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Hallucinogens - LSD, , , and PCP

Hallucinogenic compounds found in some • Psilocybin (4-phosphoryloxy-N,N- and (or their extracts) dimethyltryptamine) is obtained from have been used—mostly during religious certain types of mushrooms that are —for centuries. Almost all indigenous to tropical and subtropical contain and are regions of South America, , and classified as . Many hallucinogens the United States. These mushrooms have chemical structures similar to those of typically contain less than 0.5 percent natural (e.g., psilocybin plus trace amounts of -, -, or - , another hallucinogenic like). While the exact mechanisms by which substance. hallucinogens exert their effects remain • PCP () was developed in unclear, research suggests that these the 1950s as an intravenous . work, at least partially, by temporarily Its use has since been discontinued due interfering with action or to serious adverse effects. by binding to their receptor sites. This DrugFacts will discuss four common types of How Are Hallucinogens Abused? hallucinogens: The very same characteristics that led to • LSD (d-lysergic diethylamide) is the incorporation of hallucinogens into one of the most potent -changing ritualistic or spiritual traditions have also chemicals. It was discovered in 1938 led to their propagation as drugs of abuse. and is manufactured from , Importantly, and unlike most other drugs, which is found in , a that the effects of hallucinogens are highly grows on rye and other grains. variable and unreliable, producing different • Peyote is a small, spineless in effects in different people at different times. which the principal active ingredient is This is mainly due to the significant . This has been used by variations in amount and composition of natives in northern Mexico and the active compounds, particularly in the southwestern United States as a part of hallucinogens derived from plants and religious ceremonies. Mescaline can also mushrooms. Because of their unpredictable be produced through chemical nature, the use of hallucinogens can be synthesis. particularly dangerous.

Hallucinogens • December 2014 • Page 1 and by what route PCP is taken, its • LSD is sold in tablets, capsules, and, effects can last approximately 4–6 occasionally, liquid form; thus, it is hours. usually taken orally. LSD is often added to absorbent paper, which is How Do Hallucinogens the Brain? then divided into decorated pieces, each equivalent to one . The LSD, peyote, psilocybin, and PCP are drugs , often referred to as that cause , which are “trips,” are long; typically, they end profound distortions in a person’s after about 12 hours. of reality. Under the influence of • Peyote: The top of the peyote cactus, hallucinogens, people see images, hear also referred to as the crown, consists sounds, and feel sensations that seem real of disc-shaped buttons that are cut but are not. Some hallucinogens also from the roots and dried. These produce rapid, intense emotional swings. buttons are generally chewed or LSD, peyote, and psilocybin cause their soaked in water to produce an effects by initially disrupting the interaction intoxicating liquid. The hallucinogenic of nerve cells and the neurotransmitter dose of mescaline is about 0.3 to 0.5 serotonin.1 Distributed throughout the grams, and its effects last about 12 brain and spinal cord, the serotonin system hours. Because the extract is so bitter, is involved in the control of behavioral, some individuals prefer to prepare a perceptual, and regulatory systems, by boiling the cacti for several including mood, hunger, body temperature, hours. sexual behavior, muscle control, and • Psilocybin: Mushrooms containing sensory perception. On the other hand, PCP psilocybin are available fresh or dried acts mainly through a type of glutamate and are typically taken orally. receptor in the brain that is important for Psilocybin (4-phosphoryloxy-N,N- the perception of pain, responses to the dimethyltryptamine) and its environment, and learning and memory. biologically active form, psilocin (4- hydroxy-N,N-dimethyltryptamine), There have been no properly controlled cannot be inactivated by cooking or research studies on the specific effects of freezing preparations. Thus, they may these drugs on the , but also be brewed as a tea or added to smaller studies and several case reports other foods to mask their bitter flavor. have been published documenting some of The effects of psilocybin, which appear the effects associated with the use of within 20 minutes of ingestion, last hallucinogens. approximately 6 hours. • PCP is a white crystalline powder that LSD: Sensations and feelings change much is readily soluble in water or . more dramatically than the physical signs It has a distinctive bitter chemical in people under the influence of LSD. The . PCP can be mixed easily with user may feel several different at dyes and is often sold on the illicit once or swing rapidly from one to market in a variety of tablet, another. If taken in large enough doses, the capsule, and colored powder forms drug produces delusions and visual that are normally snorted, smoked, or hallucinations. The user’s of time and orally ingested. For , PCP is self is altered. Experiences may seem to often applied to a leafy material such “cross over” different , giving the as mint, parsley, oregano, or user the feeling of hearing colors and seeing . Depending upon how much sounds. These changes can be frightening

