Taking the spice route: Psychoactive properties of culinary spices Intoxication and toxicity can mimic psychiatric symptoms any substances that are not typically thought of as “substances of abuse” possess—when adequate- Mly 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 il- licit 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 © STOCKCREATIONS Patients may misuse culinary spices to achieve euphoria, or a James A. Bourgeois, OD, MD “natural high.” They may present with medical or psychiat- Clinical Professor Vice Chair, Clinical Affairs ric symptoms, including acute altered mental status, but the Department of Psychiatry/Langley Porter Psychiatric Institute psychoactive substances are not identified on routine toxicol- University of California San Francisco ogy studies. In addition, patients may not attribute their use San Francisco, California of spices for psychoactive effect to “drugs,” because these Usha Parthasarathi, MBBS materials are legal and readily available. This may lead to Assistant Clinical Professor misdiagnosis of a systemic medical disorder or a primary psy- Ana Hategan, MD chiatric illness to explain the patient’s symptoms and initiat- Associate Clinical Professor ing a psychotropic agent and other psychiatric services when • • • • a substance abuse program might be a more appropriate clini- Department of Psychiatry and Behavioural Neurosciences cal intervention. Michael G. DeGroote School of Medicine Some spices contain psychoactive compounds that can Faculty of Health Sciences McMaster University 1-7 alter CNS function (Table, page 22 ), might be abused for Hamilton, Ontario, Canada Disclosures The authors report no financial relationships with any company whose products are mentioned Current Psychiatry in this article or with manufacturers of competing products. Vol. 13, No. 4 21 Table Classification of culinary spices with psychoactive effects Botanical basis Types Active ingredients Psychoactive effects Dried fruit Nutmeg Myristicin, elemicin, safrole Stimulant, sedative, hallucinogenic or seeds Vanilla Vanillin, piperonal Stimulant, sedative Fennel Anethole Stimulant, sedative Abuse Black pepper Piperine Stimulant of spices Dried flower buds Cloves Eugenol Sedative Arils Mace Myristicin Stimulant, sedative Barks Cinnamon, Eugenol, coumarin Stimulant, sedative ceylon/cassia Roots and Asarone Calamus Stimulant, sedative rhizomes Ginger Gingerols, shogaols Stimulant, sedative Turmeric Curcumin Sedative Galangal 1,8-cineole, β-pinene Stimulant, sedative, hallucinogenic Asafetida Resin, gum, essential oil, Sedative Clinical Point propenyl-isobutylsulfide, umbelliferone, vanillin Some spices contain Stigmas Saffron Picrocrocin, safranal Stimulant psychoactive Source: References 1-7 compounds that can alter CNS function, might be abused, recreational purposes, and can be toxic in nutmeg contains myristicin, a psychoactive an excessive amount. Internet resources, substance that is chemically similar to hal- and can be toxic including anonymous web-based commu- lucinogenic compounds such as mescaline. nications, and anecdotal materials about non- Its psychoactive effects could be attributed traditional recreational drugs, are available to to metabolic formation of amphetamine de- anyone with Internet access.8 However, little rivatives from its core ingredients, elemicin, research has been conducted into the preva- myristicin, and safrole.11,12 lence of abuse (Box)9 and spices’ psychoactive Nutmeg and its active component, my- properties. The lack of toxicology detection risticin, produce central monoamine oxi- of spices in the medical setting presents a di- dase (MAO) inhibition as evidenced by agnostic challenge. the ability to lower the convulsive dose The psychoactive plants used in “natural of IV tryptamine in mice and to increase high” products mainly are psychoactively brain 5-hydroxytryptamine concentra- inactive in their natural form, but extracts or tions.13,14 Although myristicin’s potency is alkaloids obtained from them might induce 1 not comparable to that of the more potent or more of 3 classifications of psychoactivity: MAO inhibitors such as tranylcypromine • stimulant and iproniazid (which is not available in • sedative the United States), it seems adequate when • hallucinogenic. compared with its low toxicity.14 Nutmeg Many of these substances are considered extract is associated with a significant anti- to be aphrodisiac, and some may be abused depressant effect in