J Forensic Sci. 2012 Sep;57(5):1388-94. doi: 10.1111/j.1556-4029.2012.02133.x. Epub 2012 Apr 26.

Dextromethorphan abuse leading to assault, suicide, or homicide.

Logan BK1, Yeakel JK, Goldfogel G, Frost MP, Sandstrom G, Wickham DJ.

• 1The Center for Forensic Science Research and Education, The Fredric Rieders Family Renaissance Foundation, Willow Grove, PA 19090, USA. barry.logan@nmslabs.com

Abstract

Dextromethorphan is a commonly encountered antitussive medication which has found additional therapeutic use [sic] 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.

© 2012 American Academy of Forensic Sciences.

PMID:  22537430