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Clinical Summary

Peyote (Lophophora williamsii) is a cactus plant found primarily in the southwestern United States. The cactus contains a significant amount of mescaline, a potent hallucinogen with structural similarities to norepinephrine. Peyote buttons and seeds are frequently ingested for recreational use but are also used in the religious ceremonies of some Native American groups. Toxicity of peyote is generally mild and self-limited, but hypotension and respiratory depression can occur. Mescaline induces some sympathomimetic effects due to its similarity to norepinephrine; marked visual hallucinations and a sense of depersonalization follow. These effects are often accompanied by unpleasant GI symptoms such as severe nausea and vomiting. Full recovery from these symptoms usually occurs within a few hours.

Management and Disposition

Treatment of peyote ingestion is largely supportive; severe toxic effects are uncommon. Marked agitation may be managed with benzodiazepines.

FIGURE 17.105

Peyote Cactus Patch. Patch of peyote crowns growing in the desert. (Photo contributor: Martin Terry, PhD.)

Pearls

  1. An individual peyote button contains about 45 mg of mescaline; a mescaline dose of 5 mg/kg usually produces psychotropic effects.

  2. Botulism poisoning has been reported from the ingestion of dried peyote buttons.

FIGURE 17.106

Peyote Cactus. An individual crown of peyote. (Photo contributor: Martin Terry, PhD.)

FIGURE 17.107

Peyote Button. This desiccated button of peyote is the form that is ingested for recreational or religious purposes. (Photo contributor: Martin Terry, PhD.)

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