Psychoactive supplements: What to tell patients
Marija S. Marković
Current Psychiatry March 1, 2023 DOI: 10.12788/cp.0339 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 41-year-old man with alcohol use disorder and spinal injury presenting to the emergency department with altered mental status and suspected intoxication |
| Interventions | Phenibut Butalbital/acetaminophen/caffeine/codeine Lorazepam |
| Dose | Lorazepam 4 mg IM |
| Citations | 1 |
| Key findings | The authors describe a patient who developed altered mental status and agitation after recently starting an online phenibut supplement while also taking butalbital/acetaminophen/caffeine/codeine. They note that herbal supplements can have psychoactive effects and that their unregulated variety complicates management, citing a 74.1% increase in US poison control calls for natural psychoactive substances between 2000 and 2017. |
Abstract
Savvy Psychopharmacology M r.D, age 41, presents to the emergency department (ED) with altered mental status and suspected intoxication.His medical history includes alcohol use disorder and spinal injury.Upon initial examination, he is confused, disorganized, and agitated.He receives IM lorazepam 4 mg to manage his agitation.His laboratory workup includes a negative screening for blood alcohol, slightly elevated creatine kinase, and urine toxicology positive for barbiturates and opioids.During reevaluation by the consulting psychiatrist the following morning, Mr. D is alert, oriented, and calm with an organized thought process.He does not appear to be in withdrawal from any substances and tells the psychiatrist that he takes butalbital/acetaminophen/caffeine/ codeine as needed for migraines.Mr. D says that 3 days before he came to the ED, he also began taking a supplement called phenibut that he purchased online for "well-being and sleep."Natural substances have been used throughout history as medicinal agents, sacred substances in religious rituals, and for recreational purposes. 1Supplement use in the United States is prevalent, with 57.6% of adults age ≥20 reporting supplement use in the past 30 days. 2 Between 2000 and 2017, US poison control centers recorded a 74.1% increase in calls involving exposure to natural psychoactive substances, mostly driven by cases involving marijuana in adults and adolescents. 3Like synthetic drugs, herbal supplements may have psychoactive properties, including sedative, stimulant, psychedelic, euphoric, or anticholinergic effects.The variety and unregulated nature of supplements makes managing patients who use supplements particularly challenging.