Originally posted at
Lycaeum
Original title: "Intoxication mortelle a la suite de la
consommation volontaire et en groupe de champignons hallucinogenes."
Summary
The authors report the fatality of a 22-year-old man after he and a group
of friends voluntarily consumed hallucinogenic mushrooms, in this case
Psilocybe semilanceata (Fr. : Fr.) Kummer. According to the best of our
knowledge, up to now, this cosmopolitan species had never caused any
fatalities, this is the first observation of this type ever made in the
world, so the so-called innocuousness of hallucinogenic mushrooms is now
questioned.
INTRODUCTION:
From the pre-Columbian period on, 2,000 years ago, hallucinogenic
mushrooms have been worship in Central America. During the Spanish
conquest, this cult was known as TEONANACALT. the soothsayers consumed
hallucinogenic mushrooms in order to communicate with the Gods and to get
information about their patients diseases, how to treat them... Nowadays,
it has almost disappeared from Mexico. This mushroom cult was studied by
Wasson (37), Heim identified and cultivated the concerned species (10, 11,
12), which enabled Hoffman to isolate and identify the active components.
Those are derivatives from serotonin or from 5-hydroxytryptamin such as
psilocin (4-hydroxy-N, N-dimethyltryptamin). More recently, related
derivatives were identified : baeocystin
(4-phosphoryloxy-N-methyltryptamin) and norbaeocystin
(4-phosphoryloxy-N-tryptamin) (18). Many amines are also found in these
mushrooms, but in smaller quantity. Very little is known about their
biological properties (1, 17).
Whereas the religious and medical use of hallucinogenic mushrooms has
disappeared, the recreational use is increasing. Nowadays, there is a
marked increase in the use of hallucinogenic mushrooms everywhere in the
world and especially in the United States, Great Britain and in Australia
(27). Many popular scientific works were written about hallucinogenic
mushrooms, sometimes with a printrun of 100,000 or more ! (21, 25, 34,
35). In order to avoid any harvesting problems, some companies openly (if
not legally) propose the equipment, the techniques and even the spores in
home growing kits.
Recently, several URL's and electronic bulletin boards which are totally
dedicated to the subject were created on Internet, where everything is
possible. In France, this phenomenon is not so severe, probably because of
the regulations forbidding the harvesting of hallucinogenic mushrooms that
were published in the latest mycological issues. However, the song
`Mangez-moi' (eat me) which openly encouraged such harvesting was quite
successful on the radio before being subjected to restrictions.
CASE REPORT:
The facts we relate here are based on statements made by persons who took
part in a `mushroom party'. The state prosecutor opened an inquiry and two
questioning took place, one made by the `gendarmes', the other by judicial
policy officers. The first questioning was made the following day, but
obviously, the participants did not have a fresh mind. The second was made
a few days later to get more precise information, which was not easy as it
dealt with the consumption of hallucinogenic drugs. We will only sum up
the facts that are important for the reasons and understanding of this
fatal poisoning. According to the paragraphs L626, L627, L628 of the
French `Code de la Santé publique', no names or places will be cited
hereafter.
M. A., a 22-year-old man living in Finistère (France), decided on the 29th
of September 1993, to spend the afternoon harvesting hallucinogenic
mushrooms in the damp fields of the area. According to his friends, he was
used to harvesting. He was also used to drinking alcohol and smoking
cannabis on a regular basis. He was penniless and his usual cannabis
dealer had just been arrested, subsequently, mushrooms were an easy
substitute. He left home at 1:30 p.m. and came back around 6:00 p.m. to
meet some friends of his in their usual bar. They said he was already high
on drugs as he had eaten on-site an unspecified number of raw mushrooms.
He felt dizzy, suffered from abdominal cramps and had difficulties in
breathing. His friends noticed that he was pale, he sometimes sweated
abundantly and he behaved as if he was drunk. Despite this alarming
symptomatology, he took a dozen of mushrooms out of his bag and ate them
in front of his friends, inviting them to share the remaining mushrooms
boiles in tea. Four of them accepted to do so. They boiled the tea at 8:30
p.m. using 20 to 40 mushrooms. This tea was shared and rapidly caused
different effects depending on the persons, which is common in this type
of poisoning.