Hallucinogens • December 2014 • Page 2 and can cause panic. Some LSD users reflexes, behavior, and perception.3 The severe, terrifying and psychological consequences of psilocybin feelings of despair, fear of losing control, or use include hallucinations, an altered fear of insanity and death while using LSD. perception of time, and an inability to discern fantasy from reality. Panic reactions LSD users can also experience flashbacks, and also may occur, particularly or recurrences of certain aspects of the if a user ingests a large dose. Long-term drug experience. Flashbacks occur effects such as flashbacks, risk of suddenly, often without warning, and may psychiatric illness, impaired memory, and do so within a few days or more than a year tolerance have been described in case after LSD use. In some individuals, the reports. flashbacks can persist and cause significant distress or impairment in social or PCP: The use of PCP as an approved occupational functioning, a condition anesthetic in humans was discontinued in known as -induced persisting 1965 because patients often became perceptual disorder (HPPD). agitated, delusional, and irrational while recovering from its anesthetic effects. PCP Most users of LSD voluntarily decrease or is a “ drug,” meaning that it stop its use over time. LSD is not considered distorts of sight and sound and an addictive drug since it does not produce produces feelings of detachment compulsive drug-seeking behavior. (dissociation) from the environment and However, LSD does produce tolerance, so self. First introduced as a street drug in the some users who take the drug repeatedly 1960s, PCP quickly gained a reputation as a must take progressively higher doses to drug that could cause bad reactions and achieve the state of intoxication that they was not worth the risk. However, some had previously achieved. This is an abusers continue to use PCP due to the extremely dangerous practice, given the feelings of strength, power, and unpredictability of the drug. In addition, invulnerability as well as a numbing effect cross-tolerance between LSD and other on the that PCP can induce. Among hallucinogens has been reported. the adverse psychological effects reported are— Peyote: The long-term residual • Symptoms that mimic , psychological and cognitive effects of such as delusions, hallucinations, mescaline, peyote’s principal active , disordered thinking, and a ingredient, remain poorly understood. A sensation of distance from one’s recent study found no evidence of environment. psychological or cognitive deficits among • Mood disturbances: Approximately 50 Native Americans that use peyote regularly percent of individuals brought to in a religious setting.2 It should be emergency rooms because of PCP- mentioned, however, that these findings induced problems—related to use may not generalize to those who repeatedly within the past 48 hours—report abuse the drug for recreational purposes. significant elevations in Peyote abusers may also experience symptoms.4 flashbacks. • People who have abused PCP for long periods of time have reported memory Psilocybin: The active compounds in loss, difficulties with speech and psilocybin-containing “magic” mushrooms thinking, , and weight loss. have LSD-like properties and produce These symptoms can persist up to one alterations of autonomic function, motor year after stopping PCP abuse.

