INTRODUCTION Dextromethorphan-associated neurotoxicity with cerebellar edema syndrome is a recently described clinico-radiological condition resembling pediatric opioid use-associated neurotoxicity with cerebellar edema syndrome. METHODS To describe two children with dextromethorphan-associated neurotoxicity with cerebellar edema syndrome from a tertiary care hospital in North India. The...
Clinical ToxicologyMarch 30, 2026Annie Silvester, Sarah Hampton, Tom W May et al.
Introduction: Wood-lover paralysis is a rare complication of Psilocybe mushroom ingestion. The clinical spectrum is poorly characterized and published cases remain limited. Case presentations: We describe three patients who developed acute muscle weakness following ingestion of Psilocybe mushrooms in Victoria, Australia. Written informed consent was obtained from these patients for publication...
INTRODUCTION: Recreational drug poisonings pose a growing public health concern. European-level data remain limited, although poison centres are well placed to monitor related health incidents. This study analysed temporal trends in recreational drug poisonings reported to six European poison centres. METHODS: Aggregated retrospective data were collected over four years (2021-2024) from poison...
Clinical ToxicologyJanuary 6, 2026D. Jorgenson, Eliezer Santos León, J. Priyanka Vakkalanka et al.1 citation
INTRODUCTION: Psychoactive mushroom edibles are gaining popularity, yet little is known of their clinical effects. These unregulated products are widely available, often with unlisted ingredients and inconsistent formulations, underscoring the need for more research to address public health concerns. We aimed to investigate recent trends in demographics and clinical effects associated with...
Clinical ToxicologySeptember 15, 2025Zhifan He, Rui Tang, Min Feng et al.1 citation
Introduction Psychoactive Psilocybe spp. mushrooms pose significant public health risks. We report a cluster of Psilocybe keralensis poisonings in Chengdu, China, highlighting its unique clinical features and cardiovascular complications.Case Series Four patients ingested 16–90 g of wild mushrooms (misidentified as an edible species, but later molecularly confirmed as Psilocybe keralensis)....
Clinical ToxicologyJuly 8, 2025Margot Balcaen, Nik De Brabanter, Nick Verougstraete et al.1 citation
Synthetic cathinones, known as 'gravel' or 'bath salts', include α-pyrrolidinoisohexiophenone and its analogues α-pyrrolidinovalerophenone and α-pyrrolidinohexanophenone; often referred to as 'flakka' on the street or 'zombie drug' in media reports. Documented motivation for use includes libido enhancement and appetite suppression. Since its international scheduling,...
Recreational ketamine use has increased in the last decades with incidental reports of urological complications. This study aimed to explore trends in the number of acute intoxications and urological complications from recreational ketamine use in the Netherlands. We retrospectively studied data from 2018 to 2024 from inquiries on ketamine toxicity to the Dutch Poisons Information Centre and...
Clinical ToxicologyMarch 1, 2025Ella P Edwards, Laurence A Gray, Muhammad E M O Elamin et al.2 citations
Ibogaine is a psychoactive alkaloid derived from the root bark of the West African shrub Tabernanthe iboga. It is not licensed in the United Kingdom but is used by individuals to alleviate drug or alcohol use. A retrospective analysis of telephone enquiries involving ibogaine between 1 January 2012 and 31 December 2022 to the United Kingdom National Poisons Information Service was performed....
Clinical ToxicologyMarch 1, 2025Mirte J Zuidema, Elles Reimerink, Dena Akhoundzadeh et al.1 citation
The persistent increase in the use of 3,4-methylenedioxymetamfetamine has led to an increase in emergency department presentations. Our aim was to study the most frequent reasons for admission to the intensive care unit of critically ill patients with 3,4-methylenedioxymetamfetamine intoxication and to describe their complications, management and outcome. This retrospective cohort study...
This study hypothesized that 3,4-methylenedioxymetamfetamine intoxication presents with distinct clinical features and outcomes when combined with other substances of misuse, compared to mono-3,4-methylenedioxymetamfetamine intoxication. This study investigated the clinical presentation of acute mono-3,4-methylenedioxymetamfetamine intoxication, 3,4-methylenedioxymetamfetamine intoxication with...
Clinical ToxicologyFebruary 20, 2025Courtney Temple, Matthew S. Correia, Ma Gonzaga et al.3 citations
The labeling of psychoactive mushroom gummies we tested was overall inaccurate. Products suggesting Amanita muscaria content instead contained serotonergic tryptamines, including some which falsely claimed to be free of psilocybin.
Recent decades have witnessed an extraordinary global crisis of drug misuse. Although opioid analgesics receive the most attention, numerous other drugs have increased rates of misuse. Ketamine and esketamine offer a unique natural experiment to explore two medications that are similar pharmacologically but differ in their availability to users and in their regulation by government agencies....
