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DXM is not K. I mean, obviously, but to me they are just two extraordinarily different animals. K (to me) is not interesting at lower doses. I pretty much need to hole for the drug to be worthwhile. DXM can a good time (if you're into that) at the 2nd plateau... I guess the equivalent of a dissociative buzz, a little like being drunk except not (some say it works well with beer at that level, though, and I believe it, if you've got the stomach for it).
...the worst part of DXM (even if you get powder, to some extent) is drinking the stuff and enduring pain while you wait for the trip to start. There's nothing pleasant about that, although the typical purge just prior to the trip is quite cleansing.
K is an incredibly pure, clean experience, at least in the hole. DXM usually has a "down-and-dirty" druggy feel. It does last four hours or so (longer if you get DXM polistirex - though your peak will be lower - and more intense depending on how you potentiate it. There is a geeky aspect to DXM built around dose timings, when you drink the grapefruit juice or smoke what the hell ever. I enjoyed that back in the day).
Some people do get "robo itch" and a few are allergic to the point of breaking out in hives.
...the afterglow. Some people get a hangover the next day, that manifests as being low-energy, kind of out of it, maybe a delicate stomach. Others get an "afterglow." As someone who was depressed when I was younger and did this, that was the reason I did the drug. For four or five days, my depression lifted. I had good perspective on my life and could just do what was good for me instead of irrationally hating it. It was like a breath of fresh air when I was drowning. So I did it when I felt like I had to (not so often). It never lasted, of course, and eventually the afterglows turned into hangovers. I never experienced this with K (though I didn't do a ton of that, and never injected). I did with MXE, albeit a bit differently.
I don't think DXM is going to cause long-term damage unless you do it often (at least more than once a week? YMMV). The process of consuming DXM made it easy to for me to limit it (a few others here did go full Kerflap. Must have iron stomachs). If you have abdominal/GI issues... I mean, you know what you're dealing with. DXM is hell on the digestive system in any form, when you take it. Expect a bunch of stomach discomfort, since you've filled it with syrup or pills (even the powder is supposedly an irritant). Then you'll either vomit, which at least gets rid of it, or not, which spares your esophagus, but then you get the shits sometime later, and if you have irritable bowels I would guess that could be an issue. DXM's metabolites are excreted in any event, and don't form crystals or whatever K does that kill your bladder. I think the risk from occasional use is just exacerbating any ulcers or IBS or whatever you've already got. Just like drinking a bunch.
It is a more "mobile" drug than K - with K, you just lay there - where it is fun to roam around and explore. Being outside (somewhere no one will harass you) at night is probably one of the best ways to do it. There is a certain familiar dissociation feeling, but it is not much like K and in no way a replacement. Certain RCs are more like it. The specific one I am thinking of can cause eye issues if used much (I think? It's been long enough that I can't be sure without looking at my notes, which aren't here), but there are others - all of them obviously can be looked into but still more of an unknown w/r to potential issues.
People do put up with the process of taking DXM for a reason. It was worth it to me at one point. It's not now. I'm not depressed, I'm older, my stomach would react much more now than then, and the trips themselves changed after a point (DXM heads here call it losing the magic, but I guess that's true in some way for most drugs).