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_{The following is not intended to be legal advice. For specific legal counsel please contact an attorney.}

In 2024 fentanyl, a cheap, incredibly potent narcotic, ripped a gash through the nation. With overdose deaths involving fentanyl reaching 89,740¹, states are increasingly mandating fentanyl education in schools to protect young people. This blog post examines the growing trend of these educational reforms and what they mean for educators.

Addressing the Overdose Crisis

Fentanyl education is increasingly mandated in schools across the US to combat the rising tide of overdose deaths. States like Alabama (via the Price Hornsby Act), Illinois, California, Oregon, and Washington are implementing reforms requiring or strongly encouraging fentanyl awareness instruction, particularly in grades 6-12. These mandates often align with existing drug and alcohol education programs, requiring schools to incorporate age-appropriate, research-based curricula addressing the dangers of fentanyl, synthetic opioids, and counterfeit drugs. While some states provide curriculum resources, others leave implementation to local districts, creating a need for effective educational programs like ACT on Drugs Presents a Conversation with The Drug Lady, which offers modules on fentanyl and other substances, lesson plans, and resources to help schools meet these new requirements and equip students with crucial knowledge.

The Price Hornsby Act: A Catalyst for Reform

The first of such reforms to catch our attention was Alabama’s Price Hornsby Act. Named after an Alabama teen tragically lost to Fentanyl overdose. We’ve written an article dedicated to the Price Hornsby Act in particular which can be found on our resources page. We then looked into other states that had similar laws.

State-by-State Fentanyl Education Laws: Alabama, Illinois, California, Oregon, and Washington

Along with Alabama, four other states, Illinois, California, Oregon, and Washington are leading the charge with mandated educational reforms focused on fentanyl prevention and awareness.

So what do these reforms mean for health teachers and administrators?

Alabama’s Mandate: 2024-2025 School Year Requirements

Alabama schools should have already implemented been impacted this 2024-2025 school year. With the passage of the Price Hornsby Act, fentanyl education is now mandatory for grades 6-12. Not only is it mandatory, but it must be “comparable to instruction provided for other drug and alcohol education and prevention programs.”²
“Commencing with the 2024-2025 school year, each local education agency shall annually provide research-based instruction related to fentanyl prevention and drug poisoning awareness to students in grades six through 12 in a manner comparable to instruction provided for other drug and alcohol education and prevention programs.”

Illinois Law: Implementation for 2024-2025

Illinois schools are also required to implement Fentanyl education into their curriculum.
“Beginning with the 2024-2025 school year, the program shall include instruction, study, and discussion on the dangers of fentanyl in grades 6 through 12.”³

California: Integrating with Existing Health Curriculum

California Schools have a little more leeway when it comes to implementing Fentanyl education. They are only required to educate students on Fentanyl if their school already requires health education for graduation.
“If the governing board of a school district or the governing body of a charter school requires a course in health education for graduation from high school, the governing board of a school district or the governing body of a charter school shall include, commencing with the 2026–27 school year, instruction in the dangers associated with fentanyl use.”⁴

Oregon Fentanyl Education: Curriculum Development by State Agencies

Oregon schools may have an easier time educating their students on Fentanyl. While Fentanyl education is a requirement starting with the 2024-2025 school year, government agencies will be charged with developing the curriculum.
“… the Oregon Health Authority, State Board of Education and Alcohol and Drug Policy Commission shall collaborate on developing curricula supplements to be implemented by school districts related to: (1) Dangers of synthetic opioids, including fentanyl or any substituted derivative of fentanyl, and counterfeit and fake drugs.”⁶

Washington Fentanyl Education: Encouraging Awareness and Providing Resources

Washington Fentanyl education laws seem the least stringent of the aforementioned states. Government agencies are responsible for developing learning materials for their schools. Schools are also “strongly encouraged” not constrained to educate students on Fentanyl starting with the 2024-2025 school year.
“The office of the superintendent of public instruction shall actively distribute the materials developed under subsection (1) of this section to school districts, public schools, educational service districts, and community-based organizations that provide extended learning opportunities, and strongly encourage the incorporation of age-appropriate materials in classrooms, as well as in family and community communications.”⁷

Effective Fentanyl Education Programs: Meeting the Mandates and Protecting Students

Though this is great progress in the fight against Fentanyl, teachers in Alabama, California and Illinois will have to find ways to educate their students. Schools nationwide have implemented various strategies when it comes to drug education with limited success.

ACT on Drugs Presents a Conversation with The Drug Lady: A Comprehensive Fentanyl and Drug Education Curriculum

ACT on Drugs Presents a Conversation with The Drug Lady is a research-based curriculum taught by former DEA forensic chemist Lynn Riemer. Lynn has been educating students about drugs in-person for over 20 years.

