A man in his early twenties was found dead at home with no external injuries or obvious internal lesions. Toxicological analyses revealed extremely high concentrations of dextromethorphan (DXM), an over-the-counter antitussive, and no other drugs were detected. This appears to be the first reported death caused by a single overdose of DXM in Japan. While DXM is commonly used worldwide and has become popular among young people for its euphoric, hallucinogenic, and dissociative effects, fatal cases of DXM poisoning are rare and usually involve multidrug ingestion. The authors argue that public awareness should be increased about the risks of massive DXM ingestion.
A woman in her thirties was found dead with aroma liquid, bath salt products, and hypnotic drug tablets nearby. Autopsy revealed pulmonary congestion and edema. Analysis detected four designer drugs: 4-methoxy PV8, PV9, 4-methoxy PV9, and diphenidine, plus three benzodiazepines (triazolam, flunitrazepam, nitrazepam) and alcohol. Femoral blood concentrations of the cathinones and diphenidine were 2.69, 0.743, 0.261, and 1.38 μg/ml, respectively, markedly higher than earlier cases; alcohol was 1.52 mg/ml. The cause of death was poisoning from these cathinone drugs and diphenidine, compounded by benzodiazepines and alcohol.