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Home , Dextromethorphan, Dissociative, Hallucinogen, Ketamine, Phencyclidine

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TITLE and , Including LSD, PCP, , . National Institute on Abuse Research Report Series. INSTITUTION National Inst. on Drug Abuse (DHHS/PHS), Rockville, MD. REPORT NO NIH-01-4209 DATE, 2001-03-00 NOTE 10p. AVAILABLE FROM For full text: http://drugabuse.gov. PUB TYPE Reports - Descriptive (141) EDRS PRICE MF01/PC01 Plus Postage. DESCRIPTORS *Drug Education; ; Illegal Drug Use; *Lysergic Diethylamide; Moods; *Prevention IDENTIFIERS Dissociation; *Hallucinogens;

ABSTRACT Research is developing a clearer picture of the dangers of -altering drugs. The goal of this report is to present the latest information to providers to help them strengthen their prevention and treatment efforts. A description is presented of dissociative drugs, and consideration is given as to why people take hallucinogens. The physical characteristics of LSD are described along with its mood altering effects. Specific facts about dissociative drugs are also included such as the forms of phencyclidine (PCP); the nature of ketamine and dextromethorphan; their street names; and their side effects. (Contains a glossary of terms and 10 references.) (JDM)

Reproductions supplied by EDRS are the best that can'an be made from the original document. Hallucinogens and Dissociative Drugs, Including LSD, PCP, Ketamine, Dextromethorphan. National Institute on Drug Abuse Research Report Series

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2 NATIONAL INSTITUTE ON DRUG ABUSE Research Report

Drugs with street names like acid, angel dust, and K distort the way a user perceives time, motion, colors, sounds, and UCIN GE S self. These drugs can disrupt a person's ability to think and communicate rationally, or even to recognize reality, sometimes I. SSOC TAT resulting in bizarre or dangerous behavior. Hallucinogens such elQ Including LSD, PCP, as LSD cause to swing kJ- Ketamine, Dextromethotphan wildly and real-world sensations to assume unreal, sometimes Hallucinogens cause their frightening aspects. Dissociative What are effects by disrupting the inter- drugs like PCP and ketamine may hallucinogens? action of nerve cells and the make a user feel disconnected . and out of control. Hallucinogens are drugs Distributed throughout the In addition to their short-term that cause and , the serotonin effects on and mood, profound distortions in a system is involved in the control LSD is associated with psychotic-like person's of reality. episodes that can occur long after of behavioral, perceptual, and a person bas taken the drug, and Under the influence of hallucino- regulatory systems, including PCP and ketamine can cause gens, people see images, hear mood, hunger, body tempera- respiratory , heart sounds, and feel sensations that ture, sexual behavior, muscle rate abnormalities, and a with- seem real but do not exist. Some control, and sensory perception. drawal syndrome. Use of LSD and hallucinogens also produce LSD (an abbreviation of the other hallucinogens by secondary rapid, intense emotional swings. German words for "lysergic school students has declined since 1998, but ketamine and LSD are '....41. becoming more widely used at dance clubs and all-night 4t. by older teens and young adults. e." MDA research is developing

a clearer picture of tbe dangers 44..- of these mind-altering drugs. We have compiled the scient& information in this report to inform readers and to strengthen prevention and treatment efforts. Psil n and

.11ii ore pants that people hove used to Alan I. Leshner,Ph.D. produce "visions! Director National Institute 'on Drug Abuse 3 .S. Department of Health and Human Services Nationalinstitutes of Health(44- (*Noe NIDA RESEARCH REPORT SERIES acid diethylamide") is the drug dissociationfrom the environ- Why do most commonly identified with ment and self. But these mind- the term "" and the altering effects are not people take most widely used in this class of hallucinations. PCP and ketamine hallucinogens? drugs. It is considered the typical are therefore more properly hallucinogen, and the character- known as "dissociative anesthet- Hallucinogenic drugs have istics of its action and effects ics." Dextromethorphan, a widely played a role in human described in this Research Report available suppressant, life for thousands of years. apply to the other hallucinogens, when taken in high doses can Cultures from the tropicsV)the including , , produce effects similar to those arctic have used to induce and . of PCP and ketamine. states of detachment from reality The dissociative drugs act by and to precipitate "visions" What are altering distribution of the neuroL to provide mystical transmitter glutamate throughout insight. These plants contain dissociative the brain. Glutamate is involved chemical compounds, such as drugs? in perception of , responses mescaline, psilocybin, and ibo- to the environment, and memory. gaine, that are structurally similar Drugs such as PCP (phen- PCP is considered the typical to serotonin, and they produce cyclidine) and ketamine, dissociative drug, and the their effects by disrupting normal which were initially description of PCP's actions and functioning of the serotonin sys- developed as general effects in this Research Report tem. Historically, hallucinogenic for surgery, distort perceptions largely applies to ketamine and plants were used largely for of sight and sound and produce dextromethorphan as well. social and religious, , and feelings of detachment- their availability was limited by

