First Published in Mushroom The Journal of Wild Mushrooming Fall 2006
Well, just when you think you have got a handle on things, along comes
the unexpected: to wit.
On the evening of Tuesday, August 15, 2006, I received a call from the major Hospital of one of our larger cities in the Northeast. The patient, a 28 yr old male of East Indian nationality came to the Emergency Room seeking help following the ingestion - by smoking -- of mushrooms he had picked and consumed from a nearby area.
On the previous Sunday (Aug. 13) he picked the mushrooms, dried and then smoked them the following day in order to get "high". He reported that he quickly developed a fever of 102, and had abdominal pain. These symptoms completely obliterated the pleasant intoxication he was expecting. When he recovered on Tuesday he sought medical attention thinking that he was in the "second day recovery period of Amanita poisoning". [This is the usual presentation of Amatoxin poisoning: onset of vomiting, diarrhea and bloody stool, intestinal distress, fever and headache usually 6 to 8 hrs following oral ingestion; a diminution of the symptoms on the following day, followed by a return of the symptoms on the third and subsequent days. Without assistance, death comes about a week after ingestion caused by the collapse of liver functions. With prompt modern medical attention all but the weakest, youngest, oldest or medically compromised patients usually recover. To my knowledge, none of the dozen or more cases of verified Amanita poisonings that I have been involved with over the past 15 or so years have ended in death.]
The patient thought the mushroom he dried and smoked was an Amanita, and said that he had smoked them in the past in order to get high. In the hospital he was frightened but had no physical symptoms aside from a minor constellation associated with fear. Related to his fear, it is important to note that his father is a prominent Physician at a nearby major medical facility and the patient did not want the father to know about this episode or his practice of smoking mushrooms in order to get high.
A fresh specimen of the mushroom was available at the ER, apparently brought in by the patient, and four digital images were emailed to me, arriving within the half hour. The images were out of focus, but it was nevertheless obvious that they were of a red-capped Russula. The disc (center of the cap) was of a darker red, the stem had a bit of a grayish brown stain, suggesting perhaps R. krombholzii, which was my tentative identification.
This and several other potential species names were given to the medical team at the Emergency Room. They were also informed that there were hundreds of red capped Russulas in the Northeast and that further identification would require the work of a specialist in this genus. Although R. emetica is the name often applied to any red capped Russula, it is a rather uncommon species. I was not aware of any in this group that are deadly. Some irritate the GI tract but this toxic effect is often neutralized by boiling and discarding the water and/or cooking with sour cream, Hungarian/Slovakian style. (* But see below.)
The medical staff and I agreed that the fact the patient thought that this Russula was an Amanita suggested that he did not know his mushrooms and should cease the practice of attempting to get high by this method. I underlined the dangers of mistaking a psychoactive species for a deadly one and suggested that the patient speak in person to a trained mycologist who could reinforce this message. Following consultation with a mycologist in the area, contact information was provided to the patient via the ER staff.
The case ended with my report filed two hours after the initial call: neat, clean and straightforward, or so I thought.
On the following day I Googled "Smoking + Mushrooms" and found several well developed web sites dedicated to an exploration of this practice. Most testimonials spoke to the effects of smoking Psilocybe -"Magic" mushrooms - although companion websites addressed the merits, methods, and problems of smoking A. muscaria. Included were descriptions of detailed organic chemistry pathways, as well as a scientific literature, legal issues, etc. Who would have known? I am reminded of Bill Joy's edict concerning technological possibilities/realities in our nano-techno world: "If you can imagine it, it is already being done."
The "first person accounts" of smoking muscaria that were posted on the web sites seemed to accord pretty well with the first person accounts given to me from those muscaria-eaters that I have interviewed: "weird" hallucinatory effects, complete with cognitive and physical disorientation and uncomfortable sensations. Smoking marijuana along with A. muscaria was said to reduce and/or substantially eliminate the strong nausea effects (and undoubtedly enhance the hallucinatory experience). There was great variability of the personal experiences, and interestingly, many were not much interested in repeated use of the mushroom. This, too, accords with my first person interviews. Several people I have spoken with who have eaten muscaria said they tried it a second time only to verify that it was as bad as they thought the first time.
* In the interest of being thorough I also Googled "Smoking + Russula" finding the following site extoxnet.orst.edu/newsletters/n25_82.htm. The article describes mushroom poisonings among Laotian immigrants in California who were sickened by both Amanita and Russula with the Russula producing symptoms similar to those of Amatoxins. The authors conclude, "The Russula toxin has not been identified, but it results in a shorter incubation period -- 1-2 hours -- followed by minor gastrointestinal and parasympathetic symptoms and hallucinations."
Holy Smokin' Russula! Perhaps ours patient was on to something after all! Aside from the name, he may have known his mushrooms better than any of us thought.
But …The case cited was from a 1981 incident, rather enigmatic and controversial. Although from a CDC source of highest regard (Morbidity and Mortality Weekly Report, June 4, 1982/ Volume 31 /Number 21.) it seems to stand alone in the toxicology literature.
Puzzled, I contacted Dr. Michael Beug, NAMA's toxicology go-to guy. His response follows:
have interviewed hundreds of people who have intentionally ingested Amanita
muscaria and/or Amanita pantherina (containing ibotenic acid and muscimol) as
well as a wide range of species that contain psilocybin and psilocin. None had
ever mentioned smoking the mushrooms. Also in the over 2,000 mushroom
poisonings reported to NAMA over the past 30 years, there has been no [[only
one]] reference to smoking mushrooms until now. However, I would expect that
smoking mushrooms would volatilize some of the active ingredient and clearly
others have explored this practice as evidenced by the websites that one
discovers when Googling Smoking + Mushrooms."
Concerning Russula toxins, Dr. Beug reports, "In the NAMA database I find reports of poisonings by Russula species involving 25 people with various stages of gastrointestinal distress - often quite severe. I just rediscovered one other case from a few years ago of smoking a red-capped Russula to get high and the person just wound up nauseous. Usually no one was able to identify the Russula that had made them ill. Two people were poisoned by what appeared to be Russula claroflava, two by what was generally described as Russula emetica, one serious GI with convulsions and disorientation from R. nigricans, two poisonings from Russula occidentalis, two from a mixture of Russula paludosa and R. claroflava, one from R. virescens, and two from R xerampelina that included GI distress, severe chills, hematemesis for both people plus in one there was also anuria, cramps, fever, and leucocytosis. Among the unidentified Russula poisonings of 13 individuals, the following symptoms appeared once: blood in stools, disorientation, mydriasis, salivation, tachycardia, agitation, and breathing difficulties; two had weakness, nausea, sweating; three had cramps; 4 had chills, and 7 experienced vomiting and diarrhea.
I know nothing about any specific toxins in Russula species but after reviewing the database, I am quite reluctant to sample Russulas, they seem to pack a pretty good punch at times."
So…with this advice in mind, perhaps we should all go through our field guides to re-edit: All Russulas should be considered inedible and unsmokable