Document Type : Case Report
Authors
1 Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
2 Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
Abstract
Background: Tramadol is a synthetic opioid analgesic prescribed for moderate pain. Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) is a naturally occurring psychoactive compound found in certain mushrooms, often referred to as "magic mushrooms" and is classified as a Schedule I substance. This case report aimed to present the unexpected detection of psilocybin in a 100 mg tramadol tablet.
Case Presentation: This case report presents the forensic identification of psilocybin in a tablet labeled as tramadol 100 mg. Analysis was conducted using Gas Chromatography–Mass Spectrometry (GC-MS). A high concentration of psilocybin was confirmed, and additionally, 60 mg of tramadol was detected in the analyzed tablet.
Discussion: Active compounds of some mushrooms, such as Psilocybe cubensis and Paneolus, have psychotropic agents with hallucinogenic effects. Psilocybin is a prodrug of psilocin, meaning it's converted into psilocin in the body, and Psilocin then acts as a serotonin receptor agonist, particularly on the 5-HT2A receptor, leading to visual hallucinations, euphoria, and altered cognition. These effects can be particularly dangerous when combined with other opioids and psychoactive substances that do not have a determined dosage and intensify each other's effects.
Conclusion: This case underscores the importance of drug monitoring and advanced toxicological analysis in combating the public health threat posed by drug adulteration.
Keywords
Main Subjects
- Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clinical pharmacokinetics. 2004;43(13):879-923.
- Alrashdi S, Paudyal V, Elnaem MH, Cheema E. Causes, nature and toxicology of tramadol-associated deaths reported in the peer-reviewed literature: a systematic review of case studies and case series. Drugs Ther Perspect. 2021;37(9):422-32.
- Milano G, Saenz E, Clark N, Busse A, Gale J, Campello G, et al. Report on the International Workshop on Drug Prevention and Treatment in Rural Settings Organized by United Nation Office on Drugs and Crime (UNODC) and World Health Organization (WHO). Subst Use Misuse. 2017;52(13):1801-7.
- Carhart-Harris RL, Bolstridge M, Day CMJ, Rucker J, Watts R, Erritzoe DE, et al. Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology. 2018;235(2):399-408.
- Nichols DE. Psychedelics. Pharmacological reviews. 2016;68(2):264-355.
- Hasler F, Grimberg U, Benz MA, Huber T, Vollenweider FX. Acute psychological and physiological effects of psilocybin in healthy humans: a double-blind, placebo-controlled dose-effect study. Psychopharmacology. 2004;172(2):145-56.
- Tylš F, Páleníček T, Horáček J. Psilocybin--summary of knowledge and new perspectives. Eur Neuropsychopharmacol. 2014;24(3):342-56.
- Cozzi NV, Daley PF. Synthesis and characterization of high-purity N,N-dimethyltryptamine hemifumarate for human clinical trials. Drug Test Anal. 2020;12(10):1483-93.
- Moeller MR, Kraemer T. Drugs of abuse monitoring in blood for control of driving under the influence of drugs. Therapeutic drug monitoring. 2002;24(2):210-21.
- Dinis-Oliveira RJ. Metabolism of psilocybin and psilocin: clinical and forensic toxicological relevance. Drug Metab Rev. 2017;49(1):84-91.
- Rickli A, Kopf S, Hoener MC, Liechti ME. Pharmacological profile of novel psychoactive benzofurans. Br J Pharmacol. 2015;172(13):3412-25.
- Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology. 2006;187(3):268-83; discussion 84-92.
- Pasin D, Cawley A, Bidny S, Fu S. Current applications of high-resolution mass spectrometry for the analysis of new psychoactive substances: a critical review. Anal Bioanal Chem. 2017;409(25):5821-36.
- Yéléhé-Okouma M, Pape E, Humbertjean L, Evrard M, El Osta R, Petitpain N, et al. Drug adulteration of sexual enhancement supplements: a worldwide insidious public health threat. Fundamental & clinical pharmacology. 2021;35(5):792-807.
- Czepielewska E, Makarewicz-Wujec M, Różewski F, Wojtasik E, Kozłowska-Wojciechowska M. Drug adulteration of food supplements: A threat to public health in the European Union? Regulatory toxicology and pharmacology : RTP. 2018;97:98-102.
- Vahdati Hassani F, Abnous K, Mehri S, Jafarian A, Birner-Gruenberger R, Yazdian Robati R, et al. Proteomics and phosphoproteomics analysis of liver in male rats exposed to bisphenol A: Mechanism of hepatotoxicity and biomarker discovery. Food Chem Toxicol. 2018;112:26-38.
- Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13(4):533-40.
- Ahmadi H, Ramezani M, Yazdian-Robati R, Behnam B, Razavi Azarkhiavi K, Hashem Nia A, et al. Acute toxicity of functionalized single wall carbon nanotubes: A biochemical, histopathologic and proteomics approach. Chem Biol Interact. 2017;275:196-209.
- Palamar JJ, Keyes KM. Trends in drug use among electronic dance music party attendees in New York City, 2016-2019. Drug Alcohol Depend. 2020;209:107889.
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