The psychedelic call: analysis of Australian Poisons Information Centre calls associated with classic psychedelics.

INTRODUCTION: The global use of certain classical psychedelics has increased in recent years, but little is known about their spectrum of toxicity within Australia. We aim to describe calls to New South Wales Poisons Information Centre relating to exposures to classical psychedelics including lysergic acid diethylamide, psilocybin, N,N-dimethyltryptamine, ayahuasca, mescaline and ibogaine. METHODS: This is a retrospective observational study of calls to New South Wales Poisons Information Centre between January 2014 and December 2022. We identified exposures to classical psychedelics within New South Wales Poisons Information Centre database and measured the annual number of exposures, source of call (hospital, health care worker, member of the public), co-ingested substances, clinical features and advice given. RESULTS: There were 737 calls related to relevant psychedelic exposures; 352 (47.8 per cent) to lysergic acid diethylamide, 347 (47.0 per cent) to psilocybin, 28 (3.8 per cent) to N,N-dimethyltryptamine, 4 (0.5 per cent) to ayahuasca, 4 (0.5 per cent) to mescaline and 2 (0.3 per cent) to ibogaine. Cases were predominantly male (77.2 per cent) and aged between 20 and 74 years (65.6 per cent). Psychedelic calls more than doubled from 45 in 2014 to 105 in 2022 and 625 (85 per cent) of all calls were either from or referred to hospital. Co-ingestion of psychedelics with another substance occurred in 249 (33.8 per cent) of calls and the most frequent clinical features related to single substance psychedelic exposures were hallucinations (27.6 per cent), gastrointestinal symptoms (21.7 per cent) and tachycardia (18.1 per cent). Seizures occurred in 2.9 per cent of single substance psychedelic exposures. DISCUSSION: Increasing incidence of psychedelic exposure calls, including those reporting significant toxicity, likely reflects increasing community use. This may in part be driven by increasing interest in psychedelic assisted psychotherapy trials subsequently increasing public awareness. CONCLUSION: Relatively high poisoning severity contrasts with safety within clinical trials of psychedelic assisted psychotherapy that may relate to the uncontrolled nature of community use which is mitigated within clinical trial environments. Education about safe use may be useful.

Chemistry and Toxicology of Major Bioactive Substances in Inocybe Mushrooms.

Mushroom poisoning has always been a threat to human health. There are a large number of reports about ingestion of poisonous mushrooms every year around the world. It attracts the attention of researchers, especially in the aspects of toxin composition, toxic mechanism and toxin application in poisonous mushroom. Inocybe is a large genus of mushrooms and contains toxic substances including muscarine, psilocybin, psilocin, aeruginascin, lectins and baeocystin. In order to prevent and remedy mushroom poisoning, it is significant to clarify the toxic effects and mechanisms of these bioactive substances. In this review article, we summarize the chemistry, most known toxic effects and mechanisms of major toxic substances in Inocybe mushrooms, especially muscarine, psilocybin and psilocin. Their available toxicity data (different species, different administration routes) published formerly are also summarized. In addition, the treatment and medical application of these toxic substances in Inocybe mushrooms are also discussed. We hope that this review will help understanding of the chemistry and toxicology of Inocybe mushrooms as well as the potential clinical application of its bioactive substances to benefit human beings.

Management of overdoses of salvia, kratom, and psilocybin mushrooms: a literature review.

INTRODUCTION: Despite the relative reduction in opioid and other illicit substance overdoses in the past few years, clinicians must remain vigilant in keeping up to date on emerging trends with regard to potential substances of abuse. As overdoses of traditional drugs of abuse decrease in light of legislative and de-prescribing initiatives, it stands to reason that alternative agents, including natural products, have increased. Toxicities associated with these agents have been contributing to emergency department visits across the globe. AREAS COVERED: This evaluation covers salvia, kratom, and psilocybin mushrooms, and was accomplished through a comprehensive review of PubMed, SCOPUS, ProQuest Central, ProQuest Dissertations, and CINAHL. Thirty-one pieces of literature are included in this evaluation. The objective of this review is to provide clinicians with the information necessary to provide bedside care for overdoses of salvia, kratom, and psilocybin mushrooms. EXPERT OPINION: Salvia, kratom, and psilocybin mushrooms may not be an initial consideration when healthcare practitioners are triaging an overdose scenario; however, data from around the world demonstrate an increased use of these agents. While not typically fatal, clinicians must be prepared to assess these as a potential etiology of overdoses and provide appropriate supportive care.