It’s an engaging online program, which meets SHAPE national physical education standards, follows the CASEL framework for whole person education and empowers students with the knowledge and tools they need to make informed decisions about drug use.

ACT on Drugs Presents a Conversation with The Drug Lady Curriculum Modules

We offer 10 teaching modules in both English and Spanish, built to integrate with existing curriculum, including:

• Narcotics and Fentanyl
• The Brain and Addiction
• Vaping and Over the Counter Products
• Hallucinogens
• Marijuana
• Stimulants
• 2 x Stories of Recovery (One of a person recovering from Narcotic and Fentanyl use.)

The curriculum also includes lesson plans, a pre/post test, study guides, student worksheets, and other resources.

Benefits: Equipping Students, Ensuring Compliance, and Saving Resources

By partnering with ACT on Drugs, schools can:

• Equip Students with Knowledge They Need to Make Good Decisions About Drugs
• Comply with the National Physical Education Standards
• Save Time and Resources

Contact ACT on Drugs: Schedule a Tour and Implement Fentanyl Education

We’d love to help you educate your students and ensure that your school is in compliance with Fentanyl education mandates.

If you’d like to learn more about the program please visit our homepage or contact us to schedule a virtual tour.

1. https://www.progressivepolicy.org/u-s-drug-overdose-deaths-down-21-7-from-2023-to-2024/#:~:text=The%20decline%20is%20almost%20entirely,September%202023%20to%20August%202024. ↩︎
2. https://legiscan.com/AL/text/HB280/id/2990141 ↩︎
3. https://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=103-0810 ↩︎
4. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB2429 ↩︎
5. https://olis.oregonlegislature.gov/liz/2023R1/Downloads/MeasureDocument/SB238/Enrolled ↩︎
6. https://lawfilesext.leg.wa.gov/biennium/2023-24/Pdf/Bills/House%20Passed%20Legislature/1956-S2.PL.pdf?q=20250129091037 ↩︎

Narcan reverses an opioid overdose. It is an opioid antagonist. It is commonly found as a nasal spray. It is legal to posses and recognized as a lifesaving procedure. It works by knocking opioids off the brain stem and then binding to the receptors to restore breathing. If Narcan catches, it will also put the body into immediate withdrawal. The user will experience withdrawal symptoms and can be upset with the person who has put them in that state, so beware they may swing at you. If someone is unresponsive or being given Narcan, you need to immediately call 911 to get medical help on its way. 

Fentanyl and its analogues, because of the potency, may require multiple pops to catch and wake the person up. After 3 or 4 pops, if the person isn’t responding start CPR, but no recovery breaths, just chest compressions and hope paramedics get there quickly.

Here are 2 sites that will send you Narcan free of charge, they also will send you fentanyl test strips if you request them. You need to watch a short video and answer a couple questions, so they know you know how to administer it.

Endoverdose.net

The Chris Atwood Foundation

Fentanyl is a synthetic opioid pain reliever used for treating severe pain. It is 50 to 100 times more potent than morphine and 40-85 times more potent than heroin (Fentanyl Drug Facts, NIH Drug Abuse). Even in small doses it may be deadly. On the street, fentanyl may be added to heroin making the mixture more powerful than heroin alone. Heroin addicts who are exposed to this mixture may not be aware of the fentanyl additive and as a result, users who have not developed tolerance to the fentanyl additive may overdose and die. The heroin-fentanyl mixture has resulted in a dramatic increase in overdose death.

Fentanyl is very inexpensive to produce and is extremely pure. Ingredients are typically imported into Mexico from China and the final product is then smuggled into the US. Many street drugs are adulterated with fentanyl and users are often not aware of what they are using. It is not rare for this high-risk behavior to result in overdose and death. As a precaution users need to understand that the extreme toxicity of fentanyl is a real danger. Users and others must be able to recognize the signs of overdose and carry and be able to use nasal Narcan when overdose is suspected. Signs of overdose include small pinpoint pupils, falling asleep or losing consciousness, weak breathing, choking or gurgling sounds, limp body, clammy skin and blue colored lips and nails (www.cdc.gov, accessed 8/1/23). Narcan needs to be administered quickly and in doses upwards of 2-4 times the amount of Narcan used to treat the typical opioid overdose patient. Even with high doses the lifesaving efforts may fail.

Fentanyl may be injected, smoked or taken by mouth. Fentanyl vapes, sometimes mixed with nicotine, are showing up across the country. Exposure and intoxication by secondary smoke (vapors), along with several deaths, have been reported. Fentanyl and Heroin vapes have been taken off of teens who had no knowledge of what was in the vapes.

