Toxicology
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Paramedics are called to a college fraternity Halloween party where a large cauldron of “green witches brew” was being served. Several students are found intoxicated with altered mental status and hallucinations. Two male freshman students suffer generalized tonic-clonic seizures en route to the ED.

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Absinthe has two main ingredients: alcohol and oil of wormwood. Artemesia absinthium, commonly known as wormwood, is a plant in the compositae family (sunflowers and daisies) indigenous to Eurasia and North Africa. Humans have a long history with wormwood, using it for various ailments. Its first documented medicinal use occurred in 1552 B.C. when Egyptians used wormwood as an anti-helminthic. Pliny the elder later championed it as a wine fortification in the first century AD. The advent of steam distillation in the 1500s allowed for the creation of potent extracts of wormword. In 1789 Dr. Ordinaire, developed a recipe for an alcoholic beverage based on the dried leaves of wormwood. The drink quickly gained popularity among the French and in 1798, the Pernod Fils distillery began commercial production of the drink we now know as Absinthe.

Following the upheaval of the French revolution, a newly empowered upper class looked for an alternative to the traditional spirit of wine. Absinthe was the benefactor of this shift, becoming the choice drink of the flourishing bohemian lifestyle. Purported to stimulate creativity and possess aphrodisiac properties, it was the preferred drink for the artesian class.  Artists Vincent van Gogh, Pablo Picasso, Paul Gauguin, Edward Manet, Edgar Degas, and authors Oscar Wilde, Emile Zola, Paul Verlaine, Arthur Rimbaud, and Ernest Hemmingway all imbibed the potent green liquor with regularity.

In the setting of global movement towards temperance in the late 1800s, Absinthe was branded as “madness in a bottle” and blamed for inducing insane and criminal acts. The term absinthism was coined, describing a form of alcoholism characterized by delirium, hallucinations, tremors, and seizures. Absinthe was serially banned by most of the European countries, the US, and finally by France in 1915.

Absinthe traditionally contains 75-80% ethanol; is 150-160 proof, twice that of most standard whiskeys. The wormwood plant contains 1-2% volatile oil by weight; 70% of this oil is thujone (composed of α and β versions). Traditional Absinthe contained 260-350ppm thujone. Today’s watered down version must contain less than 10ppm by law.

Thujone, an aromatic hydrocarbon structurally similar to THC (the active component of marijuana), has been linked to mystical effects of Absinthe. Thujone is also present in the liquors vermouth and chartreuse. It is known to have analeptic properties, produce mood elevation, work as an anti-depressant and can also lead to anxiety and increased alertness. This is in stark contrast to ethanol, which is a depressant, anxiolytic, and amnestic. Thujone has been shown to have some activity at both nicotinic and muscarinic receptors, but these effects are largely insignificant. The majority of its effects come from inactivation of GABA receptors. Thujone is a non-competitive GABA-α chloride channel receptor blocker. Blocking GABA, the chief inhibitory neurotransmitter in the brain, leads to activation of neurons. Ethanol, on the other hand, is a GABA-α chloride channel receptor enhancer, leading to neuronal inactivation. Hence, thujone and ethanol have completely antagonistic properties. Thujone is metabolized by the cytochrome p-450 system, and its metabolites are renally excreted.  

It has been postulated that the thujone levels in traditional absinthe would have had a definite intoxicating effect. The effect of thujone in present day absinthe is less clear. The thujone content of legal absinthe today is unlikely to cause acute toxicity. However concentrated oil of wormwood is still commercially available via the Internet, and acute overdoses can still occur.

Paradoxically, the toxicity of thujone mirrors that of alcohol withdrawal. Autonomic excitation can progress to acute encephalopathy, unconsciousness, decreased seizure threshold, and tonic-clonic seizures. Permanent CNS damage may occur with repeated exposures, leading to insomnia, tremors, nightmares, dizziness, delirium, and paralysis.

