Fatalities following DMT use: two case reports and a review of the literature.

N, N-Dimethyltryptamine (DMT) is a hallucinogen found in the South American Psychotria viridis plant and is the major psychoactive ingredient in the brew ayahuasca. In this report, we performed a review of the surrounding literature and detail two deaths which recently occurred in the UK following DMT use. A literature search of both academic (PubMed, GoogleScholar) and media (using Google search engine) publications was performed to identify previously reported fatalities following DMT use. The National Programme on Substance Use Mortality (NPSUM) was also searched for deaths which have occurred in the UK following DMT use. Literature search-There have been three previous reports of fatalities following DMT use, all deemed accidental in nature, with DMT consumption taking place as part of an ayahuasca ceremony in two of these cases. NPSUM cases-Two cases were identified (Case Report 1 [CR1] & Case Report 2 [CR2]), neither of which occurred in the context of an ayahuasca ceremony. DMT was detected and quantified in femoral blood in both cases (CR1 0.23 mg/l; CR2 0.24 mg/l). There was evidence of polydrug use in both cases (CR1 n = 6; CR2 n = 9), which in each case included additional compounds which can increase serotonergic drive (CR1 cocaine, amphetamine; CR2 venlafaxine, mirtazapine). There have been two recent deaths following DMT use in the UK, both in the context of polydrug use which may have caused death due to excessive serotonergic innervation leading to serotonin syndrome. Polydrug use is increasingly common in the UK, and users of unregulated drugs should caution their use in combination with other unregulated drugs and also any prescribed medications.