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HALLUCINOGENS INFORMATION AND ISSUES HALLUCINOGENS: FACTS AND FICTION Myth Hallucinogens all contain the same basic ingredients. Fact A rather __________________ group, these compounds have different chemical structures, different mechanisms of action, and different adverse effects. Myth All hallucinogens are natural substances found in nature. Fact Some are naturally occurring substances, but many are synthetically formed substances. HALLUCINOGENS: FACTS AND FICTION Myth Hallucinogens are safe and cause little or no long term damage. Fact There are many risks associated with hallucinogen use including mood disorders, psychosis, and addiction. Myth Hallucinogens are difficult to find and are not popular amongst youth. Fact ___________________________________________________________ ________________________________________________________ HISTORY OF HALLUCINOGEN USE Hallucinogens share a rich history. Many cultures have used hallucinogens for religious or mystical experiences. The Hindu holy book, _____________________soma, a sacred substance used to induce higher levels of consciousness. The Aztecs in pre-Columbian Mexico described the ceremonial use of teotlaqualli, a paste made from the hallucinogenic flower, ololiuqui. The ________________ Indians have a long history of using peyote, a mescaline-containing hallucinogen, in religious ceremonies. HISTORY OF HALLUCINOGEN USE The synthetic hallucinogen, lysergic acid diethylamide (LSD) 25, was serendipitously discovered in 1938 by Sandoz laboratories while searching for a new ergot-derived analeptic agent. Phencyclidine also known as PCP was first made in the 1926 by Parke, Davis, and Company. But it wasn't until the 1950's that it was used as an anesthetic for humans called Sernyl. It was eventually used as a tranquilizer for animals by veterinary institutes. DMT was first synthesized in 1931, and demonstrated to be hallucinogenic in 1956. It has been shown to be present in many plant genera and is a major component of several hallucinogenic snuffs. MDMA was patented in 1913 by the German chemical company Merck supposedly to be sold as a diet pill , the company decided against marketing the drug and had nothing more to do with it. WHAT ARE HALLUCINOGENS? Hallucinogens ◦ Hallucinogens are a diverse group of drugs that cause an alteration in perception, thought, or mood. ◦ Despite their name, most hallucinogens do not consistently cause hallucinations, which are defined as false sensations that have no basis in reality. ◦ Often, they are more likely to cause changes in mood or in thought than actual hallucinations. ◦ Hallucinogens can be broken down in several major groups ◦ ◦ ◦ ◦ ◦ Lysergamides _______________________ Piperidines Indolealkylamines Cannabinols LYSERGAMIDES The lysergamides include LSD and lysergic acid hydroxyethylamide, which is a naturally occurring psychedelic found in _________________________. LSD LSD was initially derived from the ergot alkaloids produced by the fungus Claviceps purpurea as shown below , a contaminant of wheat and rye flour, by Albert Hoffman circa 1938. A tasteless, colorless, odorless liquid, LSD is usually sold as liquidimpregnated blotter paper, gelatin squares (window panes), or tiny tablets (microdots). LSD acts on ______________________receptors in the brain. The onset of psychological effects occurs approximately 30-60 minutes after ingestion of LSD, and they last for approximately 12 hours. Effect peaks at approximately 5 hours LSD -EFFECTS • The psychological effects vary both with the individual taking the drug and the physical environment surrounding the user. • Changes in mood and perception are uniform. Boundaries between users and their environment are blurred, time becomes distorted, stationary objects may seem to flow or pulsate, and color perception is heightened. • Delusions like hearing color or seeing sounds, are commonly reported. • A feeling of clarity of consciousness may be reported by the user, during which the importance of reality is diminished. • Hallucinations may occur, although users are usually aware that they are hallucinating. • Occasionally, a threatening or stressful environment may provoke feelings of severe anxiety and paranoia. This acute panic reaction is often referred to as a "bad trip" and is the most common reason for users to seek medical attention. ADVERSE EFFECTS • A transient depression may occur after LSD use. • ________________after LSD use has been reported, and an underlying or undiagnosed schizophrenia may worsen. • An unusual aspect of LSD use is the occurrence of "flashbacks," or hallucinogen persisting perception disorder (HPPD), months to years after LSD use. These are observed most commonly in persons who have used LSD more than 10 times. • During a psychotic episode, danger of suicide and homicide exists. ADVERSE EFFECTS • In addition to the psychological effects, LSD also produces sympathomimetic effects. • Increases in heart rate, blood pressure, and, occasionally, temperature may occur. • Rarely, LSD can produce life-threatening symptoms. Hyperthermia, hypertension, coma, respiratory arrest, and bleeding have been reported. • However, users remain more at risk ________________________________ than they do from the toxic effects of the LSD. • Video Part 1 Part 2 Part 3 Part 4 Part 5 _____________________ __________________derivatives include mescaline and several hallucinogenic amphetamines. These include drugs like peyote and ecstasy. PEYOTE _______________ is the psychogenic amphetamine found in the peyote cactus, Lophophora williamsii. Native Americans have used peyote for more than 8000 years. Use continues today; members of the Native American Church are still permitted to use the drug in religious ceremonies Mescaline is thought to induce hallucinations by an amphetamine-like action, although the precise mechanism is unknown. After ingestion of 6-12 peyote buttons (the dried bitter fleshy tops of the cactus), the user first begins to feel effects in 30 minutes to 2 hours. Nausea, vomiting, diaphoresis, and ataxia