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Fatal Poisoning After a Group of People in Critical Mass Voluntarily
Consumed Hallucinogenic Mushrooms

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' at a Critical Mass ride. 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 Sant� publique', no
names or places will be cited hereafter.

M. A., a 22-year-old man living in Finist�re (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, cannabino�ds, 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.) Qu�let 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
Guzm�n 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.) Qu�let (= 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 Finist�re in places where Psilocybe
semilanceata grow. Those are Hypholoma elongatum (Pers, : Fr.) Kummer ;
Hypholoma ericaeoides Orton and Hypholoma subericaeum (Fr.) K�hner. 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 Oc�anique, ESPSHOM, 13, rue du
Chatellier, BP 426, 29275 BREST cedex. e-mail : Alain.G�rault@shom.fr fax :
98 22 18 64

Daniel PICART. Equipe DRED : R�gulation Mol�culaire du M�tabolisme de
l'Alcool et des X�nobiotiques. Facult� de M�decine, 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.