Treatment of acute thujone intoxication is typically supportive care with benzodiazepines for seizure control.  Chronic use may require enrollment into a detoxification program.

Case outcome:
Both college freshmen have limited tonic-clonic seizure responsive to supportive care and intravenous benzodiazepine administration in the ED. After 48 hours of observation in the intensive care unit, both patients are discharged home and recover uneventfully. Analysis of the “green witches brew” served at the party reveals large concentrations of absinthe containing oil of wormwood and thujone.

References

  • Blumer: The Illness of Vincent van Gogh. American Journal of Psychiatry: 4/2002.
  • Greenberg, M: Diagnosis: Absinthe Intoxication Emergency Medicine News: 4/2003
  • Harris JB, Blain PG: Neurotoxicology: What the neurotoxicologist needs to know. Journal of Neurology Neurosurgery Psychiatry: 2004
  • Hold et al : α-Thujone: GABA type A receptor modulation and metabolic detoxification PNAS: 4/2000.
  • Huisman et al: Absinthe – Is its History Relevant for Current Public Health? International Journal of Epidemiology: 2007
  • Skyles et al - Alternative Therapies: Wormwood American. Journal of Health-Systems Pharm: Vol 61 2/2004.
  • Smith: Absinthe Attacks. Practical Neurology. 2006.
  • Strange et al: Absinthe: What’s Your Poison? British Medical Journal: 10/1999

 


 

 

Comments   

# Woah! Wrong info!Evan Camomile 2011-10-29 15:44
No. The info about thujone in this article has been proven incorrect. Thujone is a convulsant, and the absinthe back in the day was not at 260-300ppm it actually tested out to current US and EU standards. It is NOT related to THC at all. All traditional absinthe contained anethole and fenchone as well due to all absinthe back then, and now, containing anise and fennel as main ingredients as well.

Whatever the homemade witches brew this article's event is based on was a mock-absinthe (usually vodka maceration) probably containing wormwood oil, not the distillation of the herb which removes much of the thujone content.

You can view the science behind all this at www.thujone.info
Reply
# Entirely too much incorrect information.Brian Robinson 2011-10-29 16:05
As the Media Liaison for the Wormwood Society, a non-profit absinthe education organization, I feel it imperitive to correct the obscene amount of incorrect information in this article.

1) What was being served at the party was more than likely NOT absinthe. Traditional, authentic absinthe cannot be homemade, as it needs to be distilled. It is easier to conclude that what was served was some form of knockoff, macerated product. These homemade versions are extremely dangerous for multiple reasons, not the least of which being that we don't know everything that they decided to throw into this cauldron.

2) Authentic, traditional absinthe is not made with oil of wormwood. Only lower quality versions use oils or extracts. Properly made absinthe uses wormwood which is macerated in a base alcohol, then distilled. Thujone itself does not readily transfer into the distillate.

3) While traditional absinthe is indeed much stronger than most whiskey, it is also intended to be diluted with 3-5 parts water before being ingested, bringing it down to approximately the strength of a glass of wine.

4) Traditional absinthe did NOT contain anywhere near 260 ppm of thujone. This was conjecture postulated by Dr. Wilfred Arnold, which was based on faulty assumptions. His postulation was not followed up upon with ANY testing of the production method of absinthe or of any actual samples of absinthe. Recent studies that have been performed have shown that pre-ban absinthe, in most cases, contained thujone concentrations similar to that of current regulations. In fact, many of the most popular brands would fall under the current EU or US guidelines. (see www.thujone.info for copies of the studies)

Thank you,

Brian Robinson
Review Editor
Media Liaison
The Wormwood Society
Reply
# Not quite accurateJoe Legate 2011-10-30 03:25
Interesting article but there are some glaring errors that need to be addressed.
First, allow me to say that I am an Administrator for The Wormwood Society, the premiere absinthe education site in the world (www.wormwoodsociety.org) and I am a distiller of absinthe in the United States.