Does getting high hurt? Characterization of cases of LSD and psilocybin-containing mushroom exposures to national poison centers between 2000 and 2016.

BACKGROUND: Lysergic acid diethylamide (LSD) and psilocybin are serotonergic hallucinogens that are used primarily for recreational abuse. Small studies evaluated the efficacy of LSD and psilocybin for several psychiatric conditions. There are limited safety or toxicity data for either of these substances, especially in large populations. METHODS: This was a retrospective analysis of single-substance exposures of LSD or psilocybin-containing mushrooms (PcMs) reported to United States poison centers from 1 January 2000 to 31 December 2016. The study describes the most frequent toxicities, management sites, and medical outcomes. RESULTS: A total of 5883 PcM and 3554 LSD exposures were included. Most patients were between 13 and 29 years of age (83.9% PcM, 88.9% LSD) and primarily male (77.9% PcM, 74.1% LSD). Most common clinical effects were hallucinations (45.8% PcM, 37.4% LSD), agitation (24.1% PcM, 42.4% LSD), and tachycardia (18.0% PcM, 38.6% LSD). Serious clinical effects were infrequent, but included hyperthermia, seizures, coma, increased serum creatinine, and cardiac arrest. Most patients were treated and released from the emergency department. More LSD patients were admitted to critical care and non-critical care units than PcM patients. Moderate effect was the most frequent outcome for both substances (61.0% PcM, 62.3% LSD). CONCLUSION: These data find that LSD and PcM use occurs primarily in adolescents and young adults, who experience mild to moderate adverse effects. Serious effects are infrequent but can occur. While most LSD and PcM users require only emergency department management, LSD use is more likely to require medical admission.

Analysis of mushroom exposures in Texas requiring hospitalization, 2005-2006.

INTRODUCTION: Texas has approximately 200 species of wild mushrooms, including toxic and hallucinogenic varieties. Mushroom ingestions in Texas were studied for 2005-2006. METHODS: Data was obtained via Texas Poison Control Centers and retrospectively reviewed. Case notes were reviewed individually regarding initial reporting, age, signs and symptoms, toxic effect, management, and patient outcomes. RESULTS: A total of 742 exposures occurred during the study period. All exposures were acute and intentional. Of these exposures, 59 (7.9%) were admitted to the hospital, with 17 (28.8% of admissions) requiring admission to a critical care unit. Four cases required inpatient psychiatric admission. The average age of admitted exposures was 20.5 years, with a male-to-female predominance of 3.3:1. Eleven (22.9%) of the admitted exposures were identified, with Psilocybin being the most common agent (n = 10, 91%). Among the admissions, co-ingestions were identified with the mushroom ingestion in eleven patients (40.7%). The most common symptoms in admitted patients were vomiting (n = 34, 57.6%), nausea (n = 19, 32.2%), altered mental status (n = 17, 28.8%), abdominal pain (n = 13, 22%), and diarrhea (n = 10, 16.9%). CONCLUSIONS: All mushroom exposures examined were acute and intentional. Major toxic reactions were uncommon, and no deaths were reported. Serious poisoning from mushroom ingestion is rare in Texas; however, there is greater need for information dissemination on morbidity.

Unrecognized magic mushroom abuse in a 28-year-old man.

A 28-year-old man with a history of drug and alcohol abuse presented multiple times to the hospital over 2 months with an elusive constellation of symptoms, resolving spontaneously in each instance. This patient required a high level of care for management and stabilization, including 3 emergency department visits, 2 medical floor admissions, and 1 intensive care unit admission. In both the emergency department and inpatient setting, all laboratory and imaging study results, including gas chromatography/mass spectrophotometry of the urine, were negative/normal. A definitive diagnosis eluded multiple emergency medicine, critical care, and consulting physicians. His symptoms included altered mental status, vomiting, diaphoresis, and mydriasis. The patient later admitted using mushrooms to a nurse. In the absence of confirmatory testing, but supported by exclusionary and anecdotal data, we believe that our patient's symptoms are consistent with Psilocybe mushroom toxicity. We feel that had this been considered initially, the correct diagnosis would have led to a better utilization of resources, and we want to remind emergency physicians of the possibility of mushroom abuse in any similar clinical setting.

