If you live in Nigeria or any other part of the world at this time, you should be familiar with people tripping as a result of using cough medications. You see, cough medicine is used by people who have cough, and in fact, some people would use it for cases of asthma and this is wrong. While people can use this drug wrongly, that doesn't mean that they overdose on it, but there are a lot of people who would drink an entire bottle of cough medicine thereby misusing dextromethorphan which is the active ingredient in cough medicines, suppressing cough and could send people to begin tripping.
I wonder how people enjoy this drugs because dextromethorphan doesn't really taste good so it gets me surprised when people voluntarily ingest it in excess. While dextromethorphan usually come in syrup, some people buy it in powder form, and in both cases, they are ingested through the mouth and metabolized first by the liver to release the active form Dextrophan.
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Not all cough syrups are dextromethorphan base, prescription cough syrup are codeine based and usually have promethazine along side. The codeine in it is responsible for why a lot of people abuse this drug since codeine is an opioid but promethazine isn't an opioid.
Both codeine and morphine occur naturally, and dextromethorphan is similar to morphine where taken something that breaks down to them is the only way they can be ingested, in that when codeine gets into the body, it is broken down in the liver to become morphine and remember I talked about dextromethorphan being broken down to dextrofan in the liver making the borth drugs pro-drugs.
In the liver, these drugs are broken down by the enzyme cytochrome p450 2d6 but then, some people can consume an entire bottle of cough syrup and not feel anything because they have a 2d6 deficiency preventing the pro-drugs to become activated. Dextromethorphan isn't an Opioid, so it doesn't have the pain relieving property compared to codeine.
Dextromethorphan has serotonergic activity at the 5-HT2 receptors, and so it is adviced not to be used with other drugs to prevent drug-drug interaction. So dextromethorphan floods the brain with Serotonin which leads to the euphoria felt by the person who takes it, after which the levels crash and the person becomes more depressed.
With taking an overdose of dextromethorphan, it lead to over-excitation and this can be worsened by other agents that are in the body at the time and can lead to serotonin syndrome which is a conglomerate of signs and symptoms that occurs in individuals that are already exposed to too much serotonin leading to neurocognitive effects such as anxiety, irritability, delirium, confusion, agitation, dissociation, high blood pressure, tremors, increased temperature and other autonomic effects.
Some people can develop dependency cognitively from using dextromethorphan as a result of the brain being flooded by serotonin which would make the brain wanting the same flood of serotonin overtime. This can lead to excito-toxicity in the brain, and that can cause cell death and permanent damage in the brain leading to learning and memory problems, as well as psychosis, and in the long run, it can lead to dementia and other permanent neurotoxic effect.
The misuse of cough medications like dextromethorphan is a serious health issue. While these drugs are meant to offer relief from coughs, excessive and incorrect use can lead to significant physical and psychological problems. It's crucial to use these medications responsibly and only as prescribed to avoid their potentially dangerous effects.
Reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196581/
https://pubmed.ncbi.nlm.nih.gov/9624331/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/
https://pubmed.ncbi.nlm.nih.gov/21175434/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188627/
https://www.mountsinai.org/health-library/poison/dextromethorphan-overdose
https://pubmed.ncbi.nlm.nih.gov/19238739/
https://www.ncbi.nlm.nih.gov/books/NBK538502/
https://americanaddictioncenters.org/codeine-addiction