Let's start with "Absinthe has two main ingredients, alcohol and oil of wormwood." While alcohol is a primary ingredient, there are no reputable producers of absinthe, either contemporary or historically that uses/used oil of wormwood. The primary ingredients in absinthe are alcohol, anise, fennel, wormwood (the herb), coriander, angelica and a host of other herbs.

While it's true, US absinthe must test at -10ppm thujone content, evidence is conclusive that pre-ban absinthe generally had no higher level of thujone than contemporary absinthes. In fact, many pre-ban absinthe would easily pass the TTB's rigorous standards www.wormwoodsociety.org/index.php?option=com_content&task=view&id=251&Itemid=215. The simple fact is, thujone does not readily pass through the distillation process.

There are a number of other glaring errors but accurate information can easily be found at The Wormwood Society. I suspect the hideous example used in the article was not absinthe at all but a concoction of Everclear, oil of wormwood and green food coloring. The hapless college students were only a little less informed than Dr. Hoene and Dr. Erickson.
Reply
# So much misinformation rehashedIan Hutton 2011-10-30 20:43
It is hard to believe that this was written by two MDs. The 'information' on thujone is badly out of date and appears to be lifted from sources over ten years old. I will declare a vested interest from the start; I sell absinthe. However, as an analytical chemist and absinthe historian I have spent the best part of 10 years attempting to educate the public about absinthe. I published a peer-reviewed paper on the myths surrounding absinthe in Current Drug Discovery, September, 2002. http://www.absintheonline.com/myth_reality_absinthe.pdf

Let’s look at the ‘facts’ offered here:

1.19th century absinthe did not contain 260 to 300 ppm of thujone. Firstly there was no means of separating the thujone from other terpenes and testing to this accuracy at the time and secondly, when samples of pre-ban absinthe are now tested using GC-MS the levels are generally below 30 ppm. The often quoted source for this is actually a distiller’s manual, I have the original and it does not discuss thujone anywhere.

2.There is no similarity between the 3D molecular structure of thujone and THC. This claim was, I believe, first made in an article published in Playboy magazine in the sixties. The 2D structure diagrams may have a passing similarity but functionally the molecules do not have anything in common.

3.It is likely that the brew consumed by the students was an attempt at home-made ‘absinthe’ . There are unfortunately still many sources on the internet that claim you can make absinthe by adding oil of wormwood to alcohol and the essential oils does contain potentially toxic concentrations of thujone. On the other hand, who knows what else did this brew may have contained?

Such sloppy rehashing of misinformation is inexcusable, please check your facts before publishing!
Reply
# Outdated, Speculative and ErroneousN. Popich 2011-10-31 17:44
Instead of referencing the more recently published studies that involve veritable samples of the original liquor and/or human test subjects, this article draws heavily upon older references, at least several of which that rely upon speculative information that has since been debunked.

Among the numerous glaring errors contained in this article, absinthe was not a product of steam (water) distillation, was not traditionally crafted using wormwood oil, was not traditionally bottled at 150-160 proof (120-144 is far more representative) , and not one bottle of the several dozen original examples analyzed to date has exhibited more than a trace of thujone (Journal of Agriculture and Food Science, 2008). Ditto those results for modern facsimiles of original absinthes, traditionally distilled in accordance with the most credible treatises of the period.

The most recent studies conclude in a most convincing fashion that thujone served no role in traditional absinthe except as a convenient scapegoat with which to demonize the spirit during an era when science could provide few answers. Today, these lingering myths serve only as fodder for profiteers who have no mission except to mislead modern consumers into purchasing shoddy products.
Reply
# Startling lack of research!Tang 2011-11-02 09:21
I am shocked at the lack of legwork done for this article. It is reminiscent of old college papers that althogh the student had 3 weeks to write, was actuely written the night before.
Please - if you are going to entertain an article that is half drawn from the authors rectum, at the very least TRY to throw it into the autoclave. It only takes 10 minutes people. TEN MINUTES! Please have some respect for EP Monthly and it's readers.
Reply

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