M. B., 20 years old drank half a cup of it and felt euphoric within 30
minutes, followed by a state of drunkenness and a loss of his balance. He
started vomiting, which slightly improved his state. He admitted he had
drunk 15 beers earlier that day. M.C. 36 years old drank one cup and ate
2 or 3 raw mushrooms. One hour later, he started feeling drunk and had
colored visions. M. D., 24 years old, did not remember the quantity he
had ingested but he said he had drunk a few beers earlier. He only felt a
little drunk. M.E., 20 years old, drank one cup and felt in a drunkenness
state one hour later, followed by paresthesy and cramps in her legs. As
for M. A., the victim, the participants had different opinions. Some said
they had not seen him drinking, others said that he joined them and drank
the tea. This opinion, approved by a majority of them seems to be the
right one. Each participant finally admitted that they felt restless,
euphoric and voluble at the end of those libations. Around 10:00 p.m.,
M.A. felt somnolent and lay down. His breathing was irregular. His friends
thought he was totally drunk or had gone on a bad trip, because they could
not make him stand up and realized he had urinated in his trousers. They
only started worrying at midnight, when after some convulsions and spasms,
he stopped reacting to their calls and fell in a coma. Realizing that this
was very serious, they drove him to the hospital but unfortunately, there
were no emergency services ! Around 2:30 am; he was taken home, he was
still unconscious. The duty doctor was finally called. In vain, he tried
to resuscitate him, he could do nothing but certifying that the fatality
has occurred. Given the circumstances of the fatality, a judicial inquiry
was ordered and a postmortem examination was made to determine the cause
of the fatality.
TOXICOLOGICAL ANALYSIS
We have looked for the usual toxins in the blood and urine samples, in the
kidney and in the liver.
Blood, urine and gastric content : The GC analysis of ethanol, alcohol
and other volatile substances was negative. Barbiturates, benzodiazepins,
tricyclic antidepressives, paracetamol, cannabinoïds, opiates and cocaine
were not revealed in the urine by an immuno technique (EMIT) and
salicylates by colorimetric technique : negative. Carbon monoxyde,
paraquat and chlorinated solvents were negative, so was the amanitins of
methanol extracts from the gastric content by TLS. The detection of blood
cholinesterases was normal. Thus, it can not be a organophosphorated
pesticide poisoning. Finally, we tried to systematically detect foreign
substances in the body by HPLC and mass spectrometry. Nothing was detected
on acid, neutral and basic extracts.
Kidney and liver:
A fragment of each organ was hydrolyzed by `subtilisin',. The obtained
liquid was extracted from acid, neutral and basic environment by
dichloromethan. After an azote controlled evaporation, the dry residue was
extracted by methanol. The organic extracts were analyzed by HPLC and mass
spectrometry. No abnormal substances were found.
Study and measurement of hallucinogenic indolic components:
This was performed on methanolic extracts from the gastric content, blood
and hydrolysats from kidney and liver. We tried to detect halucinogenic
indolic components and especially psilocybin and psilocin. Psilocybin
rapidly hydrolyses in the body to create psilocin which is the
biologically active substance. This hydrolysis is performed in the ratio
100 / 72, depending on each molecular weight. We found psilocin but no
psilocybin, not even in the gastric content, which confirmed the rapid
hydrolysis because of the high acidity of the gastric juice. HPLC was the
method used to determine the quantification combined with fluorometric
detection since mass spectrometry is less effective on this kind of
chemical because the weight spectra show a very low density molecular ion
(5, 15, 16, 33, 36). A psilocybin standard was used for the
quantification. The psilocin was extracted through the hydrolysis at 37°C
of this psilocybin by alkaline phosphatase in pH 7 Tris 1M buffer
overnight.
Results :
- blood : 4 micrograms/ml of psilocin - gastric content : only trace
amounts of psilocin, which were not easily measurable because of all the
impurities we could not correctly eliminate. - kidney and liver : failed
because of an unidentified chemical interfering with psilocin
Nothing found in the literature could help us interpreting these results.
Furthermore, the blood used was drawn 36 hours after the death, thus, the
results can not be applied to the living. However, this proved that
psilocybin containing mushrooms were ingested.