In any form, fentanyl is readily disseminated into indoor/outdoor air as fine particles or liquid spray (aerosol) whenever the drug package is opened and handled. Fentanyl can be absorbed into the body through inhalation, oral exposure, or ingestion. Fentanyl is so dangerous that First Responders wear protective gear when assisting drug-overdose victims suspected of using any illicit drug. Extreme precautions are taken by First Responders to prevent exposure to Fentanyl, including:

• Always wearing nitrile glove when illicit drugs are present 
• Changing gloves when they become contaminated
• Wearing respiratory protection when powdered drugs are present or suspected
• Avoiding procedures that may result in illicit drugs becoming airborne
• Not touching their face, eyes or mouth after touching any surface that may be contaminated, even if wearing gloves and wash hands with soap and water, not hand sanitizer, even after wearing gloves

Fentanyl is being laced in all other drugs, often in prescription drugs people recognize like, Percocet, Xanax, OxyContin, and Adderall. Marijuana joints have been laced with Fentanyl, as well as Ecstasy, Molly, Heroin, Methamphetamine and Cocaine. One should assume today that everything is laced with Fentanyl! These drugs may contain deadly levels of fentanyl, and the user wouldn’t be able to see it, taste it, or smell it. It is nearly impossible to tell if drugs have been laced with fentanyl, or any other drug for that matter, until the drug is tested. Fentanyl-test-strips are available, and users should use these strips to determine if their drug of choice is adulterated with fentanyl. Results are available in 5 minutes and can make the difference between life and death.

*Users need to be cautious even if the test is negative for Fentanyl, as test strips do not detect fentanyl analogs. And there have been a number of false negatives with the test strips. These test strips are not as reliable as testing from a laboratory.

Fentanyl Analogs

There are several fentanyl analogs (something that is similar or comparable to something else) on the street including acetyl fentanyl, furanyl fentanyl, and carfentanil. They are similar in chemical structure to fentanyl and may be detected in the urine using specialized toxicology testing. Carfentanil, the most potent fentanyl analog in the U.S., is estimated to be 10,000 times more potent than morphine (dea.gov. hq092216_attach.pdf).

1. Acetyl Fentanyl: Acetyl fentanyl is a new and lethal drug and is becoming more popular among narcotic abusers. The drug looks similar to heroin and is being sold as heroin. Numerous deaths among intravenous users of this drug have been reported. The drug is available online and sold as a “research chemical.” Overdoses are treated the same as any opiate overdose. However, larger doses of rescue medications are often necessary.

2. Carfentanil: This drug is marketed under the trade name Wildnil and used as a general anesthetic for large animals, i.e. elephants, rhino’s, hippo’s and bears. It is extremely potent and claimed to be 10,000 times more potent than morphine. It is a white powder and sold on the street as heroin, it can be mixed with Heroin and/or fentanyl, and pressed into pills as well. It is often added to heroin to make it more potent. It can be mixed with cocaine and sold as a “speed ball”.

3. U-47700:  Known as “pink” on the street is about 8X more potent than morphine and can be injected, snorted or ingested. Some people have “plugged” it by dissolving it in water and inserting rectally. It has been mixed with heroin and sold as heroin. The effects are short-lived, typically resulting in dangerous double dosing. It is corrosive to mucous membranes and sublingual administration is likely to damage the mouth. Vaporizing the substance damages the lungs.  This was the substance found in fake Vicodin pills that killed the artist Prince.

4. Furanyl Fentanyl: This designer version of fentanyl is mass-produced in clandestine labs in China and smuggled into the United States. It has no approved medical use and is not approved for human consumption. It is 5X more potent than fentanyl. It has been encountered as a single substance as well as in combination with other drugs including heroin, fentanyl, butyryl fentanyl, and U-47700. This potent drug has killed hundreds of people throughout Europe and the US. Ingesting the powder may cause seizures. Treatment centers report that abusers do not respond to normal medical treatments. Higher doses of methadone are required to detoxify the user.

Newest synthetic opioids on the streets

Nitazenes

Nitazenes were developed by commercial pharmaceutical companies in the 1950’s as synthetic opioid candidates. This class of drugs has a chemical structure similar to Fentanyl but is not Fentanyl. Because of the similarity, it binds on the same Opioid receptors that Fentanyl does. These compounds are thought to be 20 times more potent than Fentanyl. Clandestine labs learned about the Nitazenes family and began production for recreational use by 2019. Since then Isotonitazene has been implicated in over 200 drug-related overdose deaths in Europe and North America but their presence is likely under-detected because many testing facilities are not set up to test for the drugs (Pergolizzi et al. Cureus, June 2021.doi 10.7759/cureus40736) 

The arrival of any new drug or intoxicant into the illicit drug supply creates tremendous burdens for first responders and emergency healthcare providers as they encounter the first overdose cases without the benefit of knowing much about the pharmacology, toxicology, or potential use or interactions of these novel agents. The problem is compounded by the fact that many street drug users may not be informed or aware of exactly what substances they have taken.  

