Many substances that are not typically thought of as “substances of abuse” possess—when adequately dosed—clinically meaningful psychoactive properties. In addition to the more familiar effects of alcohol, psychostimulants, opioids, Cannabis, and hallucinogens, you may encounter psychiatric phenomena resulting from abuse of more obscure substances, including culinary spices.
The clinician treating a patient in an apparent intoxicated state who has a negative drug screen might ask that patient if he (she) abuses spices. This might be particularly relevant when treating patients thought to have limited access to illicit substances or those with ready access to large amounts of spices, such as prisoners, young patients, and those working in the food service industry.
Abuse of spices can be a problematic diagnosis
Patients may misuse culinary spices to achieve euphoria, or a “natural high.” They may present with medical or psychiatric symptoms, including acute altered mental status, but the psychoactive substances are not identified on routine toxicology studies. In addition, patients may not attribute their use of spices for psychoactive effect to “drugs,” because these materials are legal and readily available. This may lead to misdiagnosis of a systemic medical disorder or a primary psychiatric illness to explain the patient’s symptoms and initiating a psychotropic agent and other psychiatric services when a substance abuse program might be a more appropriate clinical intervention.
Some spices contain psychoactive compounds that can alter CNS function (Table1-7), might be abused for recreational purposes, and can be toxic in an excessive amount. Internet resources, including anonymous web-based communications, and anecdotal materials about non-traditional recreational drugs, are available to anyone with Internet access.8 However, little research has been conducted into the prevalence of abuse (Box)9 and spices’ psychoactive properties. The lack of toxicology detection of spices in the medical setting presents a diagnostic challenge.
The psychoactive plants used in “natural high” products mainly are psychoactively inactive in their natural form, but extracts or alkaloids obtained from them might induce 1 or more of 3 classifications of psychoactivity:
Many of these substances are considered to be aphrodisiac, and some may be abused to increase sexual function.
The following is a review of common spices that have been reported to possess potential psychoactive properties.
Nutmeg (Myristica fragrans) is a common and easily accessible means of reaching euphoria in adults.10 The aromatic oil of nutmeg contains myristicin, a psychoactive substance that is chemically similar to hallucinogenic compounds such as mescaline. Its psychoactive effects could be attributed to metabolic formation of amphetamine derivatives from its core ingredients, elemicin, myristicin, and safrole.11,12
Nutmeg and its active component, myristicin, produce central monoamine oxidase (MAO) inhibition as evidenced by the ability to lower the convulsive dose of IV tryptamine in mice and to increase brain 5-hydroxytryptamine concentrations.13,14 Although myristicin’s potency is not comparable to that of the more potent MAO inhibitors such as tranylcypromine and iproniazid (which is not available in the United States), it seems adequate when compared with its low toxicity.14 Nutmeg extract is associated with a significant antidepressant effect in mice, which seemed to be mediated by interaction with the adrenergic, dopaminergic, and serotonergic systems.13 Nutmeg is associated with sustained increase in sexual activity in animal studies, with no evidence of adverse effects and toxicity, suggesting that nutmeg possesses clinically significant aphrodisiac activity.15
Psychoactive effects can be achieved by ingesting 5 to 15 g of nutmeg.11 Acute nutmeg intoxication produces palpitations, dizziness, anxiety, and hallucinations, mostly resolving within 24 hours, while effects of chronic abuse are reported to be similar to Cannabis use, including euphoria, giddiness, anxiety, fear, sense of impending doom, detachment, confabulation, and hallucinations.11,16 Urine drug screens are negative unless other psychoactive substances have been ingested.17
Suspected nutmeg intoxication or poisoning should be treated with supportive treatment. Use sedatives with caution because of alternating periods of delirium and obtundation during nutmeg intoxication.17
In case reports, myristicin poisoning induced CNS neuromodulatory signs that mimicked an anticholinergic hyperstimulation state.12,18 Fatal myristicin poisoning is rare; 2 cases have been reported, 1 in combination with flunitrazepam (not available in the United States).19,20 Nutmeg also has sedative properties and can cause GI symptoms when ingesting excessive amounts.1,20,21 Grover et al21 described no harmful effects on blood pressure and electrocardiogram; however, Shah et al22 reported palpitations and dry mouth.
Vanilla (species of the genus Vanilla) contains piperonal, also known as heliotropin.1 Piperonal has aromatherapeutic qualities that might elevate mood and well-being. In the early 1990s, the Memorial Sloan- Kettering Cancer Center in New York City described heliotropin as a powerful aromatherapy tool. Patients who were undergoing an MRI in an environment scented with heliotropin demonstrated a 63% reduction in anxiety compared with those who were not exposed to fragrance.23 The Smell and Taste Treatment and Research Foundation in Chicago found that vanilla can promote sexual arousal.24