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The Hallucinogenic World of Tryptamines: an Updated Review

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The Hallucinogenic World of Tryptamines: an Updated Review Arch Toxicol DOI 10.1007/s00204-015-1513-x REVIEW ARTICLE The hallucinogenic world of tryptamines: an updated review Ana Margarida Araújo1 · Félix Carvalho1 · Maria de Lourdes Bastos1 · Paula Guedes de Pinho1 · Márcia Carvalho1,2 Received: 10 March 2015 / Accepted: 25 March 2015 © Springer-Verlag Berlin Heidelberg 2015 Abstract In the area of psychotropic drugs, tryptamines years, raising international concern over tryptamines. How- are known to be a broad class of classical or serotonergic ever, the lack of literature pertaining to pharmacological hallucinogens. These drugs are capable of producing pro- and toxicological properties of new tryptamine hallucino- found changes in sensory perception, mood and thought in gens hampers the assessment of their actual potential harm humans and act primarily as agonists of the 5-HT2A recep- to general public health. This review provides a compre- tor. Well-known tryptamines such as psilocybin contained hensive update on tryptamine hallucinogens, concerning in Aztec sacred mushrooms and N,N-dimethyltryptamine their historical background, prevalence, patterns of use and (DMT), present in South American psychoactive beverage legal status, chemistry, toxicokinetics, toxicodynamics and ayahuasca, have been restrictedly used since ancient times their physiological and toxicological effects on animals and in sociocultural and ritual contexts. However, with the dis- humans. covery of hallucinogenic properties of lysergic acid dieth- ylamide (LSD) in mid-1900s, tryptamines began to be used Keywords Tryptamines · Hallucinogens · 5-HT2A recreationally among young people. More recently, new receptor · Toxicokinetics · Toxicodynamics · Toxicity synthetically produced tryptamine hallucinogens, such as alpha-methyltryptamine (AMT), 5-methoxy-N,N-dimeth- yltryptamine (5-MeO-DMT) and 5-methoxy-N,N-diisopro- Introduction pyltryptamine (5-MeO-DIPT), emerged in the recreational drug market, which have been claimed as the next-gener- Recreational drugs have always played a part in human ation designer drugs to replace LSD (‘legal’ alternatives to society, but, in recent years, the drug market has changed LSD). Tryptamine derivatives are widely accessible over significantly. In addition to the well-known illicit drugs the Internet through companies selling them as ‘research such as cocaine, amphetamine, heroin or lysergic acid dieth- chemicals’, but can also be sold in ‘headshops’ and street ylamide (LSD), many new psychoactive substances have dealers. Reports of intoxication and deaths related to the appeared at a dizzying speed (EMCDDA 2014; Schmidt use of new tryptamines have been described over the last et al. 2011). The illegal status of the classical drugs of abuse has encouraged users to obtain these new options with simi- * Ana Margarida Araújo lar pharmacological effects, having the advantages of being [email protected] legal and cheaper and, theoretically, of having higher purity * Márcia Carvalho (Hill and Thomas 2011). These new substances are usually [email protected] synthetic chemicals, but may also be products from natural sources, including plant or fungal materials that can be eas- 1 UCIBIO‑REQUIMTE, Laboratório de Toxicologia, ily purchased on the Internet Web sites or through special- Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Rua Jorge Viterbo Ferreira, ized stores (Arunotayanun and Gibbons 2012; EMCDDA 228, 4050‑313 Porto, Portugal 2014) and appear in a variety of forms, such as ‘party pills’ 2 FP‑ENAS, CEBIMED, Fundação Ensino e Cultura Fernando or herbal mixtures (Babu et al. 2005; EMCDDA 2010; Pessoa, Porto, Portugal Kjellgren and Soussan 2011). Although these substances 1 3 Arch Toxicol are sold in packages labeled ‘not for human consumption’, producing memory or intellectual impairment or addiction they are intentionally marketed as replacements for illegal and that produce minimal autonomic side effects (Hollis- drugs, being sold legally in certain countries under names ter 1964). However, this definition may be considered too such as ‘research chemicals’, ‘legal highs’ or ‘designer restricted and is also often controversial, because besides drugs’ (Arunotayanun and Gibbons 2012; Kjellgren and the two main hallucinogenic classes (indolamines and phe- Soussan 2011; Musselman and Hampton 2014). These new nylalkylamines; see below section: “Chemistry”), other psychoactive substances, in fact, refer to substances typi- drug classes generally not classified as hallucinogens, such cally created by the modification of the molecular structure as cannabinoids and N-methyl-D-aspartate (NMDA) antag- of controlled psychoactive molecules or, less commonly, by