Nitazenes are specifically developed to be cheap, easy to manufacture, and highly intoxicating. There are no quality, purity, or manufacturing standards. Even if street drug buyers understand they are buying heroin mixed with nitazenes, the quality and quantity of the nitazenes would likely not be disclosed. In theory, the effects of some nitazenes can be reversed by naloxone(Narcan) but the high potency and impurities of the nitazenes might limit Narcan’s effectiveness.

Many of these new substances are metabolites of the parent drug. N-Desethyl Isotonitazene from Isotonitazene and N-Desethyl Etonitazene from Etonitazene and are listed online as not for human or animal use. (see below) 

1. Isotonitazene is the most persistent and prevalent new opioid in the U.S. today. It has been found in “fake” Dilaudid pills, sold as a brownish powder similar to brown heroin, and put into capsules. Isotonitazene is derived from a powerful opioid called etonitazene and is about 60 times more potent than morphine. When etonitazene became illegal the molecular structure of etonitazene was altered creating Isotonitazene, a schedule 1 drug in the US. Illicitly using the drug will very likely lead to addiction. It is available on the illicit drug market and mixed with cocaine is deadly.  
2. N-Desethyl etonitazene was detected by the Boulder County Coroners in Colorado mid-2023 making it the first time law enforcement has found proof of the drug’s presence in the United States. It is considered to be 10 times more powerful that fentanyl. In this case the victim had ordered Quaalude’s, a hypnotic sedative used as a recreational drug, online and did not know they were laced with etonitazene. N-pyrrolidino etonitazene has been found recently in Canada. It’s known on the street as Pyro.

Xylazine and Fentanyl (TRANQ)

The combination of Xylazine and fentanyl, called TRANQ, is used to prolong the effects of fentanyl and lengthen its euphoric effects. Overdose deaths linked to Tranq have spread across the United States.  Most overdose deaths linked to Tranq also involve combinations of cocaine, methamphetamine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids. The combination of Xylazine and Meth, or Xylazine and Cocaine, are known as speedballs on the street.

Xylazine is a non-opioid sedative, muscle relaxant and analgesic for veterinary use but is also used to adulterate and potentiate the effects of heroin/fentanyl. Its use first emerged in Puerto Rico and has spread to mainland US where it is combined with heroin and Fentanyl. The combination may be swallowed, inhaled, snorted or injected and results in profound CNS depression and decreased blood pressure, respiratory rate and heart rate. It should be suspected when opioid overdose is accompanied by profound hypotension and very slow heart rate not responsive to naloxone(Narcan). There is no antidote and intense supportive care is required. Skin wounds, known as abscesses, lesions, and necrosis, are becoming prevalent with opioids mixed with xylazine, and ER’s across the nation are seeing an increase in infections. These are not the types of wounds commonly seen with injecting drugs. These sores are developing on skin far away from injection sites, and people are reporting wounds from smoking and snorting xylazine laced substances. The death rate from overdose of this combination is said to be about 30%.

*Narcan does not respond to Xylazine alone. Since it is often mixed with other opioids it is recommended to use Narcan and hope it catches. They also do not test for Xylazine, so it flies under the radar and true data on deaths is lacking. When mixed with meth or cocaine, it acts like a speedball. Sedation comes quickly and death can occur.  New Xylazine test strips are available from harm reduction sites, health departments, and other groups in the US. But again, these test strips are not 100% accurate. And they only test for Xylazine! It won’t tell you if Fentanyl or another drug is in there.

Methamphetamine is a popular recreational drug and following the recent introduction of P2P meth it is now less expensive and more available than ever before. Meth is a central nervous system stimulant. It may be in powder or crystalline form (crystal meth). The powder may be white, tan, pink, red or brown depending on the method used to produce the drug. Meth may be smoked, snorted, ingested or injected after dissolving the powder in water. 

From the 70’s to the mid-2020’s meth was most often produced in home-laboratories and in Mexico for shipment to the US using cold medications containing ephedrine to manufacture the meth. Eventually the sale of ephedrine was limited in the United States and outlawed in Mexico. As a result, meth producers re-invented the process for manufacturing meth using legally purchased phenyl-2-propanone (P2P) and other easily available chemicals. 

The vast majority of meth on the market today is derived from P2P. It is cheaper, less contaminated, purer and more potent than ephedrine-based meth (2020 National Drug Threat Assessment, March 2021, DEA-DCT-Dir-008-21), making the drug more dangerous. 

