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Toxicology Times TOXICOLOGY (800) 677-7995 TIMES www.sdrl.com A FREE Monthly Newsletter for Substance Abuse and Opioid Treatment Volume 10, Issue 3 Programs from San Diego Reference Laboratory March, 2020 The Peril and Promise of Hallucinogens Dr. Joseph E. Graas, Scientific Director while to understand the potential impact of hallucinogens, the drugs and derivatives Dr. Renee Kilmer, Medical Director the hallucinogen class of drug on human from them also have some therapeutic po- Dr. Edward Moore, Medical Director welfare. Many hallucinogens do not cause tential. Most common is the use of nitrous Dr. Karen Wagersmith, Scientific Director addiction symptoms, although several can. oxide (aka laughing gas) in dentistry. Keta- In the past year, 2.5% of adults — nearly 6 mine has some veterinary as well as human The hallucinogen class of drugs can be de- million people — experienced marijuana anesthetic uses. Several cannabis-related fined as any drug that causes a distortion of use disorder. Likewise, repeated use of products are approved by the Food and your perception, or drugs for which percep- PCP can lead to tolerance and a substance Drug Administration (FDA) for certain tion distorting effects are stronger than oth- use disorder with withdrawal symptoms. causes of nausea. Cannabidiol (CBD), a er effects. Three types of perceptual altera- Ketamine users can develop signs of toler- naturally occurring cannabis-derived drug tions are caused by three different sub- ance and craving for the drug as well. from the same biochemical pathway as groups of hallucinogens. The first sub- THC, has been also approved by the FDA group is the classic psychedelics. Members Besides addiction, two other negative long- for treatment of certain rare seizure disor- of this subgroup are lysergic acid diethyla- term effects have been associated with use ders. Further, a specific extract of cannabis mide (LSD), N,N-dimethyltryptamine of classic psychedelics, although these ef- was approved as a botanical drug in the (DMT) from ayahuasca, psilocybin from fects are rare. Hallucinogen persisting per- United Kingdom for people with multiple certain mushrooms, and mescaline from ception disorder (HPPD) is a condition in sclerosis. peyote cactus. Tetrahydrocannabinol which certain visual effects of the drug re- (THC) from cannabis/marijuana is some- cur even after the drug has worn off. These The hallucinogen class of drugs may be times considered a member of the classic flashbacks may occur within a few days or effective for psychiatric conditions. A form psychedelics group. The second subgroup more than a year after drug use. These of ketamine has been FDA approved for is dissociatives. This group causes reduced symptoms are sometimes mistaken for other treatment resistant depression. In addition, perception of the environment and includes disorders, such as stroke or a brain tumor. small studies have shown that three addi- ketamine, phencyclidine (PCP), nitrous Another condition that is associated with tional hallucinogens, LSD, ayahuasca, and oxide, salvia, and dextromethorphan exposure to psychedelics is persistent psy- psilocybin also hold promise for alleviating (DXM). The third subgroup is deliriants. chosis. Psychosis involves visual disturb- depression. In addition, psilocybin shows Delirium can be caused by atropine and ances, disorganized thinking, paranoia, and promising preliminary results in treating scopolamine. mood changes. For example, heavy canna- obsessive compulsive disorder. bis users are more likely to have psychosis Many hallucinogens have structures similar than nonusers. The higher the level of use, There is emerging evidence that some drugs to those of natural human brain chemicals the greater the chances for psychosis. Re- in this class may be helpful with addiction. and temporarily modify the action of either searchers are not sure yet whether THC Two small studies found significant im- these neurotransmitters or of the receptors actually causes psychosis, or if there is provements in abstinence and craving for that binds the neurotransmitters. The dif- some other explanation for the link. alcohol and nicotine in dependent individu- ferent subgroups of hallucinogens affect als after treatment with psilocybin along different neurotransmitter systems. Most Another type of harm caused by this class with psychotherapy. Reductions in alcohol classic psychedelics are thought to produce of drugs is a condition that has been in the and nicotine use remained significant after their perception altering effects by impact- news lately called E-cigarette/Vaping Asso- six months in both studies. ing the action of the neurotransmitter, sero- ciated Lung Injury (EVALI). Data shows tonin, although THC acts on the endocanna- that vaping products containing THC that In each of the coming months, we will dis- binoid neurotransmitter receptors. Most are obtained off the street or from other cuss individual hallucinogens so we can dissociative hallucinogenic drugs interfere informal sources have played a major role explore in more detail how it is that a sim- with the action of the neurotransmitter, glu- in the national outbreak. Vitamin E acetate, ple molecule can exert such profound ef- tamate. Many deliriant hallucinogens inter- an ingredient found in many legal/illegal fects on our perception of reality. fere with the action of the neurotransmitter, vaping products, is also strongly linked to acetylcholine. the EVALI outbreak. Thankfully, in the References : months since its peak in September 2019, “Hallucinogens” drugabuse.gov, April 2019, retrieved Feb 14, 2020 In recent years, there has been an expanding emergency room visits related to vaping “FDA Regulation of Cannabis and Cannabis-Derived Products, Includ- ing CBD” FDA.gov Feb. 13, 2020, retrieved Feb 14, 2020. legalization of marijuana as well as a num- have started to decline. “Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products” CDC.gov, Feb. 11, 2020, retrieved Feb. 14, 2020. ber of jurisdictions in the United States “Hallucinogens and Dissociative Drugs” NIH.gov, Feb. 2015, retrieved decriminalizing psychedelics. It is worth- Despite the potential problems with using Feb. 14, 2020. Neurosci. Biobehav. Rev., 2020 Jan; 108; 423-434 Toxicology Times © 2020 San Diego Reference Laboratory. The content of San Diego Reference Laboratory’s Publication, The Toxicology Times, is provided free of charge and is intended to assist the medical personnel in the interpreta- tion of laboratory results for drug treatment programs. The information contained in The Toxicology Times is not intended or implied to be a substitute for professional medical advice. .
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