The illegal abuse of dextromethorphan, a widely used antitussive drug in clinical practice, has increasingly become an international issue. Currently, China has listed dextromethorphan in its national catalog of Category II Psychotropic Drugs and implements control measures in accordance with standards for narcotics regulation. Based on relevant literature, this study summarizes the metabolic pathways, abuse hazards, and control status of dextromethorphan, with a focus on the extraction and detection methods for dextromethorphan and its metabolites. It analyzes and discusses the applicability of these methods across different matrices, their qualitative and quantitative detection performance, and their multidimensional application scenarios in forensic appraisal. This study aims to provide a reference for the detection, identification, and abuse monitoring of dextromethorphan in the field of forensic appraisal.