Repeated snake bite for recreation: Mechanisms and implications.

Snake venom use for recreational purposes has been documented earlier. Willfully subjecting oneself to repeated lethal snake bite as a source of getting relieved of stress and recreation observed in two healthy software engineers, without any underlying psychiatric ailments or comorbidities along with probable mechanisms, are reported. Emergency physicians and practitioners have to be aware of novel methods of exposure to snake venom so as to recognize such cases and treat them accordingly.

INTRODUCTION

Globalization and technological innovations are bringing new challenges to the emergency physician. New technological innovations have contributed to profound changes in the quality of life of human beings and societal changes. Information technology (IT) is the most coveted field in modern India. While each job has its own stress, the fast and relentless pace of technology-enhanced work environment in IT has created new culture. Two healthy software engineers subjected themselves willfully for repeated snake bite and gained access to snake venom, so as to get relieved of their stress. This is reported in order to create awareness of such issues among emergency physicians and practitioners. There were three reported cases of snake venom use in psychoactive substance users to experience “high.”[123] There are few cases of such addiction to semipoisonous snakes like rat snake and green wine, reported in the local press. However, to our knowledge, this is the first report of willful exposure to snake venom from direct bite for the purpose of mental relaxation among nonusers of illicit drugs and without any underlying psychiatric disorders.

CASE REPORT

A 25-year-old software engineer came to emergency department (ED), with a request to get himself tested for HIV infection, even though he did not have any previous episodes of unprotected sexual intercourse or any illicit drug use. However, he said that he has subjected himself willfully to repeated snake bite over a period of 6 months with an interval of 30-45 days between each exposure. Patient was questioned on the awareness of toxic effects of snake venom and he had optimal knowledge. Incidentally, he said that he was stressed very much and had insomnia, due to immense work pressure. As some of his colleagues exposed to snake bite willfully felt relieved of his stress and experienced euphoria, patient accepted for willful snake bite and felt relaxed and had good sleep also. With patient's consent, he was investigated for HIV and his serology was negative. After this episode another friend of primary case, who is also a software engineer of 23 years old, came to ED with same request, as he has subjected himself to willful snake bite. He experienced sound sleep for 20-24 h and had relaxed mind after snake bite without any hang over/head ache, tremor, and sense of crawling. He also felt that his sexual desire has increased. Both of them did not experience any withdrawal symptoms. General and systemic examination including psychological assessment did not reveal any abnormalities in both. Their basic hematological and biochemical profile were within acceptable levels.

Interestingly, these two cases informed that there are different dens in different cities wherein people who want to have snake bite are allowed to sit in chairs. The person in charge of snakes holds the snake near the head end of snake just distal to lip margin. Initially, he makes the snake to inject minimal bite in little toe or index finger for minimal envenomation, and then, he makes the snake to bite in lip or tongue of individuals according to their wish. The most commonly used snakes were krait, cobra, and green snake. Persons who were bitten, showed jerky movement and left the room within few minutes. From the reports provided orally, six persons lost their life due to such procedure. Many people who use such dens were from high socioeconomic status and well educated. Some of them were youth and college students.

DISCUSSION

Ancient cultures all over the world believe that repeated snake bites/snake venom inoculation renders a person immune to fatal snake envenomation.[4] Tribal regions even in India are known to give snake bites purposefully to their children in order to protect them from fatal complications of snake bite. Lack of symptoms in our reported cases and in these primitive practices may be due to injection of too little venom, precisely the quantity needed for recreational purpose/immunity which needs further exploration.

Multiple factors like easy availability, adventure seeking, social/peer-pressure, novel sensation, pain relief, and cultural beliefs might have influenced the use of snake bite as a form of substance abuse.[3] Moreover, snakes form an important part of Hindu mythology and are worshipped even today,[5] thereby general population being unafraid of them. During middle age period, physicians used snake venom of various snakes as medicinal agents. Base on observations, we hypothesized the mechanism and uses of snake venom in clinical medicine.[6] Snake venoms have antinociceptive and analgesic activity, and certain isolated neurotoxins have demonstrated significant analgesia in animal models. The venom on entering human blood releases active metabolites such as serotonin, bradykinin, peptides, prostaglandins, and other slow reacting substances. Drowsiness was the most common symptom observed among cobra bite, which may be due to effect of toxin in brain. Literature review[7] showed that in individuals injected with cobra venom, had marked relief of pain in nearly 65% of the patients and a mild-to-moderate relief in more than 80%, and the site of analgesic action being peripheral and central nervous system.[8] Also, long-form alpha-neurotoxin from cobra venom produces a potent opioid-independent analgesic effect by acting on nicotinic acetyl choline receptors (nAChRs).[9] Cobra venom resembles to the action of morphine but differs from the opiate in that it does not produce addiction and other disagreeable or dangerous by effects. Moreover, nAChRs are involved in the mesolimbic dopaminergic reward system of the brain.[10] This pathway may be responsible for the experience of “high.”

There is a debate in the fatality/immunity due to repeated snake bites in human beings either accidentally or incidentally. Haast and Winer[11] reported complete recovery of a patient without any specific therapy even after bitten by a deadly snake Bangarus Caeruleus[11] and the authors attributed it to cross protection of existing antibody between species of Bangarus and Indian, African and Egyptian cobras, as he had a history of bites from these snakes earlier. Immunity was also reported in a reptile handler bitten by king cobra “Ophiophagus Hannah.”[12] Repeated poisonous snakes bites, though believed to render the individuals immune and reduce fatality of subsequent bites, Parrish and Pollard[13] analyzed the effect of repeated bites in 14 patients and concluded that bites from pit viper did not produce any kind of immunity and can cause death due to anaphylaxis. Limitation of this report is that the nature of snakes involved for willful snake bite could not be verified. Also, recall bias of the individuals has to be considered while interpreting patient's statements.

CONCLUSION

Physicians and practitioners have to be aware of novel methods and more research is warranted in this field both for prevention as abuse and exploration of newer therapeutic molecules from snake venom.