Prevalence of Students Who Have Ever Used Hallucinogens and PCP

14% 14% 14% 12th-graders

10th - graders 12 12 12 8th-graders 10 10 10

F8 8 8 (Data notavailable for g6 6 6 8111- and 10th - graders)

4 4 4

2 2 2

0 0 0 1992 1994 1996 1998 2000 1992 1994 1996 1998 2000 1992 1994 1996 1998 2000

LSD Other Halludnogens PCP

Source: Monitoring the Future Survey, 2000 NIDA RESEARCH REPORT SERIES3 the climate and soil conditions they require. After the develop- ment of LSD, a synthetic com- Chemist , working at the Sandoz pound that can be manufactured Corporation pharmaceutical laboratory in Switzerland, anywhere, abuse of hallucino- first synthesized LSD in 1938. He was conducting research gens became more widespread, on possible medical applications of various lysergic acid and from the 1960s it increased compounds derived from , a that develops dramatically. All LSD manufac- on rye grass. Searching for compounds with therapeutic tured in this country is intended value, Hofmann created more than two dozen ergot-derived for illegal use, since LSD has synthetic molecules. The 25th was called, in German, no accepted medical use in the Lyserg-Saure-Diathylamid 25, or LSD-25. Five years after . he first created the drug, Hofmann accidentally ingested Physical a small amount and experienced a series of frightening characteristics of LSD sensory effects: LSD is a clear or white, odorless, "My surroundings...transformed themselves in more - soluble material synthe- terrifying ways. Everything in the room spun around, sized from lysergic acid, a compound derived from a rye and the familiar objects and pieces of furniture assumed fungus. LSD is the most potent grotesque, threatening forms. They were in continuous mood- and perception. altering motion, animated, as if driven by an inner restlessness drug known: oral doses as small ....Even worse than these demonic transformations as 30 micrograms can produce of the outer world were the alterations that I perceived effects that last 6 to 12 hours. in myself, in my inner being. Every exertion of my will, LSD is initially produced in every attempt to put an end to the disintegration of the crystalline form. The pure crystal outer world and the dissolution of my ego, seemed to can be crushed to powder and be wasted effort. A demon had invaded me, had taken mixed with binding agents to possession of my body, mind, and ." produce tablets known as "microdots" or thin squares of gelatin called "window panes"; more commonly, it is dissolved, discolor soon after it is manufac- receptors, and that its effects are diluted, and applied to paper tured, and drug distributors often most prominent in two brain or other materials. The most apply LSD to colored paper, regions: One is the cerebral cor- common form of LSD is called making it difficult for a buyer to tex, an area involved in mood, "blotter acid"sheets of paper determine the drug's purity or age. cognition, and perception; the soaked in LSD and perforated other is the locus ceruleus, into 1/4-inch square, individual LSD's effects which receives sensory signals dosage units. Variations in manu- The precise mechanism by which from all areas of the body and facturing and the presence of LSD alters perceptions is still has been described as the brain's contaminants can produce LSD unclear. Evidence from laborato- "novelty detector" for important in colors ranging from clear or ry studies suggests that LSD, like external stimuli. white, in its purest form, to tan hallucinogenic plants, acts on LSD's effects typically begin or even black. Even uncontami- certain groups of serotonin within 30 to 90 minutes of inges- nated LSD begins to degrade and receptors designated the 5-HT2 tion and may last as long as NIDA RESEARCH REPORT SERIES

Structure of Serotonin and Selected Hallucinogens

SEROTONIN LYSERGIC ACID DIETNYLAMIDE 1SD

Hallucinogenic drugs are much like the neurotransmitter serotonin in their molecular structure as well as where and how they act in the brain.