MYCOLOGICAL IDENTIFICATION OF THE SPECIES IN CAUSE :
Macroscopic study :
This study failed because we could not find the mushrooms that were used
for the tea. The witnesses described the mushrooms as being : Little Brown
Mushrooms with a long slender stipe, some of them presented the papilla
which is necessary to recognize an hallucinogenic psilocybe. The victim,
who harvested them himself, used to pretend he was familiar with `Psilos'
! But in fact, he only knew one species, Psilocybe semilanceata which he
had been harvesting for years for his personal use. On the day of the
gathering, the harvesting was especially good and after having consumed
some of them raw on-site, M.A. wanted to share his discovery with his
friends. Only four of them accepted. They were reluctant but curious to
taste hallucinogenic mushrooms. The species they described corresponded to
Psilocybe semilanceata, which we had frequently found on this station.
Microscopic study
It was performed on the gastric content drawn during the postmortem
examination. The content exhibited no fragments visible to the naked eye.
The study with the microscope did not exhibit any fragments bigger than
200 micrometers. Colored preparations were made using different dyeing
reagents : ammoniacal red Congo, cotton blue, and METZLER reagent There
were no evidences of cystidia or chrysocystia, only a few basidia 4-spored
and hyphae with clamp-connections were found. The spores were not
cyanophilic, metachromatic or amyloidic. The gastric content was
centrifuged after the adding of water and diethyl ether in order to gather
more spores. On the centrifugation pallet, which were rich in spores, we
made the following observations : Smooth and ellipsoid spores of a
purplish brown color (mounted in water and ammonia 10 ), thick walled of
about 1 micrometer, size: 11.5-14 x 7-8 micrometers, and having an apical
germ pore. A GIEMSA dye showed binucleate spores. We did not observed any
spores different from those described above, which proved that only one
species of mushrooms was ingested, at least just before the fatality or
before pumping the stomach.
We did not notice any mushroom spores belonging to species known for their
hallucinogenic properties, such as Panaeolus (Fr.) Quélet and Hypholoma
(Fr.) Kummer. The observed spores belong to the families of Strophariaceae
Singer and Smith and of Bolbitiaceae Singer, known for having numerous
species that are very potent in hallucinogenic indolic components (14,32).
We do not think that standing in the acid environment of the stomach or
being cooked could have modified their size or their aspects as they are
very resistant. Considering the reported facts, the presence of psilocin
in the blood and the gastric content of the victim, and the above
observations, we do think the victim had consumed Psilocybes belonging to
the Semilanceata Guzmàn section (= Tenaces Singer).
The most likely species being here Psilocybe semilanceata (Fr.: Fr.)
Kummer. By reading the mycological literature, we noticed differences in
the sizes of the spores given by the authors. : 15 x 7 micrometers (2);
12-16 x 7-8 micrometers ( 24), but a majority indicates smaller spores :
12-14 x 7-8 micrometers (9); 12-14 x 7-8.5 (14); 12-14 x 7-8 micrometers
(38). To solve this problem, we measured the macroscopically typical
spores of a sample from our herbarium and that were gathered neat the
place where the victim had harvested his. We measured the following
average lengths : 12.5-14 x 7-8 micrometers, which are the same as those
of the spores found in the gastric content of the victim.
According to WATLING (38), the European consumers who ingest
hallucinogenic mushrooms as a recreational means often confuse three
species on-site : Psilocybe fimetaria (Orton) Watling with spores of
11-14 x 6.5-8.5 micrometers; Psilocybe semilanceata (Fr. : Fr.) Kummer
with spores of 12-14 x 7-8 micrometers and Psilocybe callosa (Fr. : Fr.)
Quélet (= Psilocybe strictipes Singer and Smith).
In this particular case, it can not be Ps. callosa, whose spores are
smaller or Ps. fimeteria because of its rarity and its particular habit in
Brittany, where only a few of them can be found, unlike Ps semilanceata
that can be gather in large quantity. These observations lead to the
conclusion that Psilocybe semilanceata is the cause of this voluntary
group intoxication and of the fatality.
