1. Dr.Hicham.Mawla Emergency Medicine
Hallucinogens
Dr.Hicham.Mawla
Emergency Medicine

2. Hallucinogens
• Hallucinogens are substances that alter sensory processing in the brain,
causing perceptual disturbances,
changes in thought processing, and depersonalization

3. Modern Day History of Hallucinogens
Vietnam War
Timothy Leary
Harvard professor
The Psychedelic Experience

4. The Nature of Hallucinogens
• Many drugs can exert hallucinogenic effects related to neurotransmitters:
Serotonin: LSD, psilocybin, DMT
Norepinephrine: amphetamine related, mescaline, MDMA
Acetylcholine: atropine, scopolamine
Dissociative anesthetics: PCP, ketamine

5. Names for Hallucinogens
Psychedelic
Psychotogenic
Psychotomimetic

6. Sensory and Psychological Effects
Altered perception.
- Synesthesia: blending of the senses. Perceptual changes.
Self-reflection
- “Make conscious the unconscious”
Loss of identity and cosmic merging
- “Mystical-spiritual aspect of the drug experience”
Aldous Huxley: Doors of Perception.
                                           

7. LSD class drugs LSD, mescaline, psilocybin, DMT, bufotenine
Primarily act on Serotonin receptors
Frontal cortex and limbic system
Also act on raphe nucleus which functions to filter incoming sensory stimuli
Disrupts the sorting process
Flood of sensations and perceptions

8. LSD-class Hallucinogens
LSD Types of Agents
These drugs cause predominantly psychedelic effects.
Of high school seniors sampled:
- 1999—12.2% had used LSD sometime during life
- 2002—8.4% had used LSD sometime during life
Albert Hofmann and LSD model

9. LSD Physical Effects LSD Types of Agents Physiological effects:
- Massive increase in neural activity in some brain regions
- Activates sympathetic nervous system (rise in body temperature, heart rate, and blood pressure)
- Parasympathetic nervous system (increase in salivation and nausea)

10. LSD Timeline
• About half of the substance is cleared from the body within 3 hours, and more than 90% is excreted within 24 hours.
Effects of this hallucinogen can last 2–12 hours.
Tolerance to the effects of LSD develops very quickly.

11. Psilocybin It is not very common on the street.
• Psilocybin—its principal source is the Psilocybe mexicana mushroom.
It is not very common on the street.
Hallucinogenic effects produced are quite similar to LSD.
Cross-tolerance among psilocybin, LSD, mescaline.
Stimulates the autonomic nervous system, dilates the pupils, increases the body temperature

12. Psilocybe Mushrooms Small brown mushrooms that stain blue to the touch
Illicit cultivation but also foraged from temperate climates

13. Psilocybe Mushrooms: Religious Use
Religious use continues in Oaxaca, Mexico

14. Dimethyltryptamine (DMT)
- A short-acting hallucinogen
- Found in seeds of certain leguminous trees and prepared synthetically.
- It is inhaled and similar action as psilocybin.
- High doses can be quite intoxicating.
- Can also cause unpleasant reactions/\.

15. DMT…it’s as common as crabgrass…
“Canary” grass; Phalaris aquatica, P. arundinacea, P. canariensis, P. tuberosa
Desmanthus illinoensis; Prairie Bundleflower
Many other sources; mostly S. America.

16. Phalaris (DMT source)

17. Desmanthus illinoesis (DMT Source)

18. Bufo Frogs…
Contains bufontinin but intoxication primarily from 5-Meo-DMT
The toad is NOT licked but glands are milked for poison

19. Amphetamine Class Mescaline
Synthetic amphetamine derivatives (DOM, MDA, MDMA)
Act on dopamine and serotonin

20. Amphetamine Hallucinogens
Drugs are chemically related to amphetamines.
They have varying degrees of hallucinogenic and CNS stimulant effects.
- Release serotonin are dominated by their hallucinogenic action
- Release dopamine are dominated by their stimulant effects

21. Amphetamine Hallucinogens
Mescaline
“Designer” amphetamines
3,4 Methylenedioxyamphetamine (MDA)
Methylenedioxymethamphetamine
(MDMA, Ecstasy)

22. Ephedra of the US E. trifurca, E. viridis, E. torreyana, E
Ephedra of the US E. trifurca, E. viridis, E. torreyana, E. nevadensis and E. californica
100 gm dried ephedra could contain anywhere from 0 to 2.6 gm of ephedrine.
This medium-sized shrub grows up to 4 feet high and appears to have no leaves. It looks like a thicket of numerous green, jointed, leafless branches with conspicuous nodes.
It actually does have small, scale-like leaves and tiny flowers of male and female cones which bloom February through April. The fruit is a seed surrounded by 2 or 3 large scales.
Preparation: The twigs are gathered, and may be used fresh, or dried for use later. Best gathered in the spring, when green, and before plant blooms.The twigs are boiled for a few minutes. in a 1:6 or 8 ratio of herb to water, allowed to steep for 5 or more minutes, then strained. The flavor and odor is agreeable and could substitute for commercial tea. Also available in capsules from Health Food Suppliers; follow the package recommendations.

23. Ephedra grows in the deserts of the Southwest

24. Mescaline
- Mescaline is the most active drug in peyote cactus; it induces intensified perception of colors and euphoria
- Effects include dilation of the pupils, increase in body temperature, anxiety, visual hallucinations, and alteration of body image, vomiting, muscular relaxation.
Very high doses may cause death.
- Street samples are rarely authentic.