12 hours. Users refer to LSD ality, mood, expectations, and user's emotions may shift rapidly and other hallucinogenic experi- surroundings. through a range from fear to ences as "trips" and to the acute Users of LSD may , with transitions so adverse as "bad some physiological effects, such rapid that the user may seem to trips." Although most LSD trips as increased pressure and experience several emotions include both pleasant and , , loss of simultaneously. unpleasant aspects, the drug's appetite, dry mouth, sweating, LSD also has dramatic effects effects are unpredictable and , numbness, and tremors; on the . Colors, smells, may vary with the amount but the drug's major effects are sounds, and other sensations ingested and the user's person- emotional and sensory. The seem highly intensified. In some NIDA RESEARCH REPORT SERIES5 cases, sensory perceptions may of LSD. The causes of these Because HPPD symptoms may blend in a phenomenon known effects, which in some users be mistaken for those of other as , in which a person occur after a single experience neurological disorders such as seems to hear or feel colors and with the drug, are not known. stroke or brain tumors, sufferers see sounds. . The effects of may consult a variety of clinicians Hallucinations distort or trans- LSD can be described as drug- before the disorder is accurately form shapes and movements, induced psychosisdistortion diagnosed. There is no estab- and they may give rise to a per- or disorganization of a person's lished treatment for HPPD, ception that time is moving very capacity to recognize reality, although some slowly or that the user's body is think rationally, or communicate drugs may reduce the symptoms. changing shape. On some trips, with others. Some LSD users may help patients users experience sensations that experience devastating psycho- adjust to the associated are enjoyable and mentally stim- logical effects that persist after with visual distraction and to ulating and that produce a the trip has ended, producing a minimize the fear, expressed of heightened understanding. long-lasting psychotic-like state. by some, that they are suffering Bad trips, however, include terri- LSD-induced persistent psychosis or psychiatric fying and nightmarish may include dramatic mood disorder. swings from to profound feelings of and despair depression, vivid visual disturb- that include fears of insanity, ances, and hallucinations. These What are the facts death, or losing control. effects may last for years and LSD users quickly develop a about dissociative can 'affect people who have no high degree of tolerance for the history or other symptoms of drugs? drug's effects: After repeated use, psychological disorder. they need increasingly larger PCP's forms and effects Hallucinogen Persisting pCP, developed in the 1950s doses to produce similar effects. Perception Disorder. Some as an intravenous surgical LSD use also produces tolerance former LSD users report experi- , is classified as a for other hallucinogenic drugs ences known colloquially as dissociative anesthetic: Its seda- such as psilocybin and mescaline, "flashbacks" and called "HPPD" tive and anesthetic effects are but not to drugs such as mari- by physicians. These episodes -like, and patients experi- juana, , and PCP, are spontaneous, repeated, which do not act directly on the sometimes continuous recur- ence a feeling of being "out of serotonin receptors affected by rences of some of the sensory body" and detached from their LSD. Tolerance for LSD is short- distortions originally produced environment. PCP was used in livedit is lost if the user stops by LSD. The experience may veterinary but was taking the drug for several days. include hallucinations, but it never approved for human use There is no evidence that LSD most commonly consists of visual because of problems that arose produces physical withdrawal disturbances such as seeing false during clinical studies, including symptoms when chronic use is motion on the edges of the field and extreme agitation stopped. of vision, bright or colored flash- experienced by patients emerging Two long-term effects es, and halos or trails attached to from . persistent psychosis and hallu- moving objects. This condition is During the 1960s, PCP in pill cinogen persisting perception typically persistent and in some form became widely abused, but disorder (HPPD), more common- cases remains unchanged for the surge in illicit use receded ly referred to as "flashbacks " years after individuals have rapidly as users became dissatis- have been associated with use stopped using the drug.7 fied with the long delay between NIDA RESEARCH REPORT SERIES taking the drug and feeling its Powdered PCPknown as can result in fracture or in effects, and with the unpre- "ozone," "rocket fuel," "love damage or failure as a dictable and often violent boat," "hog," "embalming fluid," consequence of muscle cells behavior associated with its use. or "superweed"appeared in breaking down. Very high doses the 1970s. In powdered form, the of PCP can cause , drug is sprinkled on marijuana, , , and death. Street Names for , or , then smoked, PCP's effects are unpredictable. Hallucinogens and and the onset of effects is rapid. Typically, they are felt within Dissociative Drugs Users sometimes ingest PCP by minutes of ingestion and last for snorting the powder or by swal- several hours. Some users report feeling the drug's effects for qn,s lowing it in tablet form. Normally LSD a white crystalline powder, PCP days. One drug-taking episode acid may produce feelings of detach- blotter('') is sometimes colored with water- blotter soluble or -soluble dyes. ment from reality, including dots When snorted or smoked, distortions of space, time, and microdot PCP rapidly passes to the body image; another may pro- pane brain to disrupt the functioning duce hallucinations, panic, and paper acid of sites known as NMDA fear. Some users report feelings sugar (N-methyl-D-aspartate) of invulnerability and exagger- sugar cubes complexes, which are receptors ated strength. PCP users may trip for the neurotransmitter gluta- become severely disoriented, window glass mate. Glutamate receptors play violent, or suicidal. window pane a major role in the perception Zen Repeated use of PCP can of pain, in cognitionincluding result in , and recent Ketamine learning and memory and in research suggests that repeated bump .1., . In the brain, PCP also or prolonged use of PCP can cat ValiurhaV alters the actions of , cause withdrawal syndrome ;." areen a neurotransmitter responsible when drug use is stopped. oil for the euphoria and "rush" Symptoms such as memory K associated with many abused loss and depression may persist drugs. purple for as long as a year after a Special K At low PCP doses (5 mg or chronic user stops taking PCP. special la coke less), physical effects include super acid. shallow, rapid breathing, Nature and effects super C increased blood pressure and of ketamine vitamin K heart rate, and elevated tempera- Ketamine ("K," "Special K," ture. Doses of 10 mg or more "cat Valium") is a dissociative PCP cause dangerous changes in anesthetic developed in 1963 angel blood pressure, heart rate, and . angel dust to replace PCP and currently a- boat respiration, often accompanied used in human anesthesia and dummy dust by nausea, blurred vision, dizzi- veterinary medicine. Much of the love boat ness, and decreased awareness ketamine sold on the street has peace of pain. Muscle contractions may been diverted from veterinarians' supergrass cause uncoordinated movements offices. Although it is manufac- zombie and bizarre postures. When tured as an injectable liquid, in severe, the muscle contractions illicit use ketamine is generally .8 NIDA RESEARCH REPORT SERIES7