[Hallucinogenic fungi (Psylocibe). Part I. Characteristics, results of consumption, recognition]. / Halucynogenne grzyby--lysiczki (Psylocibe). Czesc I. Charakterystyka, skutki zazycia, rozpoznawanie.

From 140 species of genus Psylocibe about 80 have hallucinogenic properties. This paper presents the morphology of these fungi and the mycological methods of their identification. According to information of users, the normal dose is 5-30 fresh wild fungi or about 0,5-2 gram of dried wild fungi tissue, but a select type of mycelium from a glass culture may have significantly higher contents of psilocybine. The effective time on the human brain is about 4-5 hours. The toxic dose of psilocybine is unknown, but genus Psylocibe may be mistaken with other, similar, very toxic fungi.

Severe rhabdomyolysis, acute renal failure and posterior encephalopathy after 'magic mushroom' abuse.

We report the case of a 25-year-old, hepatitis C-infected man, who presented with severe rhabdomyolysis and acute renal failure, and later developed posterior encephalopathy with cortical blindness after the ingestion of magic mushrooms. Conventional respiratory and cardiovascular support including mechanical ventilation, continuous veno-venous hemodialysis and corticosteroids led to improvement and the patient recovered completely over the following months. Magic mushrooms are becoming increasingly fashionable among drug users, as they are believed to be more harmless than other hallucinogenic designer drugs. So far, little is known about their possible severe side effects.

Poisonings resulting from the ingestion of magic mushrooms in Kraków.

Hallucinogenic mushrooms, also called "magic mushrooms", are becoming a more frequent cause of abuse, especially among young people, who use them experimentally for recreational purposes. In the autumn of 2004, several people were admitted to and observed in the Department of Clinical Toxicology in Krakòw after they had used magic mushrooms to experience hallucinatory sensations. Three of them had visual hallucinations, and the fourth experienced both visual and auditory hallucinations followed by the exogenous psychosis after use of Psilocybe semilanceata. One person was hospitalised for several days while the others were observed in the emergency department. The main source of information for patients about hallucinogenic mushrooms was the internet. In the cases discussed the mushroom poisoning caused no organ damage and the symptoms disappeared in about 6 hours.

[Hallucinogenic mushrooms]. / Haliucinogeniniai grybai.

The group of hallucinogenic mushrooms (species of the genera Conocybe, Gymnopilus, Panaeolus, Pluteus, Psilocybe, and Stropharia) is psilocybin-containing mushrooms. These "magic", psychoactive fungi have the serotonergic hallucinogen psilocybin. Toxicity of these mushrooms is substantial because of the popularity of hallucinogens. Psilocybin and its active metabolite psilocin are similar to lysergic acid diethylamide. These hallucinogens affect the central nervous system rapidly (within 0.5-1 hour after ingestion), producing ataxia, hyperkinesis, and hallucinations. In this review article there are discussed about history of use of hallucinogenic mushrooms and epidemiology; pharmacology, pharmacodynamics, somatic effects and pharmacokinetics of psilocybin, the clinical effects of psilocybin and psilocin, signs and symptoms of ingestion of hallucinogenic mushrooms, treatment and prognosis.

Common drugs of abuse--Part II.

Drug abuse affects a significant number of individuals of all ages. Health care practitioners must be knowledgeable about both the physiological effects of such drugs and the impact of drug-seeking behavior on their patients.

Jekyll and Hyde revisited: paradoxes in the appreciation of drug experiences and their effects on creativity.

