A case report describes a young person with dextromethorphan (DXM) use disorder, arising from misuse of NyQuil, which contains DXM, acetaminophen, doxylamine, and alcohol. DXM, related to codeine and ketamine, produces dissociative effects at high doses and has addiction liability. The patient was successfully treated with a combination of naltrexone and gabapentin, targeting NMDA and sigma-1 receptors involved in DXM's mechanism. The report suggests this combination may be a viable treatment for DXM addiction.
Exposure to cannabis increases the risk for psychoses ranging from transient psychotic states to chronic recurrent psychosis. Greater dose and earlier age of exposure raise the risk. For some psychosis outcomes, evidence supports some causality criteria, but reverse causality and confounders cannot be ruled out. Cannabis is neither necessary nor sufficient to cause psychosis; it is likely one of multiple causal components. In those with established psychosis, cannabis negatively affects the illness course and expression. Emerging evidence suggests alterations in the endocannabinoid system in psychotic disorders. Delaying or eliminating cannabis exposure could potentially reduce psychosis rates, especially in high-risk individuals.