Abstract
This is an interesting note about the observation of an altered state of perception and body awareness after ingestion of a single dose of 0.5 mg BOL-148 (1). However, several considerations should be made about the questionable causal relationship of the observed symptoms and the ingestion of BOL-148. It was reported that the young man was “a moderately anxious … worker … who usually controlled and repressed his affective expressions.” Subsequently, we learn that—15 (!) minutes after BOL-148 ingestion—“he complained of lightheadedness and expressed the fear that he might lose consciousness” and “his elevated mood gave way to one of intense anxiety merging into panic.”
Everything is told in this: small changes in body awareness had turned into a strong panic attack against the background of an anxious personality increasingly seeking attention for myriad complaints after BOL-148 ingestion, which seems to have been surreptitious (“about 15 minutes later [from ingestion] … he sought aid for his state”). Altered and intensified body experiences, such as described in this report, are typical for panic reactions and may be promoted by fixed attention to those bodily reactions to anxiety. Reactions as early as 15 minutes after drug intake also points to anxiety rather than a direct effect of BOL-148: in all published clinical experiments with BOL-148, effects appeared only after a minimum of 30 minutes. Although antipsychotics do not intensify hallucinogenic effects (2,3), this lab worker also complained of a rekindling of peak effects from co-administration of 10 mg of the low-potency neuroleptic chlorpromazine approximately four hours post BOL-148 ingestion. Moreover, it is reasonable to presume that a worker in the laboratory of H.G. Wolff in 1957 knew what an altered state looks like after ingestion of an hallucinogenic substance (4), and therefore may have been well-prepared to express certain expectations about the reactions following ingestion of LSD or LSD derivatives. It is not quite clear what, if any, informed consent was offered prior to drug administration, and it also appears that this lab worker may have self-administered BOL-148 without permission, as noted above. No information is mentioned about the source of the BOL-148, its purity and chemical composition, and so on. Finally, no evidence of the major typical effects of LSD—such as pseudo-hallucinations, intensification of visual imagery with eyes closed, synesthesias, or distortions of time and space—was given in this case report (5). The altered state described cannot be characterized as a “toxic delirium” because it was reported that the subject was always completely oriented to time, space, situation and person, and had no consistent clouding of consciousness and no hallucinations.
In contrast, there are numerous reports describing no typical LSD-like alterations from BOL-148 at doses comparable to that in this single case report, such as our study (6), and at much larger doses (2,7–11). The overall consistency of research reports on the mild subjective effects of BOL-148 is why this drug is currently referred to as the “non-hallucinogen BOL” (5). We therefore conclude that the single case report mentioned was not worthy of discussion in our original report, but we are grateful to have this opportunity to provide reassuring clarification for what remains a quite promising new approach for the treatment of cluster headache.