I encountered a drug called "Dextromethorphan" when looking up things that react with grapefruits for a fic. I found out it's been banned in Sweden since the 90s, so I couldn't use it for this specific story, but if you've got any interesting history I'd be happy so know!
Are you ready for this? Like. Ask yourself. Are you really ready for this?
In 1954, a researcher with the US Public Health Service received $282,215 (1954 dollars) from the US Navy, ostensibly to find a non-addictive alternative to an opiate drug called codeine (used for pain and and as a cough suppressant).
So the researcher found a bunch of people who had substance abuse disorder and tested 800 substances on them, trying to find ones that couldn't cause physical or psychological dependence, even on people who were prone to that sort of thing.
(Now, you might be asking if this experiment was ethical. The USPHS was concurrently doing the infamous Tuskegee Syphilis Study, so while I couldn't find any concrete answer, imma guess no.)
Out of these 800 tested substances, we use 3 today: propoxyphene (used as a painkiller), diphenoxylate (used as a diarrhea medication), and dextromethophan (a cough suppressant (and, as of 2022, part of a fast-acting antidepressant)).
Importantly, it was later noted that all of these are addictive substances and today most of them require a prescription. Though depending on where you are in the world, you might just have to be over 21 and show an ID.
You might think this sounds like a pretty standard story.
Because while the US Navy was the one handing the money to the USPHS, the US Navy had come by it via the Central Intelligence Agency.
So what stake did the CIA have in a non-addictive codeine replacement? Nothing, it turns out. That's just what they'd told the US Navy. What they really wanted was an incapacitant- a drug that causes incapacitation like unconsciousness or continuous hallucinations- without killing. Incapacitants are also useful for discrediting prominent political figures by making them look like they have severe mental health concerns, which was another reason the CIA wanted them.
This was part of a project called MKPILOT.
And wouldn't you like to know which of the three listed above they liked the most? Dextromethorphan. Because at high doses it causes severe- and incapacitating- hallucinations (this is also why it is banned in Sweden).
The problem with it is that it requires really, really high doses (about 3 grams, which would have to be packaged in some other substrate)- this would make it difficult to slip into a drink or food.
(It should be noted that around the same time, the US Army was doing research into a much more usable incapacitant called 3-Quinuclidinyl Benzilate which required as little as 150mg of the substance to be useful- it was featured in a MacGyver episode and I did a nice little review of it here. While I have no sources that say the CIA was directly involved in funding this, based on their extensive funding of similar DoD projects at the time, they probably did.)
But you wanted to know about how grapefruit interacts with dextromethorphan:
A substance in grapefruit (along with seville oranges, limes, pomelos, and possibly pomegranates) blocks the pathway by which many drugs are metabolized in the liver. This causes the levels of drug in the body to be much higher than expected. In the case of dextromethorphan in particular, it can mean that the drug stays in the body a lot longer- up to 24 hours instead of the usual 3-4 hours. It can also make side effects and toxic effects significantly worse, leading to hallucinations and sedation, even at low doses normally used for coughing.
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