What to Know About MXE Use

Methoxetamine (MXE) powder in a bag

GreenZeb / Wikimedia Commons / CC BY 3.0

The name MXE stands for methoxetamine, or its full name, 2-(3-methoxyphenyl)-2-(ethylamino) cyclohexanone. MXE is a drug from the arylcyclohexylamines family of compounds. Arylcyclohexylamines also include ketamine and PCP, which are two drugs that have been around for decades and have been used for anesthesia in humans and animals.

In contrast, MXE is a much more recently developed substance, which has been specifically developed and used as a recreational drug. MXE differs from ketamine on a molecular level. Initial reports indicate that despite its semi-legal status, MXE has longer-lasting and more intense effects than ketamine.

There have not been any formal studies to demonstrate exactly how MXE works, but it is assumed to work in the same way that ketamine does by affecting the brain's neurotransmitters and acting on their receptors. In addition to glutamate and aspartate one of the neurotransmitters thought to be affected is dopamine, which is associated with feelings of euphoria, and has a role in many addictions, including substance use disorders.

Given the fact that it has only emerged as a recreational drug in the last decade, very little is known about how to manage the medical consequences of the drug, making it a risky substance to take.

Also Known As: Methoxetamine is also known as MXE, m-ket (sometimes written as m ket), k max, k-maxx, kmaxx), mexxy (sometimes written as mexy, mexxi), mexxiem, mkat, mxxe, methoxatamine, methoxetimine, and methoxetamin.

Drug Class: MXE is an arylcyclohexylamine. It's classified as a dissociative hallucinogen.

Common Side Effects: MXE can cause increased energy, euphoria, auditory and visual hallucinations, disassociation (m-hole), severe ataxia, nystagmus

How to Recognize MXE

MXE is typically produced in the form of a white or off-white powder and may be labeled "not intended for human consumption" or sold as a "research chemical."

What Does MXE Do?

There are several ways that people take MXE. Some take it orally or sublingually (under the tongue). Some take it by nasal insufflation or snorting it into the nose. It can also be inserted into the rectum, where it's absorbed into the bloodstream, or injected into a muscle.

Doses typically range from 5 mg to 90 mg. If the drug is snorted, it can take 30 to 90 minutes to feel the effect, which can cause users to "top-up" or take more before the drug kicks in. This is a dangerous practice because the drug can build up in your system and lead to synergistic adverse effects. The effects usually last for one to three hours. If MXE is injected, the effects can begin within five minutes and last for as little as one hour.

Like other psychoactive drugs, the MXE high is described as pleasurable and includes stimulant, relaxant, and dissociative effects. But MXE also has unpredictable and intense side effects—particularly with higher doses—that are extremely unpleasant both physically and psychologically.

What the Experts Say

MXE has been available on the Internet since 2010 through online chemical manufacturers and head shops who sell it as a "research chemical" and as a "legal high." By being marketed as a research chemical, which is a way that designer drugs can be sold semi-legally, it can potentially get through a legal loophole.

The lack of credible research evidence on MXE makes it a risky substance to take both in the short term and the long term. In the short term, if you suffer from acute complications of the drug, the doctors who try to help you in the emergency room will likely not be well-versed in what you have taken or how to best treat it.

Information is not yet available on the long-term effects of MXE, so we don't currently know how taking MXE might affect your future mental or physical health, your fertility, or the health of your baby if you are pregnant or breastfeeding when you take it.

Common Side Effects

MXE has stimulant and dissociative effects, with the stimulant effects predominating at lower doses and the dissociative effects at higher doses. Depending on the set and setting and your personal reaction to the drug, you can experience an altered state of consciousness that can range from a dreamlike state to a terrifying bad trip experience of heightened, intense anxiety that can go on for several hours.

Lower Doses (up to 20 mg):
These feelings can continue as an "afterglow" for one to two hours after the main effects of the drug wear off.

