psychotropic Salvia divinorum. SIMILARITIES TO Salvia. ⢠Coleus blumei is from the same family as Salvia divinorum. ⢠Salvia divinorum has the hallucinogen ...
Coleus blumei – A Backyard Psychotropic: A Case Report and Literature Review Nitin Chopra MD, Lon Hays MD Department of Psychiatry, University of Kentucky, Lexington, KY HISTORY OF PRESENT ILLNESS
LEARNING OBJECTIVES • Present a clinical case of a patient intoxicated on Coleus blumei in the emergency room • Present a review and synopsis of Coleus blumei
BACKGROUND • Coleus blumei is from the mint family • Naturally found in Africa, Asia, Australia, and the Pacific Islands • Popular in gardens and prized for their intense leaf colors
• 21 year old Ecuadorian male, presenting to the emergency room with disorganized thoughts, odd laughter, and erratic behavior • He had been speaking “gibberish,” randomly praying, playing the “air guitar,” and ran out of the shower naked and started “rolling around in the dirt,” after attending a party • Collateral information was obtained from his family, colleagues, and psychologist, who denied any known psychiatric illness or family history • He previously tried LSD
MECHANISM OF ACTION • Coleus blumei is from the same family as Salvia divinorum • Salvia divinorum has the hallucinogen neocleordane diterpene salvinorin-A, which is unique because unlike most hallucinogens being psychoactive by acting at the 5-HT2A serotonin receptor, this is a nonnitrogenous ᴋ-opioid receptor agonist • Coleus blumei may have similar psychoactive properties EROWID EXPERIENCE VAULTS • Understanding of the psychotropic effects of Coleus blumei is limited • The Erowid Experience Vaults attempt to chronicle various drug experiences • The plant was reportedly consumed by smoking, chewing, and steeping • Vivid dreams and euphoria were described
DIAGNOSTIC WORK-UP
SIMILARITIES TO Salvia
• CBC, CMP, and TSH were within normal limits • Acetaminophen, salicylate, and blood alcohol levels were negative • Comprehensive urine drug screen was negative • CT Brain without contrast was normal
• Traditionally, Salvia divinorum was consumed by Mazatec Indians of Oaxaca, Mexico • Mexican folklore describes the Coleus as a variant from Europe • The relative potency has been debated, with belief that the Coleus blumei was medicinal, in comparison to the psychotropic Salvia divinorum
CLINICAL IMPLICATIONS
CLINICAL COURSE • In the ER, he received ziprasidone 10 mg intramuscularly twice • He was admitted to the inpatient psychiatric unit on an involuntary hold, spending much of his five day admission in seclusion • He was started on risperidone 1 mg orally twice daily • This helped a little, but he remained disorganized and religious preoccupations worsened • On day two, he was preoccupied with “love” and paranoid about his medications, family, work, and substance abuse • The risperidone was doubled to 2 mg orally twice daily • Through a series of Facebook posts, his clinical presentation coincided with the use of a potentially psychotropic plant, Coleus blumei • On day 5, his thought process improved remarkably • He was discharged home with his family .
• Coleus blumei, a possible psychotropic, is understudied, as our knowledge of related biochemical and physiological activity remains very limited • This should be considered among designer and rare substances • Further investigation is warranted
REFERENCES 1. 2. 3. 4.
Harry P. Plant Evaluation Observations. Retrieved September 6, 2014, from http://www.leugardens.org/wp-content/uploads/2014/07/Coleusevaluationresults.pdf Halpern JH. Hallucinogens and dissociative agents naturally growing in the United States. Pharmacology & Therapeutics 2004; 102:131-138. Wasson RG. A new Mexican psychotropic drug from the mint family. Botanical Museum Leaflets – Harvard University 1962. Retrieved September 6, 2014, from http://www.erowid.org/experiences/subs/exp_Coleus.shtml#General.
