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Home , Amanita muscaria, Muscimol, Psilocybe semilanceata, Recreational drug use

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sweating, numbness, confusion and difficulty Magic concentrating. Longer term, flashbacks may In addition to their most common title, magic occur, during which the user re-experiences the mushrooms go by a wide range of names Module 1982 trip days, months or even years later, perhaps including Shrooms, Mushies, Magics, Liberties, following subsequent use but also as a Philosopher’s Stones, Amani and . They Substance misuse: result of stress (physical or emotional) or fatigue, are fungi containing the chemical . which can trigger severe anxiety or paranoia. This pro-drug is converted in the body to hallucinogenics Tolerance can develop rapidly, and psychological , which has psychoactive properties. – though not physical – dependence can occur.1 Although there are over 180 psilocybin- From this CPD module you will learn: containing mushrooms found across the world, Substances the most commonly used in the UK is • What a hallucinogenic drug is, how they exert their effects and the This learning module will focus on magic semilanceata, a small, light brown risks associated with their use mushrooms and lysergic acid diethylamide, more known as the liberty cap. There is also the more • Detailed information about the two most used , magic commonly known as LSD, as these are the two potent muscaria, also known as the mushrooms and LSD hallucinogenic widely used recreationally. fly , which resemble the red and white It is worth noting that use toadstools of tales, though this contains • Some of the less commonly used psychedelic drugs appeared to increase during the COVID-19 additional psychoactive chemicals such as • Some relevant measures for hallucinogenics pandemic, while use of substances such as and which can cause ecstasy and nitrous fell, in all likelihood , drooling, dizziness and vomiting as well because these are more associated with highly as convulsions. They are therefore less popular ASHA FOWELLS, PHARMACIST a significant role in emotional functioning and socialised environments such as clubs and among users.4-6 memory. There is also a school of that festivals, which were largely curtailed.3 Magic mushrooms may be eaten raw or This CPD module on misused substances hallucinogens stimulate disorganised activity focuses on drugs that are used for their in the brain, reducing self- and hallucinogenic effects. See C+D’s other CPD self-, which can lead to a sense of modules for information on substance misuse disassociation - this experience is sometimes of at tinyurl.com/depressants1, referred to a “trip”.2 image– and performance-enhancing drugs at This group of drugs is different to many tinyurl.com/imageperfdrugs, drugs others in that the substances tend to be taken at tinyurl.com/dissociatives and at sporadically rather than regularly. That is not tinyurl.com/stimulants1. to say that this reduces the risk associated with taking the drugs. Not only are the effects Defining hallucinogenics unpredictable, it is not uncommon to have a Hallucinogens, also known as psychedelics, are “” (particularly if the user is in a negative psychoactive substances that interfere with mental or emotional state beforehand). This can sensory . For example, someone’s include extreme anxiety, fear or panic, a sense grasp of auditory or visual stimuli may be of loss of control or paranoia, and frightening altered, their sense of time and can , which can lead to behaviours that also be affected in addition to their mood put the user and/or others in danger.1 and cognition. Users may also experience While some people enjoy a sense of hallucinations – seeing or hearing things that are and relaxation after using a either not there or are distorted in some way.1 psychedelic drug, there can also be other less Psychedelics exert this effect by mimicking pleasant effects in the short-term, including serotonin and stimulating those pathways in the dizziness, blurred vision, lack of coordination, brain, notably in the temporal lobe, which has , dyspnoea, , vomiting, Magic mushrooms contain psilocybin, which is converted in the body to the psychoactive psilocin

chemistanddruggist.co.uk/update-plus July 2021 | Module 1982 | Substance misuse: hallucinogenic drugs | 1 of 3 cooked. Additionally, they can be dried and experience enjoyable and meaningful, others either included as an ingredient in a or find it terrifying, and there is a risk that long made into a . It is also possible to obtain forgotten and perhaps traumatic experiences liquid psilocybin extract. The strength is may resurface. Whether positive or negative, the unpredictable, influenced by a range of factors trip is frequently draining, mentally, physically, including mushroom , freshness, location and emotionally, and there can be a strong sense grown and the season. For the same reason, of fatigue and dissociation in the days following the duration of action also varies, but most the experience. It has been recommended that commonly the effects are felt after around users – particularly first timers – allow at least half an hour