The effects vary with dose, and dextromethorphan users describe a set of distinct dose-dependent "plateaus" ranging from a mild effect with distorted visual perceptions at low (approximately 2-ounce) doses to a sense of complete dissocia- tion from one's body at doses of 10 ounces or more. The effects typically last for 6 hours. Over- the-counter that contain dextromethorphan often contain and decon- gestant ingredients as well, and high doses of these mixtures can seriously increase risks of Extra-strength cough is the most common source of abused dextromethorphan. dextromethorphan abuse. evaporated to form a powder sion of sexual assaults referred to Where can I get that is snorted or compressed as "drug rape." into pills. more scientific Ketamine's chemical structure Nature and effects and are of dextromethorphan information on similar to those of PCP, and its Dextromethorphan (sometimes hallucinogens effects are similar, but ketamine called "DXM" or "robo") is a is much less potent than PCP cough-suppressing ingredient in and dissociative with effects of much shorter a variety of over-the-counter cold drugs? duration. Users report sensations and cough medications. Like PCP ranging from a pleasant feeling and ketamine, dextromethorphan Fact sheets on LSD, PCP, other of floating to being separated acts as an NMDA receptor antag- illicit drugs, and related topics from their bodies. Some keta- onist. The most common source are available free, in English mine experiences involve a of abused dextromethorphan is and Spanish, with a call to NIDA terrifying feeling of almost com- "extra-strength" cough syrup, Infofax at 1-888-NIH-NIDA plete sensory detachment that is which typically contains 3 mil- (1-888-644-6432) or, for the deaf, likened to a near-death experi- ligrams of the drug per milliliter 1- 888- TTY -NIDA (1-888-889-6432). ence. These experiences, similar of syrup. At the doses recom- Further information on to a "" on LSD, are called mended for treating hallucinogens and dissociative the "K-hole." (1/6 to 1/3 ounce of , drugs can be obtained also Ketamine is odorless and taste- containing 15 mg to 30 mg through NIDA's home page less, so it can be added to bever- dextromethorphan), the drug is (www.drugabuse.gov) and from ages without being detected, and safe and effective. At much the National Clearinghouse for it induces . Because of higher doses (4 or more ounces), Alcohol and Drug Information these properties, the drug is dextromethorphan produces (NCADI) at 1-800-729-6686. sometimes given to unsuspecting dissociative effects similar to NCADI's Web' site is www.health.org. victims and used in the commis- those of PCP and ketamine. NIDA RESEARCH REPORT SERIES

