Hallucinogens And Dissociative Drug Use And Addiction Hallucinogen Drug Use And Addiction Series JASSIN M. JOURIA Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Users of hallucinogens and dissociative drugs are often drawn in by the promise of a relaxed, vivid dream-like state. However, the truth is that these drugs often leave the user unable to differentiate between fantasy and reality, disrupting their ability to think and communicate and leading to intense feelings of panic and paranoia. An array of physical effects, in the worst-case scenario, can be fatal. Clinicians must be prepared to address the psychiatric and physical effects of hallucinogen drug use as well as addiction treatment. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacy content is 3.5 hours. Statement of Learning Need Health clinicians need to understand the difference between the signs and symptoms of hallucinogen substance use and addiction to other medical conditions. Emergency as well as inpatient and outpatient clinicians should be able to evaluate patients suffering from hallucinogen use, as hallucinogens comprise a diverse group of drugs that alters perception, thought, or mood. Course Purpose To provide clinicians with knowledge of hallucinogenic drug use and addiction, including diagnosis and treatment to help patients maintain sobriety. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. Hallucinations are defined as false sensations a. coupled with a change in mood. b. that impact memory. c. that have no basis in reality. d. caused by actual events. 2. Patients under the influence of hallucinogens may best be described as a. exhibiting a euphoric state. b. showing a wide range of unusual, sudden, volatile behaviors. c. being agitated and aggressive. d. being always “laid back.” 3. True or False: Hallucinogens are more likely to cause changes in mood or in thought than actual hallucinations. a. True b. False 4. Which of the following is a synthetic hallucinogen? a. Lysergic acid diethylamide b. Dimethyltryptamine (DMT) c. Mescaline d. Lysergic acid amide 5. There is no perfect method to categorize hallucinogenic substances because many overlap in a. structure. b. pharmacology. c. clinical features. d. All of the above 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction Hallucinogens are a diverse group of drugs that cause alterations in perception, thought, or mood. This heterogeneous group has compounds with different chemical structures, different mechanisms of action, and different adverse effects. Despite their description, most hallucinogens do not consistently cause hallucinations. The drugs are more likely to cause changes in mood or in thought than actual hallucinations. Hallucinogenic substances that form naturally have been used worldwide for millennia to induce altered states for religious or spiritual purposes. While these practices still exist, the more common use of hallucinogens today involves the recreational use of synthetic hallucinogens. Hallucinogen And Dissociative Drug Toxicity Hallucinogens comprise a collection of compounds that are used to induce hallucinations or alterations of consciousness. Hallucinogens are drugs that cause alteration of visual, auditory, or tactile perceptions; they are also referred to as a class of drugs that cause alteration of thought and emotion. Hallucinogens disrupt a person’s ability to think and communicate effectively. Hallucinations are defined as false sensations that have no basis in reality: The sensory experience is not actually there. The term “hallucinogen” is slightly misleading because hallucinogens do not consistently cause hallucinations. How hallucinogens cause alterations in a person’s sensory experience is not entirely understood. Hallucinogens work, at least in part, by disrupting communication between neurotransmitter systems throughout the body including those that regulate sleep, hunger, sexual behavior and muscle 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com control. Patients under the influence of hallucinogens may show a wide range of unusual and often sudden, volatile behaviors with the potential to rapidly fluctuate from a relaxed, euphoric state to one of extreme agitation and aggression. Synesthesias is an anomalous blending of the senses, where an affected person may hear colors, feel or see sounds and taste shapes. Synesthesias are often reported by an individual using hallucinogens such as lysergic acid diethylamide (LSD). History And Use Of Hallucinogens Naturally occurring hallucinogens can be found in plants and mushrooms in certain parts of the world, and they grow in many locations in the United States. Included in these naturally occurring substances are dimethyltryptamine (DMT), psilocybin and psilocin, mescaline, salvinorin A, lysergic acid amide (LSA), and atropine and scopolamine. Because hallucinogenic drugs may alter human consciousness, they have been used throughout history by diverse cultures for religious, medicinal or mystical purposes. The Hindu holy book, Rig Veda, mentions soma, a sacred substance used to induce higher levels of consciousness. No definition is given for levels of consciousness. Soma is extracted from the juice of the hallucinogenic mushroom Amanita muscaria. The Aztecs of pre-Columbian Mexico have talked about the ceremonial use of teotlaqualli, which is a paste made from a hallucinogenic flower, called ololiuqui. It was rubbed on the skin of Aztec priests and soldiers, because it was thought to eliminate fear and place the user in a “proper” mental state to serve the Aztec gods. The Mexican Indians have a long history of using peyote, which is a mescaline-containing cactus, in religious ceremonies. Hallucinogens have also been proposed as a cause 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com of the "immoral and illicit" behavior of women who were tried in the Salem, Massachusetts witch trials. The first synthetic hallucinogen, lysergic acid diethylamide (LSD), was discovered unintentionally in 1938 by Sandoz laboratories, a commercial pharmaceutical enterprise, while they were searching for a new ergot- derived analeptic agent. Its discoverer, a Swiss chemist named Albert Hoffman, began to experience hallucinations after an accidental percutaneous exposure to the drug. Sandoz began marketing the new drug in 1947. Delysid, as the drug was called, was used by psychiatrists who believed its use in psychotherapy could help the patient access repressed emotions. It first appeared in the United States in 1949 when it was used as a model to study schizophrenia due to its potent psychotomimetic effects. The applications of LSD quickly broadened to include numerous other medical and clandestine uses. The United States Central Intelligence Agency conducted human experiments with LSD. They