and can last somewhere between three months to elapse before taking it again. five to nine hours depending on how much is Tolerance builds quickly, and redosing tends to ingested. One of the biggest associated risks have little impact on the experience.7-9 is ingesting a poisonous mushroom in error. Even more so than magic mushrooms, Another significant downside is a persistent LSD can be very difficult to handle for those headache in the days immediately after the trip with pre-existing mental illness, particularly in combination with a comedown, during which psychosis, and can trigger a psychotic episode. the individual feels low in mood and energy; Bad trips can be difficult to handle for the most these effects are not uncommon.4-6 level-headed individual, bringing with it feelings Legally, magic mushrooms are Class A drugs of anxiety, fear, panic, dysphoria, paranoia, under the , and the confusion, disorientation, unwanted , 2005 Drugs Act strengthened existing legislation frightening , hyperawareness of LSD is usually sold as small impregnanted squares of paper, which are then placed onto the tongue by putting both fresh and prepared psilocybin – physiological processes such as circulation, or psilocin-containing mushrooms into Class A. and even an existential crisis. Having a coping out of control can be very frightening.5 epilepsy, while also being metabolised by the This means that all forms are illegal to possess, strategy – listening to a particular song or Less commonly used psychedelic drugs include: monoamine oxidase pathway, meaning there distribute or sell.4 looking at a pleasant picture, for instance – is key • N-bomb/NBOM is a powerful hallucinogenic are several potential significant interactions in such situations.9 and has been detected in some products sold with prescribed medication.11 LSD as LSD. Often sold as small squares of paper, it • DMT, or dimethyltryptamine, is a highly potent LSD is a synthetic usually sold as Set and setting only works when absorbed through the lining but short acting psychedelic drug. It comes impregnated small squares of paper (known as The dimensions of risk that apply to all substance of the mouth, and users have reported a very in a range of forms, from white crystals in its tabs or blotters) that are placed onto the tongue, misuse – drug, person and place – are certainly intense trip, often with physical effects such purest form to a pink/yellow/orange powder tiny pellets that are swallowed, or liquid that is applicable when it comes to psychedelics, but as nausea, vomiting, tremors, increased heart or solid (both of which are most commonly dropped onto the tongue or into food or drink. It whether a trip is good or bad can really come rate and pressure, , insomnia, snorted), a brownish or green mixture added goes by a wide range of names, some relating to down to two factors: set and setting. The former agitation and aggression.10 to herbs such as to make changa the drug name itself (L, Acid) while others refer relates to the individual’s mindset, including their • 2CB, or 2,5-dimethoxy-4- (which is smoked), or a red-brown liquid that to the formulation (Tabs, Blotters, Dots, Micro mood, expectations, thoughts and disposition. In bromophenethylamine, is another synthetic may be drunk in a shamanic tea. The effect is Dots), images shown on the impregnated pieces terms of the latter, the specific place and social psychedelic, which also has intense, with users often reporting a vivid out of paper (Stars, Smilies, Rainbows, Flash), or the situation can have a significant impact, with properties. It comes as a white powder, of body experience, during which the world effect (Trips). LSD is a Class A drug.7 better outcomes in familiar places surrounded which may be snorted, or swallowed as a appears totally distorted. Some users have The effects of LSD are experienced around by friendly faces (and perhaps a “sober sitter” pill or capsule. The combined hallucinogenic felt unable to move and likened it to a near- 30-90 minutes after ingestion, peaking at the who is level-headed and able to provide and stimulant effect is dose dependent but death experience.12,13 two-to-three-hour mark, and lasting for up reassurance or distraction if needed), compared can be dangerous in terms of the impact on • Salvia is a Mexican in the sage family to nine to 14 hours. There are a huge number to the difficulties that may ensue in a chaotic and . Furthermore, and is therefore sometimes called Holy Sage of variables affecting all these parameters, environment (such as a festival or party) with anxiety and paranoia are not uncommon or Herbal Ecstasy. The fresh leaves may be such as amount taken, any other drugs taken, lots of people around who are strangers and in users. It has also been suggested that chewed, a tincture made from them, or the the individual’s size, etc. While some find the therefore not trusted. Feeling overwhelmed and 2CB is riskier for people with diabetes or leaves dried and then smoked. It provokes