During production of methamphetamine, the chemical structure of the drug may “flip” creating 2 stable versions of the same compound. These versions are called isomers and each isomer, D-meth and L-meth, has different effects on the body. L-meth does not have psychotropic effects and was present in significant amounts in early P2P. However, by 2019 manufacturers learned to remove L-meth from P2P so that today’s P2P is about 97%-99% pure psychoactive D-meth.

Smoking or injecting meth produces an intense rush (flash). The “flash” is extremely pleasurable but lasts only a few minutes. Snorting or ingesting the drug results in euphoria without a flash, starting 3-5 minutes after taking the drug and lasting 15-20 minutes. Following the “flash” users experience an immediate euphoria and rush accompanied by increased alertness, wakefulness and physical activity. The “high” from the drug starts quickly and fades quickly inducing people to take repeated doses in a binge pattern, giving up food and sleep for several hours or several days resulting in a “crash” culminating in cognitive issues, depression, cravings, anxiety, and sleep problems. 

The increased levels of d-isomer in P2P induce an intense and prolonged euphoric high with severe physical repercussions including increased blood pressure and respiratory rate, increased body temperature, increased risk of liver failure and elevated risk of heart attacks or strokes. P2P meth may cause schizophrenia and other psychoses. Meth derived from ephedrine causes users to stay awake and act socially aggressive. In contrast, P2P users tend to stay isolated and experience hallucination or delusions (NIDA. 2023, October 9. References. Retrieved from https://nida.nih.gov/publications/research-reports/methamphetamine/references on 2024, February 19).

The physical and mental side effects of P2P are prolonged and sometimes irreversible. Users are at risk of organ failure and struggle with paranoid episodes, psychosis and, like users of ephedrine-meth, report the sensation of bugs crawling under their skin. P2P meth tends to be laced with other addictive drugs including fentanyl. As a result, users may require very prolonged detoxification. The other effects of P2P meth are similar to those of ephedrine-based meth. (S Quinones, Atlantic, November 2021. theatlantic.com)   

Effects on the brain

The effects of methamphetamine on the brain are related to its chemical effects resulting in the release of huge amounts of dopamine affecting the reward-region of the brain, creating extreme pleasure and reinforcing drug taking behavior. Repeated release of large amounts of dopamine is the basis for rapid addiction to this drug. As a result of the huge amount of dopamine released it is not unusual that one dose of methamphetamine may result in addiction. Besides addiction, prolonged use of the drug causes weight loss, anxiety and confusion, sleep problems, violent behavior, hallucinations and psychosis.” Meth mouth” is a common problem. Continued use of methamphetamine affects coordination, learning, emotions and memory. 

Short-term effects of methamphetamine

The short-term effects of the drug are increased wakefulness and increased physical activity, decreased appetite, increased libido, rapid heart rate, increased blood pressure and elevated body temperature. Users may have dilated pupils, profuse sweating, and panic. Death may occur as a result of high body temperature, convulsions or cardiac arrest. 

Long-term effects

Long-term effects are psychosis, paranoia, hallucinations, repetitive motor activity, loss of memory, aggressive or violent behavior, severe dental problems (meth mouth) and weight loss. Meth has become highly associated with risky sexual behavior, increasing the risk for contracting hepatitis B or C and HIV. Perhaps the most devastating effect on the addict and his/her friends/family is that the addict rarely returns to being the person he/she was before exposure to meth. 

Meth induced psychosis symptoms may last for months or years after a person has quit using methamphetamine. Stress may precipitate spontaneous recurrence of methamphetamine psychosis in people who had experienced psychosis before using meth (Glasner-Edwards S, CNS Drugs 2014;28:1115-26).

Significant changes occur in the user’s brain. Functional imaging studies of the brain have demonstrated alterations in the activity of the dopamine system that are associated with impaired motor activity and impaired verbal learning (Volkow ND.  Am J Psychiatry 158(3):377– 382, 2001). Studies in chronic methamphetamine users have also revealed severe structural and functional changes in areas of the brain associated with emotion and memory, which may account for many of the emotional and cognitive problems observed in these individuals (Chang L. Addiction 102(Suppl 1):16–32, 2007). 

Withdrawal 

The symptoms of methamphetamine withdrawal are primarily fatigue, depression, increased appetite, anxiety, irritability, headaches, agitation, excessive sleeping, vivid or lucid dreams, and suicidal ideations. Symptoms may last for days in occasional-users and weeks or months in chronic users. The severity is also dependent on the amount of methamphetamine used. 

Effects on the fetus, Infants and children 

Methamphetamines damages the fetus resulting in permanent brain abnormalities with subsequent delay in language skills and aggressive behavior. Prenatal exposure leads to future self-control problems in early school-age children, including poor attention, poor self-regulation skills, and poor problem-solving skills; all due to changes in the frontal cortex of the brain. Poor growth through 3 years of age has been documented. 

