Cousin took three or four boards at a time, room, bar and everything (place), recently there was a foaming at the mouth into the hospital." However, this did not make her give up the idea of taking medicine."I'm worried, but I don't care. People like us definitely want to die. It's no big deal." She explained that her mother had always been strict with her in her studies. In her opinion, school was painful, life was boring, most of the friends she made could not communicate with each other, and dextromethorphan was like a spice pack in a boring life, which could temporarily bring her happiness.
Such beliefs come from the environment in which the addict lives. Many people abuse dextromethorphan to escape pain from family, social circles, school or life, or to fit into certain circles through medication.
Xu Jie's department strongly advises patients to stay away from the environment that allows them to abuse dextromethorphan after discharge. Li Yang also observed that the four or five people who successfully quit dextromethorphan had one thing in common: they all broke away from their original social circles and started a new life.
In December 2021, the State Food and Drug Administration converted dextromethorphan oral preparation into prescription drug
* Over the next five years, the number of patients coming to quit dextromethorphan increased year by year, with at least 300 between January and September 2021 alone.
In December 2021, the State Food and Drug Administration issued an announcement on the conversion of dextromethorphan hydrobromide oral single preparation from over-the-counter drug to prescription drug, and 11 related varieties of drugs were required to revise the safety information in the package insert, including deleting the expression "no addiction and tolerance after long-term administration" and supplementing adverse reactions caused by overdose.
* However, many people's abuse behavior has not been affected because dextromethorphan tablets, which are already prescribed, remain readily available for a long time.
When purchasing online, you only need to fill in your name, ID card number, mobile phone number, disease history, select one of the diseases such as "cough" and "bronchitis", confirm that the disease has been diagnosed and dextromethorphan has been used, and you can get the electronic prescription issued by the Internet hospital, and then buy medicine with the prescription. For skilled people, it took less than five minutes to choose medicine, ask for advice, prescribe prescriptions, and buy medicine.
This fall, Xiaoya bought ten boxes of dextromethorphan online at one time, which obviously exceeded the normal dose, but she was not restricted in any way when operating. In a QQ group of dozens of dextromethorphan abusers, members had discussed using the identities of fugitives published online to buy drugs.
And offline, not every pharmacy strictly abides by prescription drug regulations. Chen Meng has been buying dextromethorphan in pharmacies for more than ten years. Many shop assistants in pharmacies know him and form a tacit understanding of "I buy you sell" with him. In the past year he has gone to buy medicine and not once has he been asked for a prescription.
Xu Jie believes that the easy availability of dextromethorphan exacerbates its potential for abuse. On the one hand, the drug is cheap, and even teenagers have some purchasing power over it. On the other hand, although a single preparation is prescribed, it is readily available in practice. To this, Xu Jie suggested strengthening the supervision of dextromethorphan,"Especially minors to buy this drug, Must register, At the same time limit the number of boxes to buy, Can't say you want to buy 10 boxes, That is obviously abnormal."
Xu Jie's expectations are becoming reality. Since December this year, the state has further upgraded the management of dextromethorphan, and dextromethorphan oral single preparation has been listed in the prohibited list of drug network sales (first edition).
On online platforms such as Tieba, many people are discussing whether drugs such as Yumei Tablets, Dextromethorphan Oral Solution and Dextromethorphan Syrup can be used as substitutes, while others are selling extra tablets on hand or even selling so-called "stronger" drugs.
At the beginning of December 2022, dextromethorphan could not be purchased through a common e-commerce platform.
circle
After taking medicine, Xiaoya will be more talkative than usual, communication desire is stronger. In case she couldn't find someone to talk to at that time, she tried to find people of her own kind.
Xiaoya searched for keywords on Weibo and saw a QQ group QR code. The name of the group was very obscure, and it could not be seen that it was related to drug abuse. There were 60 members in the group, most of whom were girls of the same age as Xiaoya. They shared experiences of dextromethorphan abuse, calling it od (overdose) and affectionately calling each other hubby. They carefully maintained their secret space. The group announcement read,"Do not spread information within the group to the outside, or the group will explode."
In the group, Xiaoya made a friend, sometimes they would talk about small things around them, sometimes talk about pictures and things that happened after taking medicine, and the latter was a secret she couldn't tell her parents, roommates and some real friends.
Similar dextromethorphan od groups are not uncommon. In private circles, members share feelings and thoughts that are not known to others, and receive companionship and warmth in the process of exchanging secrets.
Wang Juan can understand why some DM abusers join such communities. In her view, many people don't get enough emotional support and life guidance at the age when they need adult guidance most, so they choose to enter a circle that can provide emotional comfort for them."For example, no one pays attention to me in daily real life and thinks I'm important, but in that circle they praise me, accept me, support me, think I'm one of them, do you think I want to go?" For insiders, circles support their self-development and embody personal value, so they are often difficult to break away from.
OD circles in the form of Group chats are quietly growing on the Internet, and these years, there have also been many offline groups abusing drugs such as dextromethorphan. More than one interviewee mentioned that the first pill they took was given by a friend and that they had taken it with friends.
Years later, recalling the people who introduced him to federal cough syrup, tramadol and dextromethorphan, Chen Meng thought they were just a group of teenagers who had just come out of society. But when he took medicine and played with them, he had a sense of identity.
When he was still young, Chen Meng experienced parents divorce, mother left home, father died, can only follow grandpa and several other relatives to live, grow up rarely get family care and discipline, because of the special family structure, in school also by some students with strange eyes, the third semester dropped out of school. "Many drug abusers are lonely in their hearts. Their families don't give them warmth. When they reach the top of society, they realize that some bad people mistakenly think that they have received warmth, and then they are biased." Chen Meng said.
Engaged in psychological counseling, addiction research and intervention practice for many years, Wang Juan found that most people, especially minors will abuse drugs or even drugs, and family has a lot of relationship,"Sometimes reflected problems are actually the whole family system problems." Whether it is lack of support and discipline, indulgence, or high expectations of children, it is inappropriate. In the absence of proper guidance from the family, some people try to use drugs to cope with or avoid life problems, which is confirmed in the descriptions of many respondents.
Wang Juan called on parents to pay attention to their children's emotional needs."In adolescence, adult guidance is very important to help them solve problems, teach them how to solve problems, and cultivate a normal healthy attitude towards life. I think this is a responsibility that parents of minors need to assume."
In recent years, Chen Meng has repeatedly regretted drug abuse. If he had never taken medicine and gone to school, he might have become a doctor. His grandfather was a famous local Chinese medicine doctor, and he decided to study medicine since childhood.
In early October this year, Chen Meng tried to quit medicine again. At noon on October 19, he couldn't help but walk into the familiar drugstore,"take four boxes," he said to the clerk, and then went to the convenience store next door to buy Coke.
Walking down the street, he quickly broke 24 tablets of dextromethorphan into his palm. Along the way, he passed a garbage can. At one moment, the idea of "whether to throw away 12 tablets" came up, and disappeared in the next second. He glanced left and right to make sure that no one was paying attention, then threw all the pills into his mouth and sent them down with Coke.
After taking the medicine, the pressure in Chen Meng's heart suddenly lessened."Anyway, I've already taken it." However, regret quickly welled up in his heart."I persisted for so many days, and you ruined it all of a sudden."
(At the request of the interviewee, Xiaoya Wen, Lei Zeyu, Chen Meng, He Jing and Li Yang are pseudonyms)
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