  • Feeling of calmness
  • Increased energy
  • Euphoria
  • Disconnection from problems and concerns

Higher doses (40 mg to 50 mg):
When taken in higher doses, the effects of MXE are much more intense (and more similar to related drugs like ketamine and PCP), including:

  • Feelings of intense intoxication
  • Anxiety
  • Auditory and visual hallucinations
  • Feeling disconnection from your body
  • Severe ataxia (lack of coordination and clumsiness)
  • Nystagmus (a condition that causes involuntary shaking or wobbling of the eyes)
  • Dissociation (often referred to as an "m-hole" parallel to the k-hole experience on ketamine)

Marijuana appears to intensify MXE in a negative way, causing severe disorientation and distress, slurred speech, and difficulty communicating. Users can also become hyperthermic and hyperpyrexic (high fever), which is potentially fatal.

Hospital reports show that, while people can recover from MXE toxicity, this recovery period can require several days of hospitalization, with treatment including detox medication, intravenous fluids, and respiratory support. In addition, news stories have blamed several deaths on the consumption of the drug.

Very little objective information is available about MXE—most of it is anecdotal, posted on internet forums by users, or reported by emergency physicians who have dealt with acute cases. These individual reports give an idea of what someone says about their personal experience with the drug, but do not necessarily predict other users' experiences.

If you or anyone else has taken MXE and appear to be losing consciousness, call 911 immediately. Inform the paramedic that MXE was taken, as well as any other drugs or alcohol that were also consumed. The effects of MXE can be life-threatening.

Signs of Use

If someone you care about is using MXE, you might notice the following signs:

  • Changes in sleep habits
  • Shifts in priorities
  • Sudden change in social network
  • Irritability
  • Mood changes
  • Presence of drug paraphernalia

Myths & Common Questions

New psychoactive substances or "legal highs" like MXE are not a safe, legal alternative to ketamine—in fact, they are often more potent and unpredictable than the illicit drug they are designed to mimic.

Tolerance, Dependence, and Withdrawal

Anecdotal reports from users indicate that tolerance builds up quickly and that the drug has a high potential for addiction. Some users report taking high doses several times a day in an effort to maintain the positive effects on their initial low doses. This is often coupled with emotional difficulties and associated social problems. There is limited data regarding MXE dependence, but researchers believe that its similarity to ketamine may mean that it carries a similar risk of dependency.

How Long Does MXE Stay in Your System?

The length of time MXE stays in your system depends on several factors, including how much you take and how you take it (i.e., orally, snorted, or injected) as well as your age, metabolism, hydration, and activity levels. MXE is not detected via a standard urine toxicology screen.

Addiction

Addiction to MXE is certainly possible, especially since it is thought to affect the neurotransmitter dopamine, which signals the brain that a reward is on its way. When users experience a spike in dopamine levels, it reinforces the desire to use again and the brain requires more and more of the drug to achieve feelings of pleasure. The result: compulsive drug-seeking behavior. This can include spending large amounts of time seeking and using the drug and neglecting work and family responsibilities.

As there is very little information available, many addiction counselors and medical staff may not have even heard of the drug, let alone know about the effects. This may make forming a therapeutic relationship and effective addiction treatment for this drug particularly challenging.

Withdrawal

Once people have developed a dependence on or addiction to MXE, they are likely to experience symptoms of withdrawal if they suddenly stop taking the drug. These symptoms can range from mild to serious and can impact the body and mind, including:

  • Depressive thoughts
  • Insomnia
  • Memory loss
  • Impaired judgment
  • Disorientation
  • Clumsiness
  • Body aches and pains

How to Get Help

While there is no specific treatment for MXE addiction, there are some proven treatment options that could help you or someone you love. Treatment may include supervised detox, rehab (inpatient, outpatient, or residential), cognitive-behavioral therapy, family therapy, support groups, relapse prevention, and medication for any co-occurring mental illnesses.

If you have a problem with MXE use, talk to your doctor. Together, you can figure out the right treatment to begin the road to lasting recovery.

Addiction Resources

Don't wait to get help. The Substance Abuse and Mental Health Services Administration has a national helpline (800-662-4357) as well as an online treatment locator to find mental health services in your area.

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