The global use of certain classical psychedelics has increased in recent years, but little is known about their spectrum of toxicity within Australia. We aim to describe calls to New South Wales Poisons Information Centre relating to exposures to classical psychedelics including lysergic acid diethylamide, psilocybin, N,N-dimethyltryptamine, ayahuasca, mescaline and ibogaine. This is a...
Dear Editor,Ayahuasca is a traditional psychoactive infusion of the Amazonian indigenous people composed mainly of a mixture of Psychoteria viridis or related species (containing N,N-dimethyltrypta...
Recreational nitrous oxide use has grown in popularity among young people and has become a serious public health problem. Chronic use of nitrous oxide can lead to a functional vitamin B12 deficiency and neuropsychiatric complications. This study aimed to investigate the characteristics of neuropsychiatric complications associated with nitrous oxide use and to enhance clinicians' awareness of...
Abstract Introduction: Misuse of inhaled nitrous oxide is a growing concern in France. It is known to alter concentrations of vitamin B12, which is required as a cofactor for methionine synthase and methylmalonyl-CoA mutase activity. Hence, measurement of the concentrations of cobalamin metabolism biomarkers, including vitamin B12, homocysteine, and methylmalonic acid, could assist in the...
INTRODUCTION: Ketamine is a pharmaceutical drug possessing both analgesic and anaesthetic properties. As an anaesthetic, it induces anaesthesia by producing analgesia with a state of altered consciousness while maintaining airway tone, respiratory drive, and hemodynamic stability. At lower doses, it has psychoactive properties and has gained popularity as a recreational drug. OBJECTIVES: To...
In 2023, Oregon enacted laws regulating the manufacture and use of psilocybine products in licensed facilities for supervised sessions with trained facilitators. This commentary summarizes the final rules for psilocybine services in Oregon, and provides perspectives from a clinical toxicologist on some of the issues that may arise. These include the scope of practice for non-clinical...
Synthetic cannabinoid receptor agonists (SCRA) are commonly encountered new psychoactive substances. Here we report the recent detection of ADB-BUTINACA in samples from patients attending United Kingdom emergency departments with toxicity after suspected drug misuse and describe the associated clinical features. Consenting adults (≥16 y) presenting to participating hospitals with toxicity after...
Clinical ToxicologyMarch 28, 2022S. Ivory, J. Rotella, Jennifer L. Schumann et al.
Abstract Introduction 25B-NBOH is a synthetic hallucinogen closely related to the “NBOMe” family of N-substituted 2C phenethylamine derivatives. There have been no published reports documenting the clinical toxicity of NBOH derivatives. Case series Five patients presented to the Emergency Department (ED) with altered conscious state following exposure to powder sold as “powdered LSD” at a...
The recreational use of new psychoactive substances (NPS) is increasing worldwide. Among them, the arylcyclohexylamine family including phencyclidine (PCP) and ketamine derivatives is increasing. We report a non-fatal intoxication mainly due to arylcyclohexylamine compounds illustrated by molecular networking (MN). A 37-year-old man with a history of drug abuse was discovered with several bags...
Clinical ToxicologyDecember 1, 2021Ruben Goncalves, M. Labadie, Simon Chouraqui et al.
Abstract Background and aims MDMB-4en-PINACA is a synthetic cannabinoid receptor agonist (SCRA) that has recently emerged. Data regarding clinical presentations in the event of intoxication is scarce. This study presents MDMB-4en-PINACA identification in cannabis consumers with clinical and analytical descriptions. Methods Between November 2020 and March 2021, all patients with unexpected or...
Clinical ToxicologyNovember 2021Darren M Roberts, Kulanka H Premachandra, Betty S. Chan et al.
Adulteration, substitution or contamination of illicit substances can have clinically significant implications when other illicit substances are included. Such circumstances can present as clusters of poisonings, including severe toxicity and death following exposure to unexpected illicit substances. We report a cluster of laboratory-confirmed lysergic acid diethylamide (LSD) in a powder that...
Introduction: Illicit substance use is an increasing problem all over the world, especially in adolescents and young adults. It is a challenge to make a definitive diagnosis of a specific substance in a poisoning case without toxicology laboratory confirmation. We confirmed the presence of N,N-dimethyltryptamine (DMT) by liquid chromatograph tandem mass spectrometer (LC/MS/MS) in biologic...
Amanita muscaria (AM) and A. pantherina (AP) contain ibotenic acid and muscimol and may cause both excitatory and sedating symptoms. Gastrointestinal (GI) symptoms are not classically described but have been reported. There are relatively few reported cases of poisoning with these mushrooms in North America. This is a retrospective review of ingestions of ibotenic acid and muscimol containing...