onists, may also produce effects that overlap with those; finding new drug classes, in order to create alternative psy- these drugs showed to be behaviorally dissimilar in humans choactive compounds and to circumvent drug abuse legisla- and have distinct mechanisms of action. Subsequently, tion (Gibbons 2012; Hill and Thomas 2011). Glennon (1996) added to the definition that the hallucino- More than 300 different new psychoactive substances gens are also agents that have the 5-HT2A receptors as pri- have been synthesized since the beginning of the twenty- mary site of action and produce full substitution in animals first century, and the number identified in the European trained to discriminate the hallucinogen 2,5-dimethoxy- Union has risen abruptly from 14 in 2005 to 81 only in 4-methylamphetamine (DOM). For this reason, these drugs 2013 (EMCDDA 2014). These substances may belong to are also known as classical or serotonergic hallucinogens. different chemical classes such as tryptamines, phenethy- lamines, cathinone derivatives, synthetic cannabinoids, and piperazines (EMCDDA 2014). In 2012, four new The evolution in the use of tryptamines: tryptamine derivatives were formally notified to the Early from natural substances to synthetic drugs Warning System (EMCDDA 2012). Although that may seem a small number, it is more than what was notified in Nature is an astonishing ‘laboratory’ that has the ability to the previous 3 years combined. In fact, among the recently produce compounds that cause profound effects on several highlighted new psychoactive substances, the demand for organs, including the central nervous system (CNS). Since synthetic tryptamines has won popularity in the last few prehistory, humans have used these compounds, particu- years (EMCDDA 2014) due to their hallucinogenic proper- larly naturally occurring hallucinogens, taking advantage of ties, replacing the consumption of the traditional hallucino- their psychotropic properties for many purposes (Metzner gens (Winstock et al. 2014). 1998; Nichols 2004; Sanders et al. 2008). Scanty information is available on these new tryptamine Ayahuasca, also known as ‘vine of the souls’, is a hal- derivatives, which are rarely subject to studies in animals lucinogenic brew made out of Banisteriopsis caapi alone or humans, so that the real composition of these products, or in combination with other plants, as Psychotria viridis. their acute and long-term effects, their possible interactions Rivier and Lindgren (1972) identified the chemicals respon- with other substances, their toxicological risks or even their sible for the effects of this brew: the Banisteriopsis caapi addictive potential remain unknown (Sanders et al. 2008; is the source of the major β-carbonile alkaloids harmine, Schmidt et al. 2011). The escalating market of these prod- harmaline and tetrahydroharmine (THH), while the leaves ucts resulted in a consequential increase of intoxication of Psychotria viridis are rich in N,N-dimethyltryptamine cases and deaths related to their consumption (Boland et al. (DMT). After oral administration in humans, DMT is 2005; Jovel et al. 2014; Tanaka et al. 2006). While com- rapidly inactivated by monoamine oxidase A (MAO-A) prehensive and updated reviews are available for some new enzymes in the liver and gut; however, B. caapi contains psychoactive substances such as cathinones (Katz et al. MAO inhibitors (harmine and harmaline) that prevent the 2014; Prosser and Nelson 2012; Valente et al. 2014), pip- DMT degradation, and therefore, the combination of the erazines (Arbo et al. 2012; Elliott 2011; Monteiro et al. two plants is essential for the enhancement of the effects 2013) and synthetic cannabinoids (Seely et al. 2012), to (Cunningham 2008; McKenna 2004). Indigenous Amazo- our knowledge this is the first paper gathering data on the nian tribes traditionally use this drink in religious ceremo- chemical, pharmacological and toxicological properties of nies. It is also used in Northern South America with thera- currently known tryptamine derivatives. peutic purposes, believed to be effective in the treatment of abuse disorders and some physical maladies (McKenna 2004; Ujvary 2014). Ayahuasca is probably the most com- What is a hallucinogen? The definition mon tea with ethnomedicine applications, containing con- siderable amounts of DMT (an average dose of 100 mL of In general, hallucinogens are defined as agents that pro- ayahuasca contains approximately 24 mg of DMT) (Calla- duce changes in thought, perception and mood without way et al. 1996). DMT also occurs in other plant sources 1 3 Arch Toxicol Fig. 1 Molecular structures of the best-known natural hallucinogenic alvarius is known to secret the psychoactive substances bufotenine tryptamines. a Psilocin and psilocybin are the main hallucinogenic and 5-MeO-DMT; c LSA,
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