chemistanddruggist.co.uk/update-plus July 2021 | Module 1982 | Substance misuse: hallucinogenic drugs | 2 of 3 hallucinogenic and dissociative effects, obtained from onsite services such as security which can cause disturbing derealisation and officers and medical staff, but sometimes there fragmentation of identity – through action on is also front of house testing that enables Take the 5-minute test online receptors rather than the serotonin clubbers or festival goers to hand in a small 1. Stimulation of pathways is a 6. has a pale white pathways in the brain. The majority of users sample of the drugs they are intending to common effect exerted by hallucinogens. appearance and is often referred to as True or false find the experience short-lived but intensely take and have them analysed. This work helps liberty cap mushrooms. unpleasant. While the other hallucinogenic identify substances of concern that may put 2. Derealisation is where users tend to True or false concentrate on their self-conscious and drugs in this are Class As under the users at risk, which are usually highlighted on 7. LSD, or d-lysergic acid diethylamide, is a sense of self, feeling more centred in terms Class B drug/psychoactive substance. Misuse of Drugs Act 1971, salvia falls under the social media channels tagged into the venue or of ego and self-awareness. Psychoactive Substances Act 2016, meaning event to promote public safety, and provides True or false True or false it is illegal to produce or supply but not to information to medical and welfare service 3. Somatic effects exerted by hallucinogens 8. LSD tends to peak between 2-3 hours post .14,15 possess workers so they are able to provide informed include changes in blood pressure, ingestion. treatment to anyone suffering the ill-effects breathing and cognition to name but a few. True or false Drug testing of drug use. It also helps identify trends in the True or false 9. 2CB is an organic psychedelic. The Loop is a not-for-profit organisation that drug market, detects mis-sold, adulterated, 4. Physical dependence is common with True or false undertakes drug testing for public safety at or contaminated substances (and publicises hallucinogenic drugs. 10. Some users of strong psychedelics such as and events such as music festivals. them as previously described), and provides True or false DMT have reported feelings that they liken Some of this testing is performed on substances opportunities to engage in brief interventions 5. Psilocybin is the psychoactive ingredient to a near-death experience. with a hard-to-reach population. Pharmacists associated with . True or false are among those who can work as harm True or false References reduction volunteers: more information is 1. and Drug Foundation (2021) available at wearetheloop.org. Psychedelics 2. BBC Science Focus (2019) How do psychedelics affect the brain? Substance misuse: hallucinogenics planned CPD example 3. Release Legal Emergency and Drugs What are you planning to learn? Service (2020) Drugs in the time of As the article suggests, has increased in some respects during the COVID-19 pandemic. Therefore, I think it is important COVID: interim report for healthcare professionals to recognise the signs and symptoms of drug abuse, as well as have the competency to answer questions or direct potential users to relevant resources with respect to recreational drug use. I hope to get a better understanding of how hallucinogenic drugs 4. Frank (2021) Magic mushrooms exert their effects on users and some of the risks associated with their use. 5. Drug Science (2021) Psilocybin 6. Drug Wise (2016) Magic mushrooms How are you planning to learn it? I have taken time to download the resource packs associated with pages such as talktofrank.com so that there are materials available to staff and 7. Frank (2021) LSD patients in our pharmacy. The team decided where we could leave some of these materials in accessible spaces around our stores as well as in 8. Drug Science (2021) LSD the consultation room to engage potential users in discussion, should they wish to chat with members of the pharmacy team. 9. Drugs and Me (2021) LSD Give an example of how this learning has benefited the people using your services 10. Frank (2021) N-bomb Admittedly, our pharmacy has not seen a great deal of young patients who may be potential users of hallucinogenic drugs during the lockdown 11. Drug Science (2021) 2CB period. However, we often deal with longstanding customers who are parents of adolescents or young adults who may engage in recreational 12. Frank (2021) DMT drug use. Our team decided that an appropriate use of our time and this knowledge would be to start an “ask us anything” campaign in our stores. We printed posters and left resources around in relation to recreational drug use. The posters encouraged parents/guardians/carers 13. Drugs and Me (2021) DMT with questions to ask to speak to member of the team to talk about recreational drug use. Furthermore, if the team were unable to answer the 14. Drug Science (2021) Salvia questions, we prepared resources from sites such as talktofrank.com and drugwise.com where we could refer people for more information. In 15. Frank (2021) Salvia addition, we had a card containing the contacts list for local drug teams in the Borough for people to contact for specialist engagement.

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