Hallucinogenic Mushroom Toxicity 

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jan 31, 2011
 

Background

Hallucinogenic fungi have been used in divinatory or religious contexts for at least 3000 years. However, not until the 1950s were the involved species of fungi identified and the chemical nature of active substances determined.[1]

In general, 2 groups of mushrooms with significant psychoactive effects exist.[2]

  • Mushrooms containing ibotenic acid and muscimol (isoxazoles), including Amanita gemmata, Amanita muscaria (fly agaric), and Amanita pantherina (the panther), comprise the first group. These are not to be confused with deadly Amanita phalloides, Amanita verna, and Amanita virosa. For centuries, A muscaria has been consumed in central Asia as a hallucinogen. Some Siberian tribes report that 3 fresh A muscaria mushrooms can be lethal, while others claim that eating as many as 21 of these mushrooms is safe.
  • Psilocybin-containing mushrooms, including Psilocybe caerulipes, Psilocybe cubensis, Gymnopilus spectabilis, Panaeolus species (eg, Panaeolus foenisecii), and Psathyrella foenisecii, comprise the second group of mushrooms with psychoactive effects.

Mushrooms containing ibotenic acid and muscimol and those containing psilocybin are New World fungal hallucinogens. Reports of toxicity associated with this group of mushrooms have increased because of their growing popularity as hallucinogens.[3]

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Pathophysiology

Ibotenic acid is an agonist at central glutamic acid receptors; its decarboxylated derivative is an agonist at gamma-amino butyric acid receptors. Central effects of these hallucinogenic mushrooms are thought to be caused by these actions.[1] Although muscarinic acid originally was isolated from A muscaria, the clinical syndrome does not suggest marked significance; in fact, anticholinergic findings may be observed.

The psilocybin group contains the indoles psilocybin and psilocin. Psilocin and its phosphate ester, psilocybin, are similar in structure to lysergic acid diethylamide (LSD). They are structural analogues of serotonin (5-hydroxytryptamine); thus, hallucinogenic effects probably are mediated through effects on serotonergic receptors.[1]

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Epidemiology

Frequency

United States

Determination of the frequency of hallucinogenic mushroom toxicity is limited by a lack of a national reporting system or registry for mushroom poisoning and the fact that many affected individuals may never seek medical attention. However, estimates based on small studies or surveillance systems using self-reporting are available.

In one study of 174 adolescents with a history of substance abuse, 45 (26%) reported having used hallucinogenic mushrooms at some point in their life, often combined with alcohol or marijuana.[4] From data collected from September 2008 to December 2009, the Youth Risk Behavior Surveillance System reported that 8% of students had used an hallucinogenic drug, including LSD, PCP, angel dust, mescaline, or mushrooms, at least once in their life.[5] Use was more common among males and whites than among females and African Americans and Hispanics.

Mortality/Morbidity

Mortality from hallucinogenic mushrooms is very rare.

Age

While little data exist on the age of users of hallucinogenic mushrooms, college students are known to abuse psilocybin mushrooms.[6]

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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Diane F Giorgi, MD, FACEP  Attending Physician, Department of Emergency Medicine, Brooklyn Hospital Center

Diane F Giorgi, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American Association of Women Emergency Physicians, American College of Emergency Physicians, and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Clilton WS. The chemistry and mode of action of mushroom toxins. In: Spoerke DG, Rumack BH, eds. Handbook of Mushroom Poisoning. 2nd ed. CRC Press, LLC; 1994:165-223.

  2. McDonald A. Mushrooms and madness. Hallucinogenic mushrooms and some psychopharmacological implications. Can J Psychiatry. Nov 1980;25(7):586-94. [Medline].

  3. McPartland JM, Vilgalys RJ, Cubeta MA. Mushroom poisoning. Am Fam Physician. Apr 1997;55(5):1797-800, 1805-9, 1811-2. [Medline].

  4. Schwartz RH, Smith DE. Hallucinogenic mushrooms. Clin Pediatr (Phila). Feb 1988;27(2):70-3. [Medline].

  5. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2009. MMWR Surveill Summ. Jun 4 2010;59(5):1-142. [Medline].

  6. Rimsza ME, Moses KS. Substance abuse on the college campus. Pediatr Clin North Am. Feb 2005;52(1):307-19, xii. [Medline].

  7. Brvar M, Mozina M, Bunc M. Prolonged psychosis after Amanita muscaria ingestion. Wien Klin Wochenschr. May 2006;118(9-10):294-7. [Medline].

  8. Miller OK. Mushrooms of North America. Dutton; 1982:368.

  9. Satora L, Pach D, Ciszowski K, Winnik L. Panther cap Amanita pantherina poisoning case report and review. Toxicon. Apr 2006;47(5):605-7. [Medline].

  10. Carter OL, Pettigrew JD, Burr DC, et al. Psilocybin impairs high-level but not low-level motion perception. Neuroreport. Aug 26 2004;15(12):1947-51. [Medline].

  11. Sticht G, Kaferstein H. Detection of psilocin in body fluids. Forensic Sci Int. Sep 11 2000;113(1-3):403-7. [Medline].

  12. Raff E, Halloran PF, Kjellstrand CM. Renal failure after eating "magic" mushrooms. CMAJ. Nov 1 1992;147(9):1339-41. [Medline].

  13. Fischbein CB, Mueller GM, Leacock PR, et al. Digital imaging: a promising tool for mushroom identification. Acad Emerg Med. Jul 2003;10(7):808-11. [Medline].

  14. Goldfrank L, Flomenbaum N, Lewin N. Goldfrank's Toxicologic Emergencies. 4th ed. Appleton & Lange; 1990:575-85.

  15. Borowiak KS, Ciechanowski K, Waloszczyk P. Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction. J Toxicol Clin Toxicol. 1998;36(1-2):47-9. [Medline].

  16. Bickel M, Ditting T, Watz H, Roesler A, Weidauer S, Jacobi V. Severe rhabdomyolysis, acute renal failure and posterior encephalopathy after 'magic mushroom' abuse. Eur J Emerg Med. Dec 2005;12(6):306-8. [Medline].

  17. Hanes KR. Serotonin, psilocybin, and body dysmorphic disorder: a case report. J Clin Psychopharmacol. Apr 1996;16(2):188-9. [Medline].

  18. Riley SC, Blackman G. Between Prohibitions: Patterns and Meanings of Magic Mushroom Use in the UK. Subst Use Misuse. 2008;43(1):55-71. [Medline].

 
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