Amanita muscaria in the evolving novel psychoactive substances landscape - toxicological risks and clinical implications: a narrative review

The rapid evolution of the novel psychoactive substances market has blurred the boundaries between synthetic “designer drugs” and other emerging psychoactive products distributed outside traditional regulatory frameworks. Recently, increasing recreational and self-therapeutic interest in Amanita muscaria has led to its growing presence within the broader landscape of substances used in patterns similar to novel psychoactive substances. Widely available through online platforms and social media, it is promoted for stress reduction, mood improvement, sleep enhancement, and analgesic purposes, despite limited clinical evidence and established toxicity risks. This narrative review synthesizes available clinical and toxicological evidence on A. muscaria and its reported adverse health outcomes. Emerging reports indicate increasing intentional consumption, heterogeneous dosing practices, and presentations ranging from mild neurological symptoms to severe intoxication requiring hospitalization. Online narratives and informal harm reduction advice contribute to normalization of use and potential underestimation of risks. Within the context of novel psychoactive substances research, A. muscaria represents a regulatory and public health challenge: a non-synthetic psychoactive substance integrated into digital drug markets and self-experimentation cultures. The absence of standardized management guidelines and systematic surveillance complicates clinical response. Greater awareness of its toxicological profile, patterns of misuse, and emergency management strategies is needed to inform clinicians, toxicologists, and public health authorities.