From the Kiki challenge, which involves hopping out of a moving vehicle and dancing to the tune of Drake’s “In My Feelings” while the car continues to move, to the The Fire challenge, which purposely has teens use rubbing alcohol to set their bodies aflame for the purpose of testing one’s endurance and garnering likes and shares, the dangers associated with social media challenges are abound.
A new social media challenge is sweeping TikTok, a video sharing social media site fast becoming the most popular online platform for children and teens. The Nutmeg challenge involves ingesting large quantities of nutmeg to receive a euphoric and “high” sensation.
“This is a very risky practice,” Kirk Hughes, education director for the Minnesota, North Dakota and South Dakota Poison Control System, said. “It can cause potentially life threatening effects.”
As the coronavirus quarantine traps millions of children and teens in their homes across the Midwest, boredom is leading many to partake in the social challenge and documenting the result for countless others to watch. Nutmeg contains myristicin, a potent compound known to cause psychoactive effects if taken in large quantities, and can be dangerous.
A recent study on nutmeg intoxication that appeared in the journal of medicine found that large quantities of nutmeg has “toxic effects, including hallucinations, tachycardia, nausea, vomiting, and agitation.”
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“For 2020, we have had no reports of Nutmeg exposure in North Dakota and South Dakota so far, but we have had seven reports in Minnesota,” Hughes said. “Three of those cases were intentional ingestion and one specifically mentioned TikTok. One ended up going to the hospital.”
A 2018 report from Healthline said that "in some cases toxic doses of myristicin have caused organ failure," and adding "in other cases nutmeg overdose has been linked to death when used in combination with other substances."
“Nutmeg is one of these interesting plants with a cool name, Myristica Fragrans,” Hughes said. “If you were incarcerated in the late 1800s or early 1900s, one of the best places to work would have been the kitchen for the reason that there were many things there naturally that could get you high.”
Hughes outlined how vanilla extract and nutmeg were used as intoxicants by inmates, owing to the high alcohol content and hallucinogenic properties of the product respectfully.
“So what nutmeg does is that it causes what we call an anticholinergic effect, that means that it basically causes the same thing as if you took a Benadryl or Diphenhydramine overdose,” Hughes said. “Some people do that to get high and part of what this anticholinergic toxidrome is that it can cause hallucinations which is what they are after.”
Hughes continued, “The problem is that it can cause things that are potentially bad. Urinary tension, where the person can’t pee for a period of time. In our cases, we’ve had people come in and have to be catheterized. One case that comes to mind was that of a teenage male, which isn’t the age group you would want to be catheterized by some nurse.”
In addition to urinary tension, Hughes said the issues can go from almost benign to life threatening.
“If you take enough of it, it theoretically can cause cardiac disturbances. If you have an underlying cardiac condition or an undiagnosed cardiac genetic defect, this could be problematic. In rare cases you could have seizures from it.”
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Most recipes using the spice call for roughly 1/4 or 1/2 of a teaspoon of nutmeg per recipe, and as Healthline notes "these recipes are often split into multiple portions, leaving the actual exposure to nutmeg to be very insignificant." However, videos being shared online showed that many children were not using the already dangerous two teaspoons called for in the challenge, but rather two tablespoons — far exceeding the five grams that can be toxic.
Most concerning for medical professionals is that many of the minors participating in the challenges online are seeking the intoxicating effect of the spice and after several minutes of no effect, end up taking a second dose. According to studies, the effects can take hours to kick in and a second dose only increases the potential for toxic effects.
“Some people have described it as not a very pleasant high,” Hughes said. “A property of an anticholinergic effect is that it slows down your gut, and when it does that it stays in your body longer and is more bioavailable to the body. This causes a delayed and prolonged effect and when people do expose themselves to this they are going to be high for the better part of 12 to 24 hours which is rather prolonged.”
Hughes added, “In the cases we had this year, some of the cases presented or called the next day saying that their kids were still hallucinating.”
While the challenge calls for drinking the substance in water, some cases have been purported to consume the nutmeg on a spoon similar to the cinnamon challenge made popular in 2017 and 2018.
“In some cases it can get into the lungs and cause pneumonitis if aspirated,” Hughes said. “It doesn’t belong in the lungs and can get there from violent coughing. Aside from all the other concerns with nutmeg, if someone has asthma or are predisposed to having an attack, it’s going to cost you an overnight in an ICU at a minimum.”
Should someone ingest toxic levels or nutmeg, Hughes advises to contact the free, 24-hour professional advice of the emergency poison management services.
“As long as it is not immediately life threatening, people should call the poison help hotline at 1-800-222-1222,” Hughes said. “Do not wait for symptoms to appear. We are HIPAA compliant so we not going to get anyone in trouble and are a part of the healthcare team.”
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According to Hughes, in approximately 32% of cases where people go to the emergency room, the medical staff call the emergency poison management service unbeknownst to the patient.
“If you need to go to the ER and you go on your own, you’ll be treated like any other patient, but we have relationships with all the healthcare facilities in Minnesota, North Dakota and South Dakota and if you call us and we deem that you need to be seen, we can call ahead and have them ready for the patient,” Hughes said. “Then you don’t have to wait around in chairs with all the other potential COVID-19 patients. That’s what I would recommend.”
Hughes did express that the poison help hotline should be used for non-life threatening issues.
“If someone is having difficulty breathing, chest tightness or those types of symptoms, those would be an obvious 9-1-1 case,” he said.
For those looking to avoid unintentional nutmeg overdosing, experts said to consider that cooking with nutmeg in small amounts is safe. For more information on toxic edible substances, visit https://www.health.nd.gov/ and search for “Hazard Analysis and Risk-Based Preventive Controls for Human Food.”
