Clinical Toxicology
October 1, 2011
S. Hill, Simon H. L. Thomas
289 citations
Clinicians have limited reliable data to guide management of patients with toxicity from emerging recreational drugs. The harms of these substances are not fully documented, though they are clearly not without risk. Current acute management is pragmatic, primarily extrapolated from experience with longer-established stimulant or hallucinogenic drugs such as amphetamines, MDMA, and LSD.
Clinical Toxicology
January 1, 2008
221 citations
Salvia divinorum and Kratom are unscheduled dietary supplements that activate opioid receptors and produce distinct psychoactive effects. Salvinorin A, from Salvia divinorum, is a highly selective kappa-opioid receptor agonist that causes visual hallucinations and synesthesia. Kratom's main alkaloid, mitragynine, acts as a partial opioid agonist with morphine-like effects, while its minor alkaloid 7-hydroxymitragynine is more potent than morphine. Both Kratom alkaloids activate supraspinal mu- and delta-opioid receptors, which explains their use by chronic narcotics users to ease opioid withdrawal. Despite widespread Internet availability, these substances elude traditional toxicologic monitoring, and the article aims to inform toxicologists and poison control specialists about them.
Clinical Toxicology
January 1, 2014
93 citations
Two men, aged 17 and 31, became acutely ill after taking drugs labeled 'NBOMe' or 'Holland film'. They experienced confusion, agitation, high blood pressure, rapid heart rate, fever, sweating, and dilated pupils, with some also having seizures, muscle breakdown, and abnormal liver function. Treatment required benzodiazepines and other medications. Urine analysis detected 25B-NBOMe in both patients and 25C-NBOMe in one. NBOMe compounds strongly activate serotonin and adrenaline receptors, explaining the symptoms. Clinical testing for these drugs is not widely available, so clinicians and laboratory staff are key to detecting these dangerous substances.
Clinical Toxicology
June 2, 2023
Leo J. Schep, Robin J Slaughter, Martin Watts et al.
63 citations
Ketamine is a dissociative drug used in emergency medicine that also has become popular recreationally. Acute adverse effects include impaired consciousness, dizziness, irrational behavior, hallucinations, abdominal pain, and vomiting. Chronic use can impair verbal information processing and cause cystitis and cholangiopathy. Diagnosis of acute intoxication relies on patient history and clinical features such as vomiting, sialorrhea, or laryngospasm; chronic effects are confirmed by endoscopic retrograde cholangiopancreatography for cholangiopathy and cystoscopy for cystitis. Treatment of acute toxicity is supportive, with benzodiazepines recommended for agitation and excess neuromuscular activity. Chronic effects are typically reversible with abstinence.
Clinical Toxicology
January 1, 2010
Shaun D. Carstairs, F. Lee Cantrell
48 citations
Use of peyote and mescaline, though uncommon, led to clinically significant effects that required medical treatment in a substantial number of patients. Most clinical effects were mild or moderate, and no life-threatening toxicity was observed in this case series.
Clinical Toxicology
February 28, 2014
Ashraf Kamour, David A. James, Robert Spears et al.
23 citations
Acute toxicity from recreational use of alpha methyltryptamine (AMT) in the UK, reported to the National Poisons Information Service from March 2009 to September 2013, involved 63 telephone enquiries, mostly in 2011 and 2012. Most patients were male (68%) with a median age of 20 years; ingestion was the most common route. Compared to mephedrone users, AMT users more frequently experienced acute mental health disturbances (66% vs. 32%), stimulant effects (66% vs. 40%), and seizures (14% vs. 2%). Toxicity from AMT has been encountered since January 2011, though still infrequent.
Clinical Toxicology
November 2, 2023
Alexandr Gish, Florian Hakim, Camille Richeval et al.
4 citations
Ayahuasca, a traditional Amazonian psychoactive brew, is the subject of a letter to the editor. The letter likely discusses aspects of ayahuasca's composition, effects, or research context, though the abstract is truncated and does not provide a complete finding or argument. The available text only identifies the substance and its traditional use, without presenting a specific result, claim, or analysis.
Clinical Toxicology
February 20, 2025
Courtney Temple, Matthew S. Correia, Ma Gonzaga et al.
3 citations
An analysis of psychoactive mushroom gummies found that their labeling was generally inaccurate. Products that suggested they contained Amanita muscaria instead contained serotonergic tryptamines, and some falsely claimed to be free of psilocybin.
Clinical Toxicology
March 4, 2026
L. Hondebrink, Katrin Faber, Aza Kader et al.
1 citation
Recreational drug poisonings reported to six European poison centres increased significantly between 2021 and 2024, although they represented only about 3% of all calls. The total number of cases rose from 5,619 in 2021 to 7,229 in 2024, with the largest increases observed in Austria, Freiburg (Germany), and the United Kingdom. The most frequently implicated drugs were delta-9-tetrahydrocannabinol (THC), cocaine, amfetamine, and MDMA. Rising rates were seen for THC in Austria and Freiburg; cocaine in Freiburg and the UK; amfetamine in Freiburg and Sweden; and ketamine in Austria, Freiburg, and the UK. In 2024, amfetamine poisonings peaked in Freiburg (0.63%) and Sweden (0.94%), cocaine in Freiburg (0.78%) and the UK (0.74%), and ketamine in the Netherlands (0.42%) and the UK (0.24%). Coordinated European monitoring could support timely public health interventions.
Clinical Toxicology
January 6, 2026
D. Jorgenson, Eliezer Santos León, J. Priyanka Vakkalanka et al.
1 citation
Among 362 reported exposures to psychoactive mushroom edibles, most involved a single substance and were intentional. Polysubstance exposures more than doubled the odds of hospital admission and of moderate or worse toxicity. Confusion and central nervous system depression were also strongly linked to admission and greater severity. No deaths occurred. The effects of these unregulated products are unpredictable, and clinical presentations vary widely.
Clinical Toxicology
September 15, 2025
Zhifan He, Rui Tang, Min Feng et al.
1 citation
Four patients in Chengdu, China, were poisoned after eating 16–90 g of wild mushrooms misidentified as edible but later confirmed as Psilocybe keralensis. Symptoms began within 5–20 minutes, with hallucinations starting between 10 and 180 minutes. All developed hypertension, one with a rapid rise to 182/110 mmHg and evidence of myocardial injury (peak cardiac troponin T 188.70 pg/mL) and transient skeletal muscle involvement. Supportive treatment led to full recovery. The authors note that altered myocardial biomarkers signal potential cardiovascular risks and recommend cardiac monitoring for high-risk patients in future psilocybin research, and that wild mushroom foraging should be avoided.