25. Peyote
Lophophoria williamsii contains 1.5% mescaline (b-3,4,5-trimethoxyphenethylamine)
3mg/kg potent intoxication
Up to 8 to 10 hour duration
Continued religious use in North America
Other cacti used in South America and also…

26. Harvesting Peyote

27. Natural Range of Peyote

28. The Peyote Ceremony
Stewart OC. Peyote Religion. Norman, OK: University of Oklahoma Press, 1987.
Aberle DF. The Peyote Religion Among the Navaho. Chicago, IL: Aldine Publishing Co., 1966.

29. MDMA (‘Ecstasy’) Graphic taken from www.erowid.com
Acknowledgement for photograph to follow.

30. Psychostimulants
The most common psychostimulants (cocaine, MDMA and amphetamine) act on the synapse to increase the activity of dopamine, noradrenaline and serotonin.
Graphics reference to follow.
Cocaine blocks pre-synaptic reuptake

31. MDMA (‘Ecstasy’)
A synthetic amphetamine derivative, usually sold as small tablets or capsules
Many tablets sold as ecstasy also contain other chemicals including: ketamine, GHB, amphetamine, caffeine.
A recent study (Baggott et al 2000) found that:
63% contained MDMA
29% contained other substances (e.g. caffeine, psuedoephedrine)
8% contained no MDMA

32. MDMA (‘Ecstasy’): Effects
Immediate sought after-effects, 4-6 hours in duration
euphoria, increased confidence, increased perception of closeness to others, visual hallucinations
Negative effects
jaw clenching, anxiety, paranoia, insomnia, dry mouth, increased body temperature

33. Party drug culture High levels of activity: hydration and hyperthermia
Poly-drug use, illicit and misuse of prescribed substances:
Viagra used primarily within the gay community
Anti-depressants and benzodiazepines thought to increase the ‘high’ or relieve the ‘come down’ associated with party drug use
Photograph acknowledgement to follow.

34. Risks of Ecstasy Toxicity: MDMA overdose is rare
associated with intense sympathomimetic responses and active hallucinations as well as thermoregulatory, neurologic, cardiovascular, hepatic and electrolyte disturbances (Gowing et al 2002).
Risks of adulterants
Dependence syndrome (occasionally)
Some evidence of cognitive impairment as a result of long term use (Kalant, 2001)
Association between long-term MDMA use and emotional disturbance (depression).

35. Anticholinergics Attach to Ach receptors and act as antagonists
Found in Belladonna, Nightshade, Jimsonweed and Mandrake plants

36. Ach Antagonists Plants containing scopolamine
Low doses produce amnesia, fatigue, mental confusion, dreamless sleep and loss of attention
High doses: Hallucinations, paralysis of respiratory system, coma, and death.
Side Effects: increase in sympathetic activity
Hot as a hare, dry as a bone, red as a beet, and mad as a hen

37. Datura stramonium Leaves typically cut and smoked
Contains atropine, scopalomine
Ancient ceremonial use in the U.S.
Occasional report of death by ingestion of root
Many other sources for atropine
and scopalomine
Member of Nightshade family
“Jimson weed”

38. Dissociative Drugs Dissociative Drugs PCP (phencyclidine) Ketamine
Dextromethorphan

39. • Phencyclidine (PCP) It was developed as an intravenous anesthetic,
but found to have serious adverse side effects.
It differs from the other traditional hallucinogens.
It is a general anesthetic in high doses.
It causes incredible strength and extreme violent behavior.
Management of the severe psychological reactions requires drug therapy.

40. PCP physiological effects
- Hallucinogenic effects, stimulation, depression, anesthesia, analgesia
- Large doses can cause coma, convulsions, and death.
PCP psychological effects
- Feelings of strength, power, invulnerability;
perceptual distortions, paranoia, violence,
Potential for psychotic break.

41. Ketamine (“Special K”)
Anesthetic developed to replace PCP, manufactured by Pfizer
Used in human and veterinary medicine
Injected or dried and snorted
Feelings of floating, or sometimes terrifying “bad trip” called “K hole”
“Vitamin K”
“K”
“Bump”

42. DXM (dextromethorphan)
Cough suppressant
(Also used to boost effects of analgesics for severe pain)
Typical dose mg. for cough
4 or more ounces may cause distorted visual perceptions, similar effects to PCP and Ketamine
“Robo”
Internet groups to discuss “Robo-ing”

43. Statistics on Use National Survey on Drug Use and Health (2004 & 2005)
Monitoring the Future (National Survey) (2005)
Drug Abuse Warning Network (DAWN)

44. NSDUH Hallucinogen Statistics
Percentages of Past Year Hallucinogen Use among Persons Aged 12 or Older, by Age Group: 2004 and 2005

45. Monitoring the Future Hallucinogens 2005
Psychedelics
2.4
4.0
5.5
LSD
1.2
1.5
1.8
Others
2.0
3.5
5.0

46. Hallucinogens in ER Visits, 2005
Drug
Drug-Related ER Visits DAWN Hospitals
Cocaine
448, 481
Heroin
164, 572
Ketamine
275
LSD
1,864
PCP
7,535
Misc. hallucinogens
3,792

47. AAPCC Annual Report 2005 662 Substance
Number of human exposures reported to US Poison Control Centers
Hallucinogenic mushrooms
849
Muscarine mushrooms 19
Hallucinogenic plants
355
Solanine plants (nightshade family)
1,166
Ketamine
161
Dextromethorphan (APA/ASA)
67,038.00
Hallucinogens (general, various)
1,924
Mescaline/peyote
102
PCP
662
2005 Annual Report of the American Association of Poison Control Centers’ National Poisoning and Exposure Database. Clinical Toxicology, 44: , 2006