TREATMENT FOR PSILOCYBIAN MUSHROOM POISONING

The major dangers associated with psilocybin poisonings are primarily psychological in nature. Anxiety or panic states ("bad trips"), depressive or paranoid reactions, mood changes, disorientation and an inability to distinguish between reality and fantasy may occur. Recommended treatment for this type of poisoning should always be primarily supportive. Mycologist Dr. Joseph Ammirati of the University of Washington and his colleagues claim that "no specific treatment can be recommended for psilocybin poisoning in humans". Other doctors have "stress[ed] the importance of measures to reduce absorption of the toxins involved". This involves either, e.g., gastric lavage or emesis Lincoff & Mitchell, 1977; Rumack & Saltzman, 1978; Smith, 1978). Emesis. 15-30 cc of ipecac syrup followed by large amounts of oral liquids (500 cc). Supportive treatment: i.e. the "talk-down" technique is the preferred method for handling "bad trips". It involves non-moralizing, comforting, personal support from an experienced individual. This is further aided by limiting external stimulation such as intense light or loud sounds and letting the person lie down and perhaps listen to soft music. Tranquilizers need only be used in extreme situations and are generally not considered to be necessary. Diazepam, 0.1 mg/kg in children, up to 10 mg in adults, may be used to control seizures. According to Dr. Rick Strassman of the University of New Mexico, anti-psychotics have gone out of favor for the treatment of `bad trips'. Specifically, medicines with anti-cholinergic side effects, such as chlorpromazine, should not be given as these mushrooms can have marked anti-cholinergic effects of their own. In 1988, Dr. Jansen noted that cases which present medically fall into several groups: Those who have taken the drug with little knowledge of hallucinogens and in the absence of sensible persons who can take care of them. These are more likely to be adolescents. They may self-present but are more often brought for medical attention by their parents. Those who fall as a result of impaired balance or muscle weakness and are knocked out or otherwise injured as a result. Those who are having a `bad trip'. These may involve acute anxiety and panic, depression, paranoid reactions, disorientation and an inability to distinguish between reality and fantasy. Cases of idiosyncratic physical reactions such as cyanosis. Those with recurring phenomena after the mushroom effects should have passed, including prolonged psychosis. When the history is clear and the signs are suggestive of psilocybian intoxication, it is best not to artificially empty the stomach either by emesis with ipecac or by lavage. Treatment shows that emptying the stomach had no effect on the duration or intensity of the experience once psychological manifestations had properly commenced. Dr. Jansen maintains that unless there is a reason to suspect that a more toxic fungus has been ingested, or if the patient is a young child, induced emesis is not necessary, not helpful and may make the situation much worse if the patient is already aggressive and agitated. Other doctors have also speculated that a lavage is not merited if psilocybian mushrooms have been positively identified as the source of discomfort. It has also been suggested that "gastric intubation can be difficult in these young patients who are often already distressed and not infrequently aggressive. Furthermore the mushrooms may block the standard lavage tubes [used] for drug overdoses." The inherent danger from the ingestion of wild mushrooms lies not so much in the consumption of an hallucinogenic variety, but rather in the picking and eating of a toxic species which might resemble an hallucinogenic variety. Dr. Gastón Guzmán (and his colleagues wrote that "field and laboratory studies strongly indicate that psychoactive mushroom use as it normally occurs does not constitute a drug abuse problem or a public health hazard" (Guzmán et al., 1976). In addition, a recent survey conducted among college students in California, suggests that "the low frequency and few negative effects of [hallucinogenic mushroom] use indicate that abuse does not present a social problem, nor is there evidence for predicting the development of a problem" Thompson et al., 1985).