The newborn is often born premature and small for gestational age. At the time of birth there may be placental abruption or rupture of the uterus. Infants exposed to prenatal meth also have poor suck, smaller head size, shorter length and more often require intensive care. Laboratory studies have shown that meth impairs mineral uptake in the developing cartilage thus affecting growth. 

Long Term consequences of using hallucinogens

Persistent changes in personality/attitudes, depression, spirituality, anxiety, wellbeing, substance misuse, meditative practices, and mindfulness were documented. Mystical experiences, connectedness, emotional breakthrough, and increased neural entropy were related to these long-term changes in psychological functioning (Aday JS et al.Neurosci Biohav Rev.2020 Jun;113:179). Recognizing the possibility of long-term effects is critical to prevention. These effects may occur following one-time use or in chronic regular users. Two long term conditions are (1) Persistent psychosis: characterized by disorganized thinking, paranoia and mood and visual disturbances (flash backs) and (2) Hallucinogen persisting perception disorder (HPPD): characterized by chronic hallucinations and other visual disturbances. Other unpredictable long-term effects include speech problems, memory loss, weight loss, anxiety and depression and suicidal ideation.

Psilocybin-containing Mushrooms 

Psilocybin mushrooms (Shrooms, Boomers, or Golden Tops) commonly known as “magic mushrooms” are an informal group of fungi that contain psilocybin which is metabolized by the liver to psilocin after ingestion. The mushroom has been used for hundreds of years by native peoples in North America for religious ceremonies. The mushrooms are eaten raw, cooked or made into a tea. Psilocybin mushrooms have not been known to cause physical or psychological dependence and addiction.

The psychedelic effects tend to appear about 20 minutes after ingestion and last up to 6 hours. A negative mind-set can set the stage for a negative experience and a positive mid-set means a more pleasant trip. The effects are subjective and vary among individual users. Side effects include nausea and vomiting, euphoria, muscle weakness, drowsiness, lack of coordination, panic attacks and transient psychosis. Using mushrooms rarely results in any life-threatening symptoms. Long term users may experience flash-backs, occurring weeks or months after the last dose.

Psilocybin present in Magic Mushrooms typically stimulates receptors in the brain that cause perceptual changes, emotional shifts, and spiritual awakenings. Psychedelic effects include visual changes such as halos around lights and objects, vivid colors and flashbacks. The effects appear 30 to 60 minutes after consuming psilocybin mushrooms, peak after 1-2 hours, and last about 4-6 hours with an “afterglow” period sometimes lasting several hours to several days. That is not the case with Muscimol-containing mushrooms.

Muscimol-containing mushrooms

Amanita muscaria mushrooms (Fly Agaric)

Amanita muscaria (Fly Agaric) is a red-and-white-speckled psychoactive mushroom that is native to North America. It is one of the most recognizable and widely encountered mushrooms in popular culture. Its effects are different from traditional “Magic Mushrooms”. 

“Fly agaric” is said to cause more delirium. It acts on different brain receptors than psilocin producing a dreamlike state-of-being, relaxation and sedation accompanied by extreme sweating, vomiting and defecating. Many psychedelics (including LSD, psilocybin and mescaline) are non-toxic making it difficult to overdose on these compounds. A. muscaria is toxic. Parboiling the raw mushroom twice in water weakens its toxicity but also weakens its psychoactive effects. The effects of consuming raw non-boiled mushrooms are stronger, and the risks are greater.

The three active ingredients in Amanita muscaria are muscimol, Ibotenic acid and muscarine. Muscimol and Ibotenic acid are primarily responsible for the mushroom’s psychoactive effects. Muscimol is the most potent psychoactive agent. Ibotenic acid is more stimulating and energizing. When mushrooms contain more Ibotenic acid than muscimol users typically report confusion and agitation. Muscarine is present in trace quantities and is the weakest psychoactive compound in this spotted species. 

The effects of “fly agaric” usually start within 30 min of ingestion with severe nausea, vomiting, diarrhea, cramps, tremor, ataxia (unsteadiness) and incoordination. Some users fall into a deep sleep and report having strange and frightening dreams.  After 60 min, mental status is altered and characterized by declining senses, alternating between agitation and lethargy and bizarre behaviors with disorientation and depersonalization. Visual and auditory distortions are also common. Late effects are lethargy followed by deep sleep. In extreme cases, temporary psychosis, coma and even death (rare) may occur (Rampolli FL. The Deceptive Mushroom. EJCRIM 2021:8 doi:10.12890/2021_002212). There is no antidote and only supportive care is available if needed.

