Fatal Psilocybe Case



GERAULT A., PICART D. 1996 - `INTOXICATION MORTELLE A LA SUITE DE LA CONSOMMATION VOLONTAIRE ET EN GROUPE DE CHAMPIGNONS HALLUCINOGENES. Bull.Soc. Mycol. France, t. 112, p.1-14

`FATAL POISONING AFTER A GROUP OF PEOPLE VOLUNTARILY CONSUMED HALLUCINOGENIC MUSHROOMS.'

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

merci



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