Glossary

Add: Common street name for LSD. Halludnogen: A drug that produces NMDA: N-methyl-D-ospartate, a diemiad hallucinationsdistortion in perception of compound that reacts with glutamate receptors Angel dust: Common street name for PCP. sights and soundsand disturbances in on nerve cells. emotion, judgment, and memory. Cerebral cortex: Region of the brain responsi- PCP: Phencyclidine, a dissociative anesthetic ble for cognitive functions including reasoning, HPPD: Hallucinogen persisting perception abused for its mind-altering effects. mood, and perception of stimuli. disorder; the spontaneous and sometimes con- Persistent psychosis: Unpredictable tinuous recurrence of perceptual effects of LSD Dissodative anesthetic Compound, such as and long-lasting visual disturbances, dramatic long after on individual has ingested the drug. phencyclidine or ketamine, that produces an mood swings, and hallucinations experienced by some LSD users after they have discontinued anesthetic effect characterized by a feeling of Ketamine: Dissociative anesthetic abused for use of the drug. being detached from the physical self. its mind-altering effects and sometimes used to facilitate sexual assault. Robo: Common street name for DXM: Common street name for dextromethor- dextromethorphan. Phan- Locus ceruleus: Region of the brain that receives and processes sensory signals from all Serotonhc A neurotransmitter that causes : Slang term for HPPD (see below). areas of the body. a very broad range of effects on perception, movement, and the emotions by modulating Glutamate: A neurotransmitter associated with Neurotransmitter: Chemical compound that the actions of other in pain, memory, and response to changes in the acts as a messenger to carry signals or stimuli most parts of the brain. environment. from one nerve cell to another.

References Access information

Abraham, H.D.; Aldridge, A.M.; and Gogio, P. Javitt, D.C., and Zukin, S.R. Recent advances in the on the Internet The psychophormacology of hallucinogens. phencyclidine model of . American What's new on the NIDA Web site 14: 285-298, 1996. Journal of 148:1301. 1308,1991. Information on drugs of abuse Aghajonian, G.K., and Merck, GJ. Serotonin and Sanders-Bush, E. Neurochemical Evidence That Publications and communications hallucinogens. Neuropsychopharmocology Hallucinogenic Drugs are 5-HT2c Receptor (including NIDA NOTES) 21: 16S-235, 1999. : What Next? In: Lin, G.C., and Glennon, Calendar of events Badatrom, J.R.; Chang, M.S.; Chu, H.; Niswender, RA, eds. Hallucinogens: An Update. National Links to NIDA organizational units C.M.; and Sanders-Bush, E. -directed sig- Institute on Drug Abuse Research Monograph naling of serotonin 54112, receptors: differences No. 146. NIH Pub. No. 94-3872. Washington, funding Information (Including program announcements between serotonin and lysergic acid diethylamide D.C: U.S. Government Printing Office, 1994. (LSD). Neuropsychopharmacology 21: 77S-81S, and deadlines) 1999. Ungedeider, J.T., and Pechnidc R.N. Hallucinogens. International activities In: Lowenstein, J.H.; Ruiz, P.; and Millman, R.B., Carroll, M.E. PCP and hallucinogens. Advances in links to related Web sites eds. : A Comprehensive Alcohol and Substance Abuse 9(1. 2):167.190, (access to Web sites of many other Textbook, Second Edition. Baltimore: Williams & 1990. organizations in the field) Wilkins, 1992. Christophersen, A.S. designer drugs: an overview and epidemiology. Toxicology NIDA Web Sites lees 112. 113:127.131, 2000. www.drugabuse.gov Frankenheim, J.,and Lin, G.C. Hallucinogenic NIDA Drugs. In: Craighead, W.E., and Nemeroff, C., NATIONAL INSTITUTE www.steroidabuse.org eds. Encydapda of Psychology and ON DRUG ABUSE www.clubdrugs.org Neurosdence. New York: John Wiley & Sons, NIN Publication Number 01.4209 in press. NCADI Printed March 2001 Hofmann, A. LSD: My Problem Child. New York: Feel free to reprint this publication. Web Site: www.health.org McGraw-Hill, 1980. Phone No.: 1-800-729-6686 10 U.S. Department of Education Office of Educational Research and Improvement (OERI) z National Library of Education (NLE) ERIC Educational Resources Information Center (ERIC)

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