An effective dose in adolescents and adults is approximately 6 mg muscimol and 30 to 60 mg of Ibotenic acid. This is typically about the amount found in one cap of the Amanita muscaria mushroom. However, the amount and ratio of chemical compounds per mushroom varies widely from geographical region to region and season to season. Spring and summer mushrooms may contain up to 10 times more Ibotenic acid and muscimol than autumn mushrooms. The higher concentrations trigger a wide range of pleasant and unpleasant symptoms. The relative amounts of compounds in the mushroom and the overall physical condition of the user influence the effects of the drug. Deaths from A. muscaria have been reported but with modern medical treatment fatal poisoning is rare. However, users may become extremely ill and wish they had never ingested the mushroom.

Amanita muscaria extract is produced by processing the mushroom to isolate Ibotenic acid and muscimol and allows more controlled dosing. For muscimol, 5 to 7 mg can induce a calming effect and alleviate anxiety. When the dose increases to between 10-15 mg users may experience euphoria and vivid dreams. Detoxified Ibotenic acid’s psychoactive effects start at 50 mg and peak at around 100 mg. Temporary psychosis may occur if the content of Ibotenic acid is not completely detoxified during commercial production. Micro-dosing, 1-5 mg of Amanita extract, may be the most pleasant way to achieve the mushroom’s therapeutic effects:  pain relief, mood elevation, sleep support, relaxing euphoria and warm body sensations and a sense of calm and tranquility.

Amanita Muscaria is legal in the US, except in Louisiana, and is sold online as a food supplement. It is available as raw dried mushrooms, gummies, vapes and as an extract. Public health experts are alarmed by the recent increase in use of A. muscarias extract and the lack of Federal and State control of the psychoactive substances (Leas EC et al. Am. J Pre Med, 2024: 1-6). There have recently been reports of accidental poisoning (Rampolli FL. The Deceptive Mushroom. EJCRIM 2021:8 doi:10.12890/2021_002212). 

There are substantial risks associated with ingesting this mushroom and its extracts. Unfortunately, the concentrations of the active ingredients listed on the label of the many products sold online may be inaccurate and cannot be trusted. It is a “buyer-beware” market.

Diamond Shruumz Wellness Products

Diamond-Shruumz sells “wellness products” which are derived from a variety of mushrooms including Holy Basil (Tulsu, Tulasi), Reishi mushrooms and Chaga mushrooms. These mushrooms are said to be non-toxic, reduce stress and help the body return to stable state. They are marketed to boost energy levels, improve cognitive function and mood and support the immune system. However, their products are toxic because they have been found to contain muscimol. The company cannot explain the source of muscimol and all Diamond Shruumz products were recalled in June 2024 by the company at the request of the FDA.

Another chemical found through testing upon the recall is O-Acetylpsilocin. This is a “prodrug” meaning the substance is not active until the liver breaks it down into the active compound. The active compound created is Psilocin, the psychoactive ingredient in Magic Mushrooms (Psilocybin and Psilocin). This will cause hallucinations, color shifts, perceptual changes, agitation, and other symptoms seen with use of Magic Mushrooms.

The FDA recalled their gummies, chocolate bars and cones, both micro and macro doses, in June 2024, after several people became ill. Symptoms included seizures, agitation, involuntary muscle contractions, loss of consciousness, confusion, sleepiness, nausea and vomiting, abnormal heart rates and high or low blood pressure. 

The company discovered that their products contained muscimol and reported to the FDA that “Muscimol could be a potential cause of symptoms consistent with those observed in persons who became ill after eating Diamond Shruumz products.” Muscimol is not present in Holy Basil (Tulsu), Reishi mushrooms and Chaga mushrooms. So where did it come from?

The key takeaway is that companies making these wellness products are making a buck until someone tells them they can’t. Given the substantial risks associated products containing muscimol and O-Acetylpsilocin, consumers are at risk and are not being accurately informed. 

Although these products have been recalled, it is likely that some are still available. Teens and their parents must be informed.

Synthetic Amphetamines are becoming more prevalent in the club scene and are very potent and dangerous. They are known as psychedelic phenethylamines, or the 2C Family of drugs, and are more potent and longer lasting than ecstasy. Most of the currently known 2C compounds were first synthesized by Alex Shulgin in the 1970s and 1980s, and published in his book, PiHKAL (Phenethylamines I Have Known And Loved) A love story. These compounds are structurally similar to mescaline and ecstasy and have been sold as a “legal” substitute for ecstasy in raves for years. This family of drugs includes 2C-E, 2C-I, 2C-B, 2C-T, 2C-N, 2C-NT, 2C-P, 2C-G-3, 2C-O, and 2C-T-7. Some street names include smiles, tootsie, blue mystic, 7-up, bees, nexus, and Tripstacy. They are sold online as a white crystalline powder, tablets, or pellets and can be very pure, 98-100%. These drugs are ingested (pill or tablet form), smoked, snorted and used rectally. The high can last anywhere from 4-24 hours with affects similar to ecstasy, but more intense. Common side effects include rapid heart rate, high blood pressure, dilated pupils, dangerously high body temperature, paranoia, hallucinations, chest pain, suicidal ideation, violence, and seizures. These substances have been linked to a number of deaths from serotonin syndrome and prolonged vasoconstriction. The vasoconstrictive effect may persist for days and result in sudden death from coronary artery constriction. Injection of the drug may lead to limb gangrene. Other complications include agitation, hallucinations, seizure, liver failure, or kidney failure. Toxicity may be dose related, and when mixed with other drugs such as alcohol, ecstasy, or cocaine can be lethal.

