Medical News Today: Study outlines concerns around natural psychoactive substances

New research finds that over a period of 17 years, people in the United States increased their use of natural psychoactive substances, believing them to be safe. This has led to many reports of adverse symptoms in adults and children alike.

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People have been using natural psychoactive substances for hundrends, or even thousands, of years in traditional medicine and as a part of spiritual practices.

Because these substances come from sources such as plants and mushrooms, many people believe them to be safe to use.

However, because they interfere with biological processes in the central nervous system, they can be a threat to human health. These interferences can also cause euphoria and altered states of consciousness.

For these reasons, many people are now using natural psychoactive substances for recreational purposes.

New research has studied trends in the number of people in the United States who reported adverse reactions as a result of exposure to psychoactive substances during 2000–2017.

The Center for Injury Research and Policy at the Research Institute at Nationwide Children’s Hospital in Columbus, OH, collaborated with the Ohio State University College of Medicine, also in Columbus, to conduct this study.

In the new study paper — which appears in the journal Clinical Toxicology — the researchers explain that at a global level, many such substances remain improperly regulated. This means that it can be very easy for people to obtain them via online channels.

“Opium, cocaine, and marijuana are the most commonly used and are included in the 1961 United Nations Convention on Narcotics,” the study authors write.

However, they add, “While these three well-known plant-based substances are highly regulated, other natural psychoactive substances are not currently under international control through this convention or its amendments. Lack of regulation has led to an increase in their availability, especially on the internet.”

35% of exposures occurred in teenagers

For the new study, the researchers accessed data from the National Poison Data System regarding exposures to natural psychoactive substances in U.S. populations.

They found that between January 1, 2000 and December 31, 2017, the National Poison Data System processed up to 67,369 cases of dangerous exposure to natural psychoactive drugs. This is an average of 3,743 cases per year, or around 10 cases per day.

“These substances have been associated with a variety of serious medical outcomes, including seizures and coma in adults and children,” warns study co-author Henry Spiller, the director of the Central Ohio Poison Center at Nationwide Children’s Hospital.

Between 2000 and 2017, there was a general increase in the rate of exposures to natural psychoactive substances. However, there was a decrease in the exposure to most individual substances — with a few notable exceptions.

During this time, there was a 150% increase in exposure to marijuana, a 64% increase in exposure to nutmeg (which contains the hallucinogenic substance myristicin), and a 4,948.9% increase in exposure to kratom, the leaves of which contain potent mind-altering substances.

Spiller points out that 47% of the exposures to natural psychoactive substances in 2000–2017 were to marijuana, which is now legal — for medical or recreational purposes — in 33 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.

“As more states continue to legalize marijuana in various forms, parents and healthcare providers should treat it like any other medication: locked up, away, and out of sight of children,” Spiller advises. He warns that “[w]ith edibles and infused products especially, curious children are mistaking them for kid-friendly candy or food, and that poses a very real risk for harm.”

According to the study findings, 41% of the dangerous exposures occurred in people aged 19 and older, and as many as 35% occurred in people aged 13–19.

Males reported the most instances (64%) of exposure to natural psychoactive substances, and almost all (91%) of the exposures took place inside the home.

Besides marijuana, the substances to which exposure rates increased between 2000 and 2017 were Jimson weed, which accounted for 21% of exposures, and hallucinogenic mushrooms, which accounted for 16%.

Concerns regarding regulations

Kratom, khat (which contains the stimulant cathinone), various anticholinergic (central nervous system-disruptive) plants, and hallucinogenic mushrooms accounted for most hospital admissions due to exposure to natural psychoactive substances. They also accounted for most cases of serious medical outcomes.

Exposure to kratom, in particular, accounted for 8 of the 42 deaths in 2000–2017 that occurred due to natural psychoactive substances.

Also, 7 of the 42 deaths occurred in people under 18, and 5 of the 42 deaths occurred in people aged 13–19. These deaths were caused by exposure to anticholinergic plants, hallucinogenic mushrooms, kava kava, or marijuana. Two of the 42 deaths occurred in children aged 12 or younger, and both were due to exposure to marijuana.

The researchers point out that some of the plants that yield potentially dangerous psychoactive substances — particularly kratom — are not currently appropriately regulated in the U.S. In their study paper, they write:

“Kratom is currently classified as a dietary supplement, and therefore does not receive the same U.S. Food and Drug Administration quality and safety oversight as other drugs.”

This is despite the fact that “[t]he U.S. Drug Enforcement Administration (DEA) [have] voiced concerns about kratom due to its addictive potential and the deaths associated with its use,” the investigators add.

“In 2016, the DEA announced [their] intent to list kratom as a Schedule I drug, which it withdrew less than 2 months later due to negative public response,” write Spiller and team.

Based on accumulating evidence — including the results of this study — Spiller and colleagues suggest that federal institutions increase their efforts to regulate natural psychoactive substances, especially kratom, more strictly.