Many people have written me about my article: “Is Rapé Snuff Safe?” The comments range from outrage to appreciation and everything in between. Since publishing this article, I’ve had the opportunity to work 1:1 with several individuals who have been injured by rapé snuff. These individuals include people who suffered seizures upon their very first administration of rapé at a “rapé circle” to experienced plant medicine people who have experienced stroke-like symptoms after heavy use. The purpose of this follow-up article is to provide additional mechanisms by which rapé might cause harm.
If you have not read my prior article, I would start there.
Background on Rapé
Rapé is a powdered shamanic snuff made from various Amazonian plants. It is blown forcefully into the nostrils through a pipe or tube, either by oneself or by another person. The main plants used include nicotiana rustica (a potent form of tobacco), other varieties of tobacco, and various medicinal Amazonian plants. Rapé usually contains nicotine and other alkaloids that can have powerful effects on the body and mind. Nicotine acts as both a stimulant and depressant in complex ways within the body. Other alkaloids found in various rapé preparations may have anti-inflammatory, anesthetic, and antimicrobial properties.
The short term effects of rapé can include a strong burning sensation in the nasal cavities and throat, watery eyes, increased heart rate and body temperature, dizziness, nausea, and altered states of consciousness. These effects subside after 20-60 minutes typically. As an entheogenic medicine, rapé can provide access to spiritual planes of consciousness–that is, it can connect one with God. In this way, many people believe rapé to be a powerful medicine for connecting with divine realms, for prayer, or as an ally in personal healing (physical, emotional, spiritual, mental). There is no denying the power of this medicine, and in no way am I attempting to diminish it. To me, rapé is an extremely powerful medicine demanding of respect and not something to play around with casually.
Nicotine Poisoning: A Real Risk
One of the primary risks associated with rapé usage is nicotine poisoning, something rarely discussed, but experienced by some users. Nicotine is a toxic substance. Some of the effects of nicotine as a purgative and cleansing agent are due to its toxicity. In high doses, the body will attempt to clear the toxicity via means such as vomiting and defecation. Nicotine poisoning is also known to cause seizures, and even death in high enough doses. The lethal dose of nicotine is estimated to be 30–60 mg for adults and just 10 mg for children. This can vary widely with people who have developed a tolerance for nicotine vs. first time users.
The nicotine content in rapé can vary greatly, from 5-28% or even higher in some blends. To put this in perspective, 100 mg of 28% nicotine rapé would contain 28 mg nicotine. This is enough to kill a child but is far more than the usual dose, which is typically just a few grams at a time. Nevertheless, some of the Amazonian tribes that work with rapé are known to give incredibly high doses that might come close. Of course, these high doses are only given to those who have a long-standing relationship with the plants–that is people with a high tolerance.
Nicotine is absorbed rapidly through the mucus membranes in the nose, which is one reason rapé has such powerful effects. This makes nicotine poisoning a particular risk with regular, heavy use of rapé. The half-life of nicotine is usually cited to be around 2-hours, though metabolites of nicotine can persist much longer. The elimination of nicotine through the liver is heavily reliant on a cytochrome p450 enzyme. For these reasons, frequent and heavy users of rapé may eventually begin to build up toxicity that cannot be effectively cleared and might impair their liver’s ability to clear other toxins. Other plants, including Ayahuasca, contain alkaloids that inhibit various cytochrome p450 enzymes. Thus, combining rapé with other plants (including ayahuasca) can further impair the body’s ability to clear toxins. I will also note that cytochrome p450 enzymes are copper dependent and many people are functionally copper deficient, which increases the risk of harm.
Early symptoms of nicotine poisoning can include burning of the nose and throat, nausea, vomiting, dizziness, increased salivation, abdominal pain, diarrhea, headaches, hearing and vision disturbance. In severe cases it can progress to difficulty breathing, irregular heart rate, seizures, collapse, and even coma or death from respiratory failure.
Case Reports
There are case reports of non-fatal and fatal nicotine poisoning from rapé use. Here are a few, though they remain unverified at the moment due to limits on obtaining the source materials.
- A case report from 2020 details a 35-year-old man who experienced seizures and respiratory arrest after inhaling rapé he had purchased online. He required intubation and admission to the ICU.
- A 2015 paper describes a 26-year-old man who developed nicotine toxicity and recurrent seizures after using rapé he had bought over the internet.
- A letter to the editor in 2018 reports on two cases of adults who experienced loss of consciousness, seizures, and hospitalization after using rapé containing very high levels of nicotine.
- A case study in 2021 describes severe nicotine intoxication in a 19-year-old requiring ICU admission following inhalation of an internet-sourced rapé powder.
- A 2008 paper from Brazil reports on a 25-year-old man who died following seizures and respiratory arrest after insufflating a homemade rapé powder.
- A 2021 case report describing acute kidney injury in a 37-year-old man after inhaling rapé he bought online. Kidney function recovered after several weeks.
- A report from 2020 discusses a 15-year-old girl who developed respiratory failure and required mechanical ventilation after using rapé she purchased over the internet.
- A case study from 2018 reports on a 34-year-old man who experienced diplopia (double vision) and bilateral blurred vision for several weeks following insufflation of homemade rapé.
- A paper from 2015 details severe hepatotoxicity (liver damage) in a 29-year-old man after using rapé along with other herbal remedies.
- A case report discusses two women who developed chronic contact dermatitis on their face and hands after frequent ceremonial use of rapé.
Hepatotoxicity
Though not widely discussed, rapé may cause liver injury via multiple mechanisms of action. First of all, the nicotine in rapé can be directly toxic to liver cells at high doses. Nicotine metabolites accumulate in the liver, and frequent use may overwhelm the liver’s ability to detox. Other alkaloids present in rapé can also be hepatotoxic–including alkaloids found in various Datura species and other tobacco plants. These include nicotinic alkaloids like nornicotine, anabasine, anatabine, as well as tropane alkaloids.
Rapé may also contain harmful additives, or by-products that arise during its production. Additives or adulterants sometimes found in rapé preparations may also be hepatotoxic, like toluene, camphor, or certain synthetic cannabinoids. Contaminants during production and storage could also play a role.
And, as mentioned above, some alkaloids found in some rapé blends are known to inhibit the cytochrome p450 enzyme, a necessary and powerful antioxidant. Heavy or habitual use of rapé may contribute to liver damage through accumulation of toxic compounds over time.
Summary of Potential Health Risks
Rapé contains variable levels of nicotine and other alkaloids that can cause nicotine poisoning and toxicity symptoms like nausea, seizures, respiratory failure, even death. Regular use could potentially lead to addiction due to the nicotine content. Case reports indicate rapé may also cause vision changes, kidney injury, respiratory failure, and liver damage. Rapé ceremonies involve forceful insufflation which increases absorption and toxicity risks.
Mechanisms of Injury
Nicotine itself is toxic at high doses and can cause seizures, respiratory failure. Nicotine metabolites may accumulate in the liver, leading to liver damage. Other alkaloids like nornicotine, tropane alkaloids also toxic and can cause organ damage. Additives, adulterants, contaminants may play a role in some cases. Harmala alkaloids (found in Ayahuasca) may inhibit liver enzymes including cytochrome p450, leading to liver toxicity and the inability to fully metabolize nicotine. Heavy use may lead to accumulation of toxic compounds, increasing long-term risks.
Social Harms
There are additional harms not discussed herein that are common, including the damaging effects of addiction on relationships. This is beyond the scope of this post.
