The death of a 21-year-old man found with a gunshot wound to the head while he was handcuffed in the back of a police car has been ruled a suicide, the Arkansas medical examiner said.

A report released by the medical examiner’s division at the state crime laboratory also said that Chavis Carter was under the influence of methamphetamine at the time of his death. The determinations were based on both the autopsy findings and the conclusions of the Jonesboro Police Department. The report said:

At autopsy, the cause of death was a perforating gunshot wound of the head. At the time of discharge, the muzzle of the gun was placed against the right temporal scalp. The bullet perforated the cranial cavity, causing brain injuries, skull fractures, and death. The bullet exited the left side of the head.

The report also said the gunshot wound had “soot and searing” which would be consistent with smoke and fire at the entrance into the head.

Stephen A. Erickson, the deputy chief medical examiner, said in an interview that those effects indicated a gun muzzle in “tight contact” with the head during a suicide. But he added that such wounds could also show up when someone shoots another person at extremely close range.

“Anatomically you can’t tell the two apart,” he said. “If someone had very good control of you and put a gun to your head in a threatening manner, you are under their control. The manner of death is certainly based on the conclusions of the investigators taken at face value.”

Mr. Carter’s death has sparked intense scrutiny, protests and online petitions, after many questioned how a handcuffed man could shoot himself in the head, as the police department has said, using a gun that they did not find when patting him down during the arrest.

Also curious: gun used was reported stolen a month bf in the Ark town where #ChavisCarter “committed suicide,” not in Miss. where he’s from — Charles M. Blow (@CharlesMBlow) 20 Aug 12

Chavis Carter autopsy: Forensic expert calls suicide ‘possible’, ‘very unlikely’ //t.co/1aMOox5d — RiPPa (@RippDemUp) 20 Aug 12

So what now? What should happen next? Protests? Petitions? Spreading the word about #ChavisCarter? Or are we just too tired/jaded? — BlackVoices (@blackvoices) 20 Aug 12

The Jonesboro Police Department, after releasing the report, said the investigation was still not complete.