The author reports an acute, though brief, psychotic reaction to marihuana soaked in scopolamine. As young people continue to experiment with various drugs it is important for therapists to be aware of the possibility of scopolamine use when treating toxic psychoses.

THE SEARCH BY many of today's young people for drugs that will give a "mind expanding," i.e., pleasant, hallucinatory experience has included drugs of all categories, from cannabis sativa to morning glory seeds (7) to banana peels. One young man of more exquisite tastes has drawn his marihuana smoke through a hookah charged with vintage wine. In a recent letter to the editor of this journal, Bernstein and Leff (4) predicted from their experience that toxic states secondary to the ingestion of belladonna alkaloids would shortly be reported in the clinical literature. Unfortunately they predicted correctly.

This is a report of a case of acute marihuana and scopolamine intoxication from smoking marihuana soaked in scopolamine. The smoking of plants containing belladonna alkaloids for their hallucinatory effects has been practiced for centuries by Arabs, Swahilis, and American Indians. Its use American young people in this particular form has not been reported, although several investigators(2, 9) have seen it in the results of the use of a drug for the relief of asthma (Asthmador) containing belladonna and stramonium.

Case Report
The patient was a 19-year-old college student who had had previous experience with smoking marihuana and was a frequent, though not daily user. She had learned from a friend, who worked in a laboratory that he could achieve a "better high" from "pot" soaked in scopolamine. She received three such treated cigarettes from him and smoked them in the presence of some friends.

Within 30 minutes after smoking she developed reactions unlike any she had previously experienced. She began to become agitated, combative, and delusional. She reported that her girl friend appeared to be a Negro man and that other men were coming in her window. She was aware that these were hallucinations but was unable to control them. Finally she felt that she had become crazy and that these figures were coming to take her to a hospital. Voices sounded like the ringing of a telephone. Her heart felt cold, as if it was filled with ice water. Equally frightening to her was the loss of the ability to use proper grammar. She heard monkeys and owls in her room but was unable to state whether "It is owls here," or "It are owls here." Time and space perceptions were altered as she lay clinging to her bed to keep from falling off.

This state gradually cleared over the next 12 hours. Whenever she closed her eyes, however, the hallucinations returned. This lasted until 24 hours after inhalation. After clearing, there was no persistence of psychosis.

Discussion
Scopolamine is one of the active principles found in solanaceous plants which, along with atropine and hyoscyamine, are known to produce hallucinations( 6 ). Toxic psychoses as the result of the ingestion of sleeping medicines containing scopolamine have been increasingly reported (3, 5 ).

At the same time, the question of whether marihuana ingestion can create in acute toxic psychosis is pertinent. Keeler(8) believes that there are many adverse reactions to marihuana reporting cases of panic, gross confusion, depersonalization, depression, and paranoia with its use. Allentuck(1), in his classical study in 1944 on marihuana psychosis, stated that major symptoms are "restlessness, and mental excitement of a delirious nature with intermittent periods of euphoria and an overhanging state of anxiety and dread." Thus, we must be concerned about the combined and even synergistic actions of scopolamine and cannabis in the creation of an acute toxic state.

Fortunately for the patient described above, there was no residuum. Others may not be so lucky. One of the most dangerous results of scopolamine toxicity with its hallucinations is the activation of a hitherto latent psychosis. In the population most interested in discovering new hallucinogenic drugs for pleasure the risks are high, since it raises the potential for more permanent damage to those with already severely weakened defenses or borderline personalities. Diagnosis of toxic states in young people must include investigation of the possible use of scopolamine as well as marihuana. Psychotherapeutic efforts should include warnings of its dangers.

REFERENCES

1. Allentuck, S., cited by Solomon, D.: The Marijuana Papers. New York: Bobbs-Merrill Co., 1966, pp. 278-283.
2. Angrist, B.: The Bad Trip, Psychiatric Progress 3:5-6, 1968.
3. Bernstein, S., and Leff, R.: Toxic Psychosis from Sleeping Medicines Containing Scopolamine, New Eng. J. Med. 277:638-639, 1967.
4. Bernstein, S., and Leff, R.: Toxic Psychoses From Over-the-Counter Preparations (Ltrs. to Ed.). Amer. J. Psychiat. 124:1270, 1968.
5. Bradford. M. E.: More Cases of Atropinism (Ltrs. to Ed.), New Eng. J. Med. 277:1209, 1967.
6. Downing, D, F: "Psychotomimetic Compounds," in Gordon, M.: Psychopharmacological Agents. London: Academic Press, 1964, p. 579.
7. Fink. P. J., Goldman, M. J.. and Lyons, I.: Morning Glory Seed Psychosis. Arch. Gen. Psychiat. 15:209-213, 1966.
8. Keeler. M. H.: Adverse Reaction to Marihuana, Amer. J. Psychiat. 124:674-677, 1967.
9. Keeler. M. H., and Kane, F. J., Jr.: The Use of Hyoscyamine as a Hallucinogen and lntoxicant, Amer. J. Psychiat. 124:852-854, 1967.