DISCUSSION:
This fatality, probably the first of this kind, that occurred after the
consumption of Psilocybe semilanceata leads to several hypothesis. The
postmortem examination results did not reveal any severe diseases or any
organic causes related to the death. The victim was apparently healthy. A
mushroom poisoning is highly probable since no other toxins were found.
The inadvertent consumption of toxicological species causing severe
amatoxin muscarine poisoning and red blood cell damage can not be
considered since the symptomatology is different. Furthermore, no
amatoxins were found in the gastric content and the postmortem examination
did not reveal any hemolytic syndromes.
The possibility that people with little experience had misidentified the
mushrooms is correctly expressed in popular scientific works about
hallucinogenic mushrooms (21, 22, 25, 34, 35) and it is especially well
described on the Internet (a, b). the American public is especially warned
against three amanitin species : Galerina venenata A.H. Smith; Galerina
autumnalis (Peck) Smith and Singer and Pholiotina filaris (Fr.) Singer
which can be found in France where other Amanita species exist, some of
them also bear hallucinogenic indolic compounds.
Finally, all Cortinarius of the Dermocybe subtype are said to cause late
renal failure, especially in the United States where a number of
hallucinogenic species grows in the woods. A poisoning of this type was
reported by RAFF (29). These information documents also warn against
dangerous mixing which increase the adverse effects of hallucinogenic
indolic compounds. The simultaneous consumption of alcohol and of other
drugs can lead to `bad trips'. Some types of medicine are also inadvisable
as a lethal effect is possible. The victim had not drunk alcohol and he
was not on drugs, he was not treated with MAOI and blood analysis had
shown no medicines. This voluntary poisoning belongs to the same category
as those usually observed with hallucinogenic mushrooms (20, 31). PEDEN
(26) who studied 44 cases that had led to hospitalization, determined
their symptomatology : nausea, abdominal pains, enuresis, hyperreflexia,
violent or on the opposite, sleepy euphoria and unrestness, pain in the
lower limbs, parasthesia, mydriase, tachychardia and hypertension. The
reported symptoms in this observations are serious and concern only the
people who were hospitalized because of adverse effects. It should be
added that every hallucinogenic mushrooms consumer does not necessary show
any physical or psychic disorders as some of them appear to resist to this
type or drugs or are not very sensitive to it. This conveys how
diversified people's reactions are when faced with this type of
intoxication. Testing pure psilocybin on man also proved that the psychic
and psychological effects were very different from one volunteer to
another (23).
It shall also be noted that adverse reactions are relatively proportional
to the dosage. In our case, the symptoms described were observed on the
people who had taken part in the `mushroom party', but the victim
exhibited the most alarming of them. A medical examination would have been
necessary to report mydriase, tachycardia and hypertension, but we can
suppose that they were present, at least by some of the participants.
PEDEN did not report any fatalities but medical cares were provided to
every in-patient, they had a lavage and this had always brought out many
fragments of mushrooms. However, BUCK (4) reported a fatality after the
accidental consumption of hallucinogenic mushrooms. A 7-year-old child
died after convulsing because he had ingested mushrooms. The case was
reported by most of the popular scientific works about hallucinogenic
mushrooms. This fatal outcome was caused by Psilocybe baeocystis Singer
and Smith. It is the American `potent mushroom'. The higher toxicity of
this mushroom is due to the presence of baeocystin and norbaeocystin which
has a bad reputation in the United States where its use is inadvisable.
Furthermore, a severe poisoning with paralysis of the lower limb,
convulsions and hypersudation was reported by YOKOHAMA in Japan (39).
An intensive medical care enabled the patient to recover. It was imputed
to Psilocybe subcaerulipes Hongo. It emerged from these observations that
pain in the legs or even paralysis of the lower limb, convulsions and
hypersudation are symptoms which must draw the attention on this kind of
poisoning as they reveal its gravity. They impose an emergency
hospitalization, which was not the case in the fatal poisoning we report
here. We also noticed in the toxicological literature an analogy between
severe or lethal poisoning with Hypholoma : Hypholoma fasciculare (Huds.