Historically, states of intoxication--like dreams and madness--are seen in either one of two opposed ways. The intoxicated are either "possessed" or "under the influence" of an external agency, or revealing hidden feelings or truths (in vino veritas). Along the same lines, artists who worked during LSD, mescalin or psilocybin intoxication often refer to feelings of either being "possessed" or "liberated," a difference that can be explained partly by their expectations and partly by their evaluations, which both tend to conform to the cultural dichotomy in interpreting the irrational. Both interpretations, however, tend to obscure not only the other, but also-it is posited-the paradoxical nature of the drug experience itself. Analysis of a protocol shows that intoxication might comprise feelings of "possession" as well as "liberation" almost simultaneously, and mediumistic and some psychedelic art shows stylistic traits that can be seen as the visual expressions of both these feelings. It seems that the "demoniacal" and "psychedelic" mode come together in experiential reality, only to be divided in the cultural sphere.

Possible mechanisms of panic attack and schizophrenia via APUD system.

Psilocybin poisoning produces biphasic reactions composed of a schizophrenic phase and a panic attack-like phase. There is a time lag of several hours between phases, which may be considered an accumulation time in certain sites between the gut and the brain. So far as 5-hydroxytryptamine (5-HT) congeners are concerned, no sites are to be found except the amine precursor uptake and decarboxylation (APUD) system. It is postulated that argyrophil cells (AC) in the foregut, neuroepithelial bodies (NEB) in the lung, and raphe nuclei (RN) in the brainstem axis are relevant to mental disorders. Schizophrenia might be due to the massive destruction of APUD cells, and the paroxysmal release of 5-HT with peptides and panneuroendocrine markers from NEB might be the cause of panic attack.

[Intoxications by hallucinogenic mushrooms]. / Intoxications par champignons hallucinogènes.

In the context of excessive use of natural or synthetic psychoactive substances, with stimulating, psychedelic and hallucinogenic effects, an increase, if not a recurrence, in consumption of Psilocybe semilanceata has been observed in France over some fifteen years. Psilocybin and psilocin are the active compounds, responsible for the hallucinogenic effects and are a part of the substance group, derived from tryptamine and characterized by an indole nucleus. We report a clinical case observed in an emergency unit and review the historical, epidemiological and pharmacological data now available for these intoxications. Of particular interests in hallucinogenic mushroom abuse are: increased consumption in the context of youth cultural and entertainment movements; possible difficulties in the diagnosis in emergency conditions; possibility of severe and fatal complications.

[The morphofunctional changes in the internal organs in the modelling of poisonings by psilocybine-containing mushrooms]. / Morfofunktsional'nye izmeneniia vnutrennikh organov pri modelirovanii otravlenii psilotsibinsoderzhashchimi gribami.

Histological analysis of the viscera in experimental poisoning with psilocybin-containing mushrooms showed nonspecific changes in all examined organs, presenting as expressed hemocirculatory disorders and intracellular dystrophy. Quantitative histochemical analysis showed appreciable shifts in the activities of enzymes involved in the cytoplasmic and mitochondrial redox processes and of specific enzymes involved in nerve tissue metabolism. This may reflect some features in the direct effects of narcotic alkaloids contained in psilocybin-producing mushrooms.

Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction.

CASE REPORT: Intentional intoxication with natural hallucinogenic substances such as hallucinogenic mushrooms continues to be a major problem in the US and Europe, particularly in the harbor complex of northwest Poland (Pomerania). A case is described of Psilocybe intoxication in an 18-year-old man resulting in Wolff-Parkinson-White syndrome, arrhythmia, and myocardial infarction. The indole concentrations of hallucinogenic mushrooms may predict the risk for adverse central nervous system and cardiac toxicity.

Presence of phenylethylamine in hallucinogenic Psilocybe mushroom: possible role in adverse reactions.

The use of mushrooms containing the hallucinogenic substance psilocybin for intentional intoxication is relatively common. Occasionally, this results in adverse reactions with typical tachycardia that is not evidently caused by psilocybin. This study demonstrates the presence of phenylethylamine in the species Psilocybe semilanceata using gas chromatography-mass spectrometry and shows that the amount of this substance may vary much more than that of psilocybin. The highest amount of phenylethylamine (146 microg/g wet weight) was observed in mushrooms from a case of three young men hospitalized because of adverse reactions. Comparison of the symptoms observed in clinical cases of magic mushroom intoxication with those after intake of pure psilocybin or phenylethylamine suggests that phenylethylamine might have a role in the development of adverse reactions to Psilocybe mushroom intake.