Ibogaine, a naturally occurring alkaloid from the Tabernanthe iboga shrub, is used in alternative medicine for alcohol detoxification despite not being a licensed therapeutic drug and evidence that it may disturb heart rhythm. A man died suddenly 12-24 hours after using ibogaine for alcohol detoxification. Autopsy revealed liver cirrhosis and heavy fatty infiltration, with an ibogaine concentration of 2 mg/l. The case highlights potential risks of ibogaine use, particularly for individuals with pre-existing medical conditions.
Microscopic examination of plant and fungal remains in the gut after death can reveal ingestion of unexpected natural psychotropic substances. In a case where a shaman was accused of causing a young man's death, the deceased had drunk ayahuasca (containing Banisteriopsis caapi and Psychotria viridis) in a ceremony. Toxicological tests confirmed DMT in the body. Microscopy of the ileum and colon also found spores of Psilocybe (magic mushrooms), pollen of Cannabis sativa, and seeds of Papaver somniferum (opium poppy). Containers from the dwelling yielded additional trace evidence.
People have used psychoactive substances for recreation throughout history, but the use of animal-derived substances, such as snake venom, is rarely reported. In India, snake venom is used recreationally for its reported effects on mood, pain perception, lethargy, and blurred vision. This review examines whether these effects are caused by the venom's constituents or are self-induced.
A dried urine spot (DUS) method using LC-MS/MS was developed to measure the tryptamine hallucinogen 5-MeO-DIPT, which is unstable in liquid urine. Ten microliters of urine were spotted on a card and extracted with methanol. The method's limit of detection was 0.1 ng/ml and lower limit of quantification was 0.2 ng/ml, with accuracy between 98.2% and 103.9% and precision between 2.7% and 8.5%. 5-MeO-DIPT was more stable in DUS than in urine stored at 25 °C. When applied to urine from known users, concentrations ranged from 0.3 to 2.3 ng/ml, lower than those measured by GC-Orbitrap-MS. The small sample volume and simplicity make this useful for drug screening.
A fatal case in the Netherlands involved 3-methoxyphencyclidine (3-MeO-PCP), a structural analog of phencyclidine sold as ant poison. The substance was detected in postmortem whole blood at 152 μg/l, and the cause of death was a combination of 3-MeO-PCP, amphetamine, and alcohol. This is one of the few reported fatalities worldwide where 3-MeO-PCP contributed to death. Improved diagnostic skills are needed to address emerging novel psychoactive substances and their public health and social risks.