precede the hallucinogenic effects, which may last _________________. ECSTASY The hallucinogenic amphetamines are structural analogs of mescaline and amphetamine. Most were derived from their parent compounds in an effort to avoid US Drug Enforcement Agency prosecution (so-called designer drugs). They all have similar psychogenic effects and toxicity. They include MDMA, MDA, MDEA, and MMDA. MDMA, also known as ecstasy, is perhaps the most well known of these compounds. First synthesized in 1914, MDMA is presently the drug of choice at "raves," ie, all-night dance parties popular in the United States and the United Kingdom. EFFECTS MDMA appears to affect serotonin neurotransmission at presynaptic and postsynaptic sites. Although it usually does not cause hallucinations, it causes changes in mood and the perception of music, reputedly increases interpersonal communication, and fosters feelings of intimacy and empathy. Animal and primate studies show significant degradation of serotonergic neurons following MDMA use. This degradation is cumulative and dose-related. This has led some experts to warn of the possibility of permanent ___________________in individuals who use the drug regularly EFFECTS • Many of their toxicities are identical to those of ____________________________. • Hypertension and tachycardia are quite common. Hyperthermia is a common and occasionally serious complication. • The combination of strenuous physical activity, dehydration, and high ambient temperatures found at raves all contribute to severe ___________________ • This also may be accompanied by renal failure. EFFECTS • Many deaths have been reported with MDMA use. • Media coverage of these deaths has resulted in the belief that water is the antidote to MDMA. Unfortunately, the consumption of large amounts of water, combined with an intrinsic SIADH-like (syndrome of inappropriate secretion of antidiuretic hormone) effect of the drug itself, often leads to hyponatremia and, occasionally, seizures. • Frequent users rapidly develop tolerance to the drug, requiring higher doses for the same effect. • Less is known about Mescaline and its negative effects. PIPERIDINES Piperidine derivatives include PCP and ketamine. PCP PCP was developed in ________________as a dissociative anesthetic/analgesic agent initially marketed under the brand name Sernylan. It was soon withdrawn from use because of severe adverse psychological reactions following its use; severe dysphoria, agitation, and psychotic behavior were all noted routinely. It was used in veterinary medicine in the 1960s and soon became a popular drug of abuse, first observed in San Francisco. During a psychotic episode, danger of __________________________ exists. EFFECTS OF PCP • The onset of effects occurs in 2-5 minutes after ingestion or smoking of PCP (often it is sprinkled on marijuana cigarettes). • Peak effect occurs by 15 minutes. The duration of action is as long as 16 hours (some users report effects persisting as long as 24-48 h). • PCP antagonizes the action of glutamate at the Nmethyl-D-aspartate receptor, blocking the influx of calcium and inhibiting neurotransmitter release. • Depending on the dose, PCP may cause either CNS excitation or depression. Cardio vascular effects are prominent. EFFECTS OF PCP • The clinical manifestations of PCP use are extremely variable and unpredictable. • The patient may appear calm or wild, disoriented, violent, stuporous, or comatose, depending on the ingested dose. Patients often have a _____________. • Temperature, heart rate, and blood pressure are elevated. Bizarre and psychotic behaviors are often noted. • PCP is associated with a much higher _______________________than other classes of hallucinogens. The combination of sympathetic effects, severe agitation, and muscle rigidity place these patients at high risk for the complications of severe hyperthermia, rhabdomyolysis, and subsequent myoglobinuric renal failure. • Their violent and bizarre behavior places them at high risk for trauma. The dissociative nature of PCP allows users to do tremendous harm to their bodies with little or no perceived pain. • Video 1 Video 2 INDOLEALHYLAMINES • The indolealkylamine group includes the 2 mushroom-derived hallucinogens (ie, psilocybin, psilocin), DMT, and bufotenine. PSILOCYBIN • Psilocybin is found in the following 3 major genera of mushrooms: Psilocybin, Conocybe,and Panaeolus. • Often growing on cow dung, they are found in most areas of the United States, with the exception of arid regions. • The effects of psilocybin last approximately 4-6 hours. Hallucinations are common. The mushrooms cause ________________________________, although cases of hyperthermia, seizures, and coma have been reported. • Misidentification of the mushrooms in the wild and on the street is common; only one third of "magic mushrooms" bought on the street contain psilocybin. Many are simply store-bought mushrooms laced with PCP. DMT • DMT is a potent psychedelic with a brief duration of action _________________ • This has earned it the nickname "businessman's trip." • It is found naturally in the bark of trees of the genus Virola, which grows in the Amazon basin. • DMT is only active when smoked or snorted. It causes more visual hallucinations and more sympathetic effects than LSD. • Several species of _______ produce venom that has psychoactive properties. Members of the genus Bufo, particularly Bufo marinus (see the image below) and Bufo alvarius, contain bufotenine and 5-MeO-DMT. • The compound 5-MeO-DMT is firmly established as a hallucinogen, whereas the role of bufotenine has not yet been established. • The toads are either licked or milked for their venom, which may then be ingested or smoked. Their dried skin also may be smoked. OTHER HALLUCINOGENS • Cannabinols-THC(Marijuana) • ________ Divinorum • Video • ____________________ PREVALENCE RATES • In 2007, 6.1 million persons aged 12 or older reported that they had used PCP in their lifetime (2.5 percent) • In 2007, more than 22.7 million persons aged 12 or older reported they had used LSD in their lifetime (9.1 percent)