mice, which seemed to to increase sexual function. be mediated by interaction with the adren- The following is a review of common spic- ergic, dopaminergic, and serotonergic sys- Discuss this article at es that have been reported to possess poten- tems.13 Nutmeg is associated with sustained www.facebook.com/ tial psychoactive properties. increase in sexual activity in animal studies, CurrentPsychiatry with no evidence of adverse effects and toxicity, suggesting that nutmeg possesses Nutmeg clinically significant aphrodisiac activity.15 Nutmeg (Myristica fragrans) is a common Psychoactive effects can be achieved by and easily accessible means of reaching ingesting 5 to 15 g of nutmeg.11 Acute nut- Current Psychiatry 22 April 2014 euphoria in adults.10 The aromatic oil of meg intoxication produces palpitations, dizziness, anxiety, and hallucinations, Box mostly resolving within 24 hours, while effects of chronic abuse are reported to be Abuse of spices: similar to Cannabis use, including euphoria, Prevalence unknown giddiness, anxiety, fear, sense of impending pidemiology of the prevalence of abuse doom, detachment, confabulation, and hal- Eof culinary spices has been limited to lucinations.11,16 Urine drug screens are nega- case reports, case series, and estimates of population use based on registry-type data tive unless other psychoactive substances (eg, 17 cases of nutmeg intoxication were have been ingested.17 reported to a Texas poison control registry Suspected nutmeg intoxication or poison- between 1998 and 2004).9 Because abuse ing should be treated with supportive treat- of culinary spices does not have DSM-5 nomenclature—other than substance abuse ment. Use sedatives with caution because of not otherwise classified—population-based alternating periods of delirium and obtunda- and clinical studies on prevalence are not tion during nutmeg intoxication.17 available. However, because individual cases may present—often in acute care setting— In case reports, myristicin poisoning for clinical attention, psychiatrists and other induced CNS neuromodulatory signs that medical specialists, such as emergency mimicked an anticholinergic hyperstimula- physicians, should consider the possibility of Clinical Point culinary spice abuse in cases of intoxication tion state.12,18 Fatal myristicin poisoning is that otherwise escape diagnostic classification. Treat suspected rare; 2 cases have been reported, 1 in com- bination with flunitrazepam (not available nutmeg intoxication in the United States).19,20 Nutmeg also has or poisoning with sedative properties and can cause GI symp- Standard treatment for alcohol intoxica- supportive measures; toms when ingesting excessive amounts.1,20,21 tion and withdrawal is indicated in cases use sedatives with Grover et al21 described no harmful effects on of suspected vanilla abuse. caution blood pressure and electrocardiogram; how- ever, Shah et al22 reported palpitations and dry mouth. Fennel The essential oil of fennel (Foeniculum vul- gare) can be neurotoxic and epileptogenic. Vanilla Skalli and colleagues recently reported a case Vanilla (species of the genus Vanilla) con- of seizure induction in a young woman after tains piperonal, also known as heliotropin.1 ingesting cakes containing fennel oil.26 Fennel Piperonal has aromatherapeutic qualities oil also has been reported to have significant that might elevate mood and well-being. interaction with the fluoroquinolone-type In the early 1990s, the Memorial Sloan- antibiotics. Be aware of adverse effects associ- Kettering Cancer Center in New York City ated with fennel ingestion; question patients described heliotropin as a powerful aroma- if atypical seizures or reactions to antibiotics therapy tool. Patients who were undergo- occur.27 ing an MRI in an environment scented with Spices such as fennel, dill, cinnamon, saf- heliotropin demonstrated a 63% reduction fron, and anise also contain psychoactive in anxiety compared with those who were substances that are chemically similar to my- not exposed to fragrance.23 The Smell and risticin, which can induce sedation, stimula- Taste Treatment and Research Foundation tion, or hallucinations.7 in Chicago found that vanilla can promote sexual arousal.24 Short-term effects of vanillin—a major Black pepper component of vanilla—include a feeling of Piperine, which gives black pepper (Piper ni- relaxation and reduced stress; long-term use grum) its spiciness, enhances thermogenesis can produce an