: Fr.) Kummer in particular, whose severe or even sometimes lethal
poisoning presented the same symptoms : pain in the lower limb, cramps,
convulsions, hypoglycemia and psychic disturbances. The toxic substances
which are in cause are nor well-known. Some of them would have some
cytotoxic properties. We considered the possibility of the consumption of
some Hypholoma species, especially those that can be found in Finistère in places where Psilocybe semilanceata grow. Those are Hypholoma elongatum
(Pers, : Fr.) Kummer ; Hypholoma ericaeoides Orton and Hypholoma
subericaeum (Fr.) Kühner. We did not detect any spores of these species in
the victim's stomach content.
Eventually; since the species are never present in large quantity, they
could not have been found in a sufficient amount mixed with Psilocybe
semilanceata to cause a severe poisoning. Considering all previous
observations, an overdose in hallucinogenic indolic compounds may have
caused the fatality. We will examine this problem according to the data
available in the literature. The treatment by psilocybin was dropped
because of the important variations in the individuals' sensitivity to
psilocybin and the adverse effects. The dosage to be taken by mouth was 4
to 8 mg for an adult (23), the maximum dosage being 150 micrograms/kg. it
is rather delicate to transpose this dosage in `mushrooms' since there is
not only psilocybin but also some other active indolic compounds which can
cause agonistic or antagonistic effects, not to mention the possible
presence of other more or less toxic mushrooms. We have found numerous
data about the amount of indolic components obtained in hallucinogenic
mushrooms. They vary significantly according to the species, which is
obvious, but they also vary in the same species!
An American study proved that the active component contents can vary in
the same species from a factor of 1 to 4 for the cultivated ones and from
1 to 10 for those growing in the wild (a, b). This `biovariability'
constitutes such an important risk for the consumers that some people
proposed to sale hallucinogenic mushrooms freely after having identified
them and checked their content in active components. This method has the
advantage of protecting the consumers from troubles. We have picked up
the following data related to Psilocybe semilanceata from different
papers. (In percentage from the weight of the dry mushroom) (1, 5, 16, 33,
36, a, b)
Psilocybin. : from 0.1 to 1.6 per cents Psiloci : from 0 to 0.6 per cents
Baeocystin : from 0 to 0.6 per cents Norbaeocystin : from 0 to 0.4 per
cents
Some variety can bear up to 2 per cents of total hallucinogenic indolic
compounds. Eventually, some varieties of Psilocybe semilanceata are
considered in the United States as being very `potent', their toxic
effects being attributed to their high contents in baeocystin and
norbaeocystin. But no evidence were scientifically proved since the
physiological properties are not well-known.
If we consider that the average content of active indolic compounds makes
up to 1 per cents of the weight of the dry mushrooms and that a dry
Psilocybe semilanceata weights around 200 mg, then, this species bears
approximately 2 mg of psilocybin. Thus, 5 of these mushroom are necessary
for a `trip'. This is what the followers of the `mushroom cult' propose by
setting the dosage to 5 to 10 mushrooms for `small trip', and to 20 to 40
for a `big trip'. The maximum dosage to avoid a `bad trip' is 60
mushrooms. Thus, the previous calculation gives 120 mg of active
components to be related to 150 mg of psilocybin, considered as likely to
cause dramatic toxic effect to an adult. It shall also be noticed that, in
the body, psilocybin hydrolyses in psilocin which is really potent and
that 150 mg of psilocybin give this way 108 mg of psilocin. Consumption of
up to 200 mushrooms were reported (26), but in this case like in any other
in which more than 80 mushrooms were ingested, vomiting had greatly
reduced the actually ingested dosage and consequently, the toxic effects.
In the case we report here, the victim had probably ingested the mushrooms
in three intakes : in the afternoon, an undetermined number raw in the
fields, in the early evening, a dozen of raw mushrooms and in the evening,
a glass of mushroom tea. This last dosage only, which was the equivalent
of 4 to 8 mushrooms, caused some effects to the other participants, and
this proves that the mushrooms were highly potent in active components.
The victim had probably ingested a large quantity of mushrooms, at least
50, most of them raw which appears to preserve or increase their activity.
He did not vomit and exhibited every symptoms of a severe intoxication
caused by an overdose. As there were no appropriate medical care, this
voluntary intoxication ended up in a fatal outcome.
