CASE REPORT TOXICOLOGY
Dextromethorphan Abuse Leading to Assault, Suicide, or Homicide
Article first published online: 26 APR 2012
© 2012 American Academy of Forensic Sciences
Journal of Forensic Sciences
Volume 57, Issue 5, pages 1388–1394, September 2012
How to Cite
Logan, B. K., Yeakel, J. K., Goldfogel, G., Frost, M. P., Sandstrom, G. and Wickham, D. J. (2012), Dextromethorphan Abuse Leading to Assault, Suicide, or Homicide. Journal of Forensic Sciences, 57: 1388–1394. doi: 10.1111/j.1556-4029.2012.02133.x
- Issue published online: 5 SEP 2012
- Article first published online: 26 APR 2012
- Received 19 Jan. 2011; and in revised form 1 June 2011; accepted 8 July 2011.
- forensic science;
- forensic toxicology;
Abstract: Dextromethorphan is a commonly encountered antitussive medication which has found additional therapeutic use in the treatment of pseudobulbar disorder and as an adjunct to opiate use in pain management. Dextromethorphan at high doses has phencyclidine-like effects on the NMDA receptor system; recreational use of high doses has been found to cause mania and hallucinations. The toxicology and pharmacology of the drug in abuse are reviewed, and the historical literature of adverse psychiatric outcomes is assessed. Five new cases of dextromethorphan intoxication that resulted in assault, suicide, and homicide are reported, together with the corresponding toxicology results. Blood concentrations ranged from 300 to 19,000 μg/L. These results are compared with typical concentrations reported in therapeutic use and impaired driving cases. Based on these findings, dextromethorphan should be considered as a potential causative agent in subjects presenting with mania, psychosis, or hallucinations, and abusers are at risk for violent and self-destructive acts.