25I-NBOMe & 25C-NBOMe

25I-NBOMe is a very potent psychedelic stimulant and considered by users to be a legal version of LSD. It is often in liquid form and put on blotter paper. It is active at very low doses (micrograms) and are generally administered on paper placed under the tongue. One indicator that it isn’t LSD, is it causes numbness of the tongue and mouth. The drug is inactive if taken orally and swallowed. The onset of effects is rapid. Effects plateau in 2-4 hours, and can last 6-10 hours – sometimes much longer depending on dose. Side effects may last up to 7 days. Users experience visual hallucinations with color shifts, euphoria, dilated pupils, changes in perception of time, increased awareness, feelings of love and empathy and mental and physical stimulation. Undesired side effects include confusion, scrambled communication, paranoia, panic, and seizures. Clinical features included tachycardia, hypertension, agitation, aggression, visual and auditory hallucinations, seizures, hyperpyrexia, clonus, elevated white cell count, elevated creatine kinase, metabolic acidosis, and acute kidney injury. (Hill SL, Clin Toxicol (Phila). 2013 Jun 4.) Deaths have been reported. 25i is now a scheduled I drug and is known as 25i, smiles, Nbome, cheap acid, designer acid, or research. 

Note: The abuse of this drug presents as sepsis, causing death. However, no bacteria are detected in the blood or culture.

Geranium Extract (methylhexanamine) DMAA

Geranium extract (methylhexanamine) or synthetic Dimethylamylamine is marketed as “Pump-It Powder” or Jacked 3D”. Dimethylamylamine (DMAA) is a synthetic drug with the same physiologic activity as geranium extract and was originally sold as a nasal decongestant. Both the plant extract and DMAA may be smoked, ingested, or snorted and effects may last 4-6 hours.  The plant extract and synthetic DMAA are sold as dietary-supplements used for treating ADHD, stimulating weight loss, improving athletic performance, and bodybuilding. The ingredient list on packages of geranium may list rose geranium, geranium oil, or geranium stems. 

DMAA is now available as 100% pure powder and sold online for laboratory research and labeled “not for human consumption”. Yet, the manufacturer recommends a limited dose of 50 mg accurately measured on a milligram scale to avoid overdose. Effects peak in about 45-60 minutes and last for 4 hours. Taking pure DMAA raises blood pressure and may lead to chest pain and even heart attack. DMAA powder produces stimulant and reward-effects similar to cocaine and methamphetamine and has a strong potential for being abused. A number of adverse events have been associated with DMAA including psychotic symptoms and paranoia, hallucinations, increased heart rate and body temperature, dilated pupils and sluggish response to direct light and distortion of the senses.

DMHA (Dimethylhexylamine)

Known as Octodrine, Vaporpac, Amidrine, or 2-AMINO-6-METHYLHEPTANE.  It is a synthetic Amphetamine developed in the 1950’s for use as an inhalant to treat bronchitis, laryngitis, and other conditions. It was never approved for oral use but is showing up in products as a dietary supplement.  It shows up in pre-workout , weight loss, and “fat burner” products, and is similar to DMAA which is banned and listed on the world doping list as a Performance Enhancing Drug (PED). It is also banned by the Military. It is on the prohibited  dietary supplement ingredient list and is listed as an unsafe food additive. It is banned in the US because there isn’t enough research to determine if it’s safe for humans. The latest animal studies suggest DMHA might cause adverse cardiovascular effects including heart attack and death.

1,3-DMBA (Dimethylbutylamine)

Small amounts can be found in some plants. However, most of the DMBA found in supplements and other products is synthetic(man made). It is similar to DMAA and is a synthetic Amphetamine that the US FDA banned in 2015. It is on the world doping list and is a Performance Enhancing Drug (PED). There are no known human safety studies, and its health effects are entirely unknown. It is showing up in pills found at gas stations, vape shops, and online. It is being mixed with other substances that can make it extremely dangerous if ingested.