CONCLUSION:
We have reported the case of a fatal poisoning after that a group of
people voluntarily consumed hallucinogenic mushrooms. These were fresh
Psilocybe semilanceata (Fr. : Fr.) Kummer. The victim had ingested them
three times on the same day and exhibited every symptom of a severe
poisoning caused by an overdose. Left with no medical care, he died from
this poisoning. The so-called innocuousness of hallucinogenic mushrooms
is now questioned. A part from common psychic disorders, hallucinogenic
mushrooms, like any other drugs, can have deleterious effects caused by an
overdose. Thus, the prohibition of harvesting, peddling and sale of
mushrooms which are said to be hallucinogenic is justified
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SOURCES INTERNET:
- (a) Teonanacalt, Food of the Gods; home page:
http://www.hyperreal.com/drugs/psychedelics/mushrooms/teonanacatl/teonatoc.html
- (b) FAQ-Psilocybe-Mushroom:
http://www.hyperreal.com/drugs/psychedelics/mushrooms/misc/FAQ-Psilocybe-mushroom
- (c) Mycological resources, home page:
http://www.igc.apc.org/mushroom/rsrc.html
- (d) Mycelium Welcome, home page:
http://www.igc.apc.org/mushroom/welco.html
- (e) Fungi perfecti, home page:
http://www.halcyon.com/mycomed/fppage.html
- (f) The World-Wide Web Virtual Library: Mycology:
http://muse.bio.cornell.edu/taxonomy/fungi.html
- (g) Fungus:
http://www.ntjeff.com/fungi/
Addresses of the authors:
Alain GERAULT. Laboratoire de Chimie Océanique, ESPSHOM, 13, rue du
Chatellier, BP 426, 29275 BREST cedex. e-mail :
Alain.Gérault@shom.fr fax : 98 22
18 64
Daniel PICART. Equipe DRED : Régulation Moléculaire du Métabolisme
de l'Alcool et des Xénobiotiques. Faculté de Médecine, BP 815, 29285 BREST
Cedex. e-mail :
Daniel.Picart@univ-brest.fr
ADDENDUM:
Some details have not been developped in this issue. They are shown
hereafter:
- Gone on his own to gather mushrooms in the fields, he consumed 30 to
50 of them, raw, right in the fields, around 3:00 pm.
- He consumed around 10 raw mushrooms around 6:00 pm.
- With some friends of his, he consumed cooked mushrooms around 8:00 pm.
The quantity ingested by each participant of the "shrooms party" was
estimated to 5 to 10. The other participants, who had not consumed any
mushrooms earlier in the day got "high" with this quantity, some of them
did even feel adverse effects : cramps, drunkeness...which proves that the
Psilocybe semilanceata variety was particularly potent.
- Conclusion after the postmortem examination by the forensic expert:
The death is due to a collapse after an overdose. Our personal
conclusions are:
- The death is due to a combination of unfavourable and aggravating
circumstances :
- Three intakes of mushrooms in short intervals with cumulative effects
( I have estimated the number to 50 mushrooms, but it is probably more).
- In this case, raw mushrooms certainly increase the toxicity.
- No vomiting (vomiting is common when the intake of mushrooms is too
important, it is a good defensive reflex of the body which prevents from a
severe poisening. The vomiting could be caused by baeocystin.)
- Variety of very potent P. semilanceata, containing an important amount
of total indolic components. According to my personal analysis psilocybin,
psilocin and baeocystin are present and also many other unidentified
derivatives. Studies are in progress in my laboratory. In this specific
case, we can not reason in terms of psilocybin because a synergy between
the different components is to be considered.
- Absolute lack of medical care, and maybe a weak resistance of the
victim, he was left several hours in the coma. Cares in hospital would
certainly have saved the victim.
- It is actually an unusual case about shrooms' consumption (but not in
toxicology where fatality or severe injuries are reported in some cases
with substances that are not said to be very toxic.)
- I would add that the accumulation of several unfavourable
circumstances is necessary. Unfortunately, all of them were gathered in
this dramatic case. The nil risk does not exist, especially about natural
stuff with changeable properties.
A. GERAULT
Ph. D., Toxicologist.
