Stimulant Methamphetamine and Dextromethorphan Use Among Thai Adolescents: Implications for Health of Women and Children

Abstract

For over a decade, amphetamine-type stimulants have made their way into the adolescent culture of Thailand. Coupled with the more recent emergence of the legal, overthe-counter cough medicine dextromethorphan (DM), they represent the most commonly abused substances among Thai youths today. Methamphetamine is the second most popular drug of abuse in Thailand, the first being cannabis. It is available in the crystalline version, ICE, and the less pure methamphetamine tablets. The tablets are frequently crushed and smoked. Its use has gained enormous popularity among teenagers and young adults, including women of child-bearing age. As such, it has become the most common drug being detected in the urine of peripartum women, resulting in peripartum and postpartum complications for both mother and child. DM is a newer drug which has gained popularity among middle school and high school students due to its easy availability as a single product over the counter. It is usually taken with soft drinks at parties and gathering. It is metabolized by CYP4502D6 to dextrorphan, the substance responsible for the feeling of euphoria. Consequently, those who are poor metabolizers often experience the "negative" effects associated with the drug. The recreational use of methamphetamine and dextromethorphan in teenagers and young adults in Thailand is a serious problem. Recognizing not only the toxicological but also the emotional and psychosocial impacts of these drugs on Thai youth is an integral part of approaching the problem.

Patterns and Perceptions of Dextromethorphan Use in Adult Members of an Online Dextromethorphan Community

“…However, the latter two findings conflict with previous reports. DXM is commonly thought to be a drug consumed at raves, parties, and gatherings (Chomchai and Manaboriboon 2012;Schwartz 2005) despite reported side-effects of difficulty in communicating (Degkwitz 1964) and speech disorders (Ziaee et al 2005). The current results reveal a subgroup of DXM adult users who prefer to use the drug alone; a worrisome preference given side-effects such as tachycardia, vomiting, dizziness, and tremor (Ziaee et al 2005).…”

“…In the United States, non-medical DXM use accounted for 35% of the DXM-related emergency department visits, with 51% of such visits occurring in those aged 12 to 20 (SAMHSA 2008). Such findings, in conjunction with case studies in other countries (Chomchai and Manaboriboon 2012;Mutschler et al 2010;Ziaee et al 2005), indicate a growing health concern given DXM's legal availability.…”

“…Recreational intake of DXM has been documented in case reports of adolescents and young adults in the United States, Germany, Thailand, and Iran (Chomchai and Manaboriboon 2012;Murray and Brewerton 1993;Mutschler et al 2010;Price and Lebel 2000;Wolfe and Caravati 1995;Ziaee et al 2005), in large-scale surveys of students in the United States (Falck et al 2006(Falck et al , 2012Johnston et al 2011), and examination of poison control, emergency room, and criminal cases (Banerji and Anderson 2001;Logan et al 2009Logan et al , 2012Wilson et al 2011). The growing need for awareness by medical practitioners of the symptoms of DXM overdose has also been noted, particularly due to the risk of associated psychiatric and central nervous system consequences (Alam, Nelson, and Bastiampillai 2013;Haroz and Greenberg 2006).…”

The potential utility of some legal highs in CNS disorders

“…Another abused substance, dextromethorphan (Bryner et al, 2006;Chomchai and Manaboriboon, 2012), is an antitussive with some affinity at the mu-opioid and N-methyl-D-aspartate (NMDA) receptors and the 5-HT and noradrenaline transporters (Codd et al, 1995;Burns and Boyer, 2013). Other clinically used drugs which have been abused include phenazepam, olanzapine, quetiapine, venlafaxine and orphenadrine (Schifano et al, 2015).…”

Using Journal Review Articles to Increase the Dissemination of Keynote and Symposia Lectures at International Medical Congresses

“…opioids, methamphetamine, ketamine and dextromethorphan) and emerging trends. The symposium was very well received by those who attended the APAMT congress, and in this issue of the Journal of Medical Toxicology, the series of mini-reviews from the symposium is published [4][5][6][7]. We hope that the wider readership of the Journal of Medical Toxicology will find these articles of interest.…”