Nutmeg abuse

December 11, 2010, 6:07 pm

There has been a flurry of news stories about nutmeg as a drug of abuse in recent days, such as this one. The reasons are not completely clear to me — has there been a resurgence of this practice among youth (this occurs periodically), or are poison centers and news organizations simply exploiting the connection to the holiday season (this occurs more than periodically)?

In any case, this renewed interest gives us a chance to review this interesting spice.  Nutmeg is extracted from the seed of the Myristica fragrans tree, an evergreen that originally grew only on the islands of the Bandas archipelago in Indonesia.  In the middle ages it was believed to protect against the plague and was at one time the third most valuable commodity in the world behind gold and silver.  It contains a large number of different toxins of two types: aromatic and terpene.

Toxic manifestations begin 3-6 hours after ingestion.  Some users are now apparently snorting nutmeg, but the pharmacokinetics of this route have not been studied.  Signs and symptoms may resemble the anticholinergic toxidrome: flushing, dry mucus membranes, tachycardia, hypertension. One possible distinguishing characteristic — according to Goldfrank’s Toxicologic Emergencies — is that with nutmeg toxicity pupils tend to be small, not dilated.  Other manifestations include agitation and altered mental status.  Large doses can cause visual distortions, hallucinations, increasing CNS depression, and coma. Abdominal pain and nausea are also common.  The only reported fatality associated with nutmeg poisoning occurred in 1908.

The mechanisms for the toxic effects of nutmeg have not been fully elucidated.  Although many references mention monoamine oxidase inhibition and conversion of some components to amphetamine analogues, these hypotheses have not been proven.

Related post: Fox News discovers nutmeg abuse

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