Is Syrian rue considered an intoxicant?

Syrian Rue as an Intoxicant

Yes, Syrian rue (Peganum harmala) is an intoxicant that can produce hallucinogenic and psychoactive effects, with potential for serious toxicity at higher doses.

Pharmacological Properties and Active Compounds

Syrian rue contains several beta-carboline alkaloids that are responsible for its psychoactive effects:

• Harmine
• Harmaline
• Harmalol
• Harmol

These compounds act as monoamine oxidase inhibitors (MAOIs), which can produce stimulant and hallucinogenic effects in humans 1. The plant has been used traditionally in various cultures, but its recreational use carries significant risks.

Intoxicating Effects

Syrian rue produces dose-dependent effects:

• At low doses (3-4g of seeds): Stimulant and mild hallucinogenic effects 2
• At higher doses: More intense hallucinogenic effects and potential toxicity
• At very high doses (e.g., 100g of seeds): Life-threatening toxicity 2

Toxicity Profile

Syrian rue can cause serious toxicity, particularly at higher doses:

• Cardiovascular effects: Hypertension and tachycardia 2
• Neurological effects: Altered consciousness, hallucinations, and potential seizures
• Metabolic effects: Elevated liver enzymes and renal markers 2
• Respiratory effects: Tachypnea and potential respiratory depression

A case report documented a patient who consumed approximately 100g of Syrian rue seeds (10-20 times the recommended dose) and developed unconsciousness, hypertension, tachycardia, tachypnea, and elevated hepatic and renal function markers requiring intubation and five days of supportive care 2.

Interactions with Other Substances

Syrian rue's MAOI properties create dangerous interactions with other substances:

• When combined with DMT-containing plants like Acacia tree bark, it can produce intense psychedelic effects by preventing the breakdown of DMT 3
• This combination has resulted in documented cases of DMT poisoning with symptoms including altered consciousness, rhabdomyolysis, and elevated liver enzymes 3

Clinical Management of Intoxication

For patients presenting with Syrian rue intoxication:

1. Ensure airway, breathing, and circulation
2. Provide supportive care, which is typically sufficient for recovery 2
3. Monitor for:
   • Cardiovascular instability
   • Respiratory depression
   • Hepatic and renal function
   • Neurological status

Regulatory and Cultural Context

Syrian rue is used in various contexts:

• Traditional medicinal uses in Middle Eastern and North African cultures
• Religious/spiritual ceremonies in some traditions
• Recreational use for its psychoactive effects
• As a component in psychedelic preparations like ayahuasca analogs 4

The legal status varies by country, but its potential for abuse and toxicity makes it a substance of concern.

Conclusion

Syrian rue should be considered an intoxicant with significant potential for toxicity, particularly at higher doses or when combined with other psychoactive substances. Its MAOI properties create additional risks through drug interactions. Medical providers should be aware of its effects and potential for serious adverse reactions.