Unexpected Detection of Psilocybin in a 100 mg Tramadol Tablet: A Forensic Case Report

Background: Tramadol is a synthetic opioid analgesic prescribed for moderate pain. Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) is a naturally occurring psychoactive compound found in certain mushrooms, often referred to as "magic mushrooms" and is classified as a Schedule I substance. This case report aimed to present the unexpected detection of psilocybin in a 100 mg tramadol tablet.Case Presentation: This case report presents the forensic identification of psilocybin in a tablet labeled as tramadol 100 mg. Analysis was conducted using Gas Chromatography–Mass Spectrometry (GC-MS). A high concentration of psilocybin was confirmed, and additionally, 60 mg of tramadol was detected in the analyzed tablet.Discussion: Active compounds of some mushrooms, such as Psilocybe cubensis and Paneolus, have psychotropic agents with hallucinogenic effects. Psilocybin is a prodrug of psilocin, meaning it's converted into psilocin in the body, and Psilocin then acts as a serotonin receptor agonist, particularly on the 5-HT2A receptor, leading to visual hallucinations, euphoria, and altered cognition. These effects can be particularly dangerous when combined with other opioids and psychoactive substances that do not have a determined dosage and intensify each other's effects.Conclusion: This case underscores the importance of drug monitoring and advanced toxicological analysis in combating the public health threat posed by drug adulteration.