Hallucinogens • December 2014 • Page 3 • : PCP is addictive—its At high doses, pressure, pulse repeated abuse can lead to craving and rate, and respiration drop. This may be compulsive PCP-seeking behavior, accompanied by , , despite severe adverse consequences. blurred vision, flicking up and down of the eyes, drooling, loss of balance, and What Other Adverse Effects Do dizziness. PCP abusers are often brought Hallucinogens Have on ? to emergency rooms because of overdose or because of the drug’s Unpleasant adverse effects as a result of the severe untoward psychological effects. use of hallucinogens are not uncommon. While intoxicated, PCP abusers may These may be due to the large number of become violent or suicidal and are psychoactive ingredients in any single therefore dangerous to themselves and source of hallucinogen.3 others. High doses of PCP can also cause seizures, coma, and death (though death • LSD: The effects of LSD depend largely more often results from accidental on the amount taken. LSD causes injury or during PCP dilated pupils; can raise body intoxication). Because PCP can also have temperature and increase effects, interactions with other and ; and can cause central , profuse sweating, loss of , such as alcohol and , sleeplessness, dry mouth, and can also lead to coma. . • Peyote: Its effects can be similar to What Treatment Options Exist? those of LSD, including increased body temperature and heart rate, Treatment for hallucinogen (such uncoordinated movements (ataxia), as psilocybin) intoxication—which is profound sweating, and flushing. The mostly symptomatic—is often sought as a active ingredient mescaline has also result of bad “trips,” during which a patient been associated, in at least one report, may, for example, hurt him- or herself.6 to fetal abnormalities.5 Treatment is usually supportive: provision • Psilocybin: It can produce muscle of a quiet room with little sensory relaxation or weakness, ataxia, stimulation. Occasionally, benzodiazepines excessive pupil dilation, nausea, are used to control extreme agitation or vomiting, and drowsiness. Individuals seizures. who abuse psilocybin mushrooms also risk poisoning if one of many existing There is very little published data on varieties of poisonous mushrooms is treatment outcomes for PCP intoxication. incorrectly identified as a psilocybin Doctors should consider that acute adverse . reactions may be the result of drug synergy • PCP: At low-to-moderate doses, with alcohol.7 Current research efforts to physiological effects of PCP include a manage a life-threatening PCP overdose are slight increase in breathing rate and a focused on a passive immunization pronounced rise in blood pressure and approach through the development of anti- pulse rate. Breathing becomes shallow; PCP antibodies.8 There are no specific flushing and profuse sweating, treatments for PCP abuse and addiction, but generalized numbness of the inpatient and/or behavioral treatments can extremities, and loss of muscular be helpful for patients with a variety of coordination may occur. , including that to PCP.

Hallucinogens • December 2014 • Page 4 How Widespread Is the Abuse of PCP Hallucinogens? In 2013, 6.5 million people aged 12 or older According to the 2013 National Survey on reported that they had used PCP in their Drug Use and Health (NSDUH)*, more than lifetime (2.5 percent) according to NSDUH. 1.1 million people aged 12 or older However, only 90,000 people reported use reported using hallucinogens within the in the past year—a decrease from 172,000 past 12 months. in 2012.

LSD Learn More For more information on hallucinogens, In 2013, more than 24.8 million people please visit aged 12 or older reported they had used http://www.drugabuse.gov/drugs- LSD in their lifetime (9.4 percent) according abuse/hallucinogens. to NSDUH. More than 1.1 million people had used the drug in the past year. Between Other Data Sources 2012 and 2013, the number of past-year * NSDUH (formerly known as the National initiates of LSD increased only slightly. Household Survey on Drug Abuse) is an annual survey of Americans age 12 and Peyote and Psilocybin older conducted by the It is difficult to gauge the extent of use of and Mental Health Services Administration, these hallucinogens because most data U.S. Department of Health and Human sources that quantify drug use exclude Services. This survey is available on line at these drugs. www.samhsa.gov.

References 1 Fantegrossi WE, Murnane KS, Reissig CJ. The behavioral of hallucinogens. Biochem Pharmacol. 2008;75(1):17-33. 2 Halpern JH, Sherwood AR, Hudson JI, Yurgelun-Todd D, Pope HG Jr. Psychological and cognitive effects of long-term peyote use among Native Americans. Biol . 2005;58(8):624-631. 3 Cunningham N. Hallucinogenic plants of abuse. Emerg Med Australas. 2008;20(2):167-174. 4 Yago,KB, Pitts, FN, Burgoyne, RW, Aniline, O, Yago, LS, Pitts AF. The urban epidemic of phencyclidine (PCP) use: Clinical and laboratory evidence from a public psychiatric hospital emergency service. J Clin Psychiatry. 1981;42:193-196. 5 Gilmore HT. Peyote use during pregnancy. S D J Med. 2001;54(1):27-29. 6 Attema-de Jonge ME, Portier CB, Franssen EJ. Automutilation after consumption of hallucinogenic mushrooms. Ned Tijdschr Geneeskd. 2007;151(52):2869-2872. 7 Schwartz RH, Smith DE. Clin Pediatr (Phila). 1988;27(2):70-73. 8 Kosten T, Owens SM. for the treatment of drug abuse. Pharmacol Ther. 2005;108(1):76-85.

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