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Hallucinogens

While hallucinogenic compounds have been used for thousands of years in cultures throughout the world, interest in their use in medical as well as social contexts in the United States peaked in the 1950s and 1960s. This article will explore LSD, Peyote & Mescaline, Psilocybin, Nutmeg, and Salvia Divinorum. Ketamine and Ecstasy/MDMA are also included under hallucinogens as part of the club drugs. There is definite overlap with the effects of club drugs. Phencyclidine/PCP, also a hallucinogenic, will be discussed in a future article.

Background

The term “hallucinogen” is derived from the Latin alucinari, meaning to wander in mind or talk idly.¹ Hallucinogens are agents that alter perceptions without major autonomic or metabolic changes or agents that cause alterations in perception, cognition, and mood as their primary psychobiologic action in the presence of an otherwise clear sensorium.²A typical hallucination induced by a classical hallucinogen (i.e., mescaline, peyote) is more accurately described as a modification of regular perception, with the user usually aware of the illusory and personal nature of their perceptions.¹In 1956, the psychiatrist, Humphrey Osmond, coined the term “psychedelic,” meaning “mind manifesting,” to describe drugs such as lysergic acid diethylamide (LSD) and mescaline. The term is a reference to the drug’s ability to illuminate normally hidden aspects of the mind or psyche.³ This term became popularized in the 1960s and is often used interchangeably with the term hallucinogen to describe both the classical hallucinogens and their effects.The oldest hallucinogen is thought to be the fly agaric mushroom, Amanita muscaria, the action of which was discovered in Siberia by observing the behavior of intoxicated reindeer. In many prehistoric and ancient cultures, the use of plant materials discovered to have hallucinogenic properties became incorporated into religious beliefs and practices, with the plants becoming sacraments used ceremonially and medicinally. In this context, they are often referred to as entheogens, used to facilitate healing, divination, communication with spirits, and coming-of-age ceremonies.^1,4 Some of these sacramental practices continue today and are legally sanctioned.Intense interest in hallucinogens in Western society began with the discovery of LSD. In 1938, in search of a new migraine medicine, Swiss biochemist, Albert Hofmann, synthesized LSD at the Sandoz Pharmaceutical Laboratories. It was not until 1943, when some of the liquid chemical substance spilled onto his hand, that Hofmann experienced the first recorded LSD “trip.” He recounted those 45 minutes after absorbing some of the chemical into his skin, he became increasingly dizzy, developed visual disturbances, and had a marked desire to laugh. An hour into the experience, he asked his assistant to call a doctor and accompany him home. In Hofmann’s mind, he was not on the familiar street that led him home but instead on a street painted by Salvador Dali, a funhouse roller coaster where the buildings yawned and rippled.³The introduction of LSD to Europe and the United States in 1949 ushered in an era in which millions of people had access to these extremely potent drugs for religious or recreational use. The personal use of hallucinogenic drugs markedly differed from their historical use under shamanic guidance, in that processing and integrating the experience was left to the individual user.LSD was regarded as a drug with enormous scientific and therapeutic potential and was used to develop new insights into the mechanisms of nerve cell transmission, visual hallucinations, and the phenomenology of schizophrenia.During the 1950s, more than 500 papers on LSD were published in scientific journals, none of which described the drug in terms of addiction or abuse.³ Early military research focusing on hallucinogens as incapacitating agents was also conducted during this period. Intelligence agencies tested these drugs, in some cases on unwitting subjects, hoping they would provide an effective means of interrogation and mind control, with little success.⁵

Hallucinogens can be synthetically produced in illicit laboratories or found in plants or fungi.^6,7

Common street names

Acid, Fry, Mind Candy, Mushrooms, Shrooms, Special K, STP, X and XTC (Ecstasy).Hallucinogens come in a variety of forms. MDMA/Ecstasy tablets are sold in many colors with a variety of logos to attract youth. LSD is sold in the form of saturated paper (blotter paper), typically imprinted with colorful graphic designs. Other hallucinogens are sold as powders.^6,7The most commonly abused hallucinogens, such as psilocybin-containing mushrooms, LSD, and MDMA are typically taken orally or smoked.

Psychological effects

• Perceptual distortions that vary with dose, setting and mood.
• Distortions of thought associated with time and space.
• Time may appear to stand still.
• Forms and colors may change and may take on new significance.

Hallucinogen Persisting Perception Disorder (HPPD)⁶:

• “Flashbacks”.
• Fragmentary recurrences of certain aspects of the drug experience in the absence of taking the drug.
• Occurrence is unpredictable, but more likely to occur during times of stress.
• Seems to occur more frequently in younger individuals.

Physical effects

• Elevated heart rate.
• Increased blood pressure.
• Dilated pupils.
• Nausea and vomiting.

Overdose effects

Serious psychological harm can occur after administration.

• Fear.
• Depression.
• Anxiety.
• Paranoia that may be long-lasting.

Death

Less common from exclusively acute overdose of LSD, psilocybin-containing mushrooms, mescaline and other hallucinogens.Deaths generally occur due to:

• Suicides.
• Accidents.
• Dangerous behavior.
• Inadvertently eating poisonous plant material.
• Polysubstance abuse.

An annual national survey of drug use among high school students in the United States found that 6.9% of 12th graders reported lifetime hallucinogen use in 2019 and 4.6% reported hallucinogen use in the past year.⁸

LSD – Lysergic Acid Diethylamide

LSD is a clear, odorless substance with a slightly bitter taste. It is available in saturated absorbent paper (e.g., blotter paper, divided into small, decorated squares, with each square representing one dose.), tablets or “micro dots”, saturated sugar cubes, or in a liquid form. LSD is produced in clandestine laboratories in the United States.⁹

Common street names

Acid, Dots, Mellow Yellow, and Window Pane

Physical effects

• Dilated pupils.
• Higher body temperature.
• Increased heart rate and blood pressure.
• Sweating.
• Loss of appetite.
• Sleeplessness.
• Dry mouth.
• Tremors.

Psychological effects

• During the first hour after ingestion, users may experience visual changes with extreme changes in mood.⁹
• User may suffer impaired depth and time perception.⁹
• Distorted perception of the shape and size of objects, movements, colors, sound, touch, and the user’s own body image.⁹
• Impaired ability to make sound judgments and see common dangers making the user more susceptible to personal injury.⁹
• Acute anxiety and depression after an LSD “trip.”⁹
• Hallucinogen Persisting Perception Disorder (HPPD) for days, weeks or months after taking the last dose.^6,9

Psilocybin

Psilocybin comes from certain types of psilocybe mushrooms. These mushrooms are found in Mexico, Central America and the United States. Psilocybin is metabolized in the body to the active drug psilocyn.^10,11Mushrooms containing psilocybin are available fresh or dried and have long, slender stems topped by caps with dark gills on the underside. Fresh mushrooms have white or whitish gray stems; the caps are dark brown around the edges and light brown or white in the center. Dried mushrooms are usually rusty brown with isolated areas of off-white.Although pure psilocybin was manufactured for experimental and clinical use in the 1960s, until recently little has been known about the pharmacologic properties of psilocybin.¹²

Common street names

Magic Mushrooms, Mushrooms, and Shrooms.Psilocybin mushrooms are ingested orally. They may also be brewed as tea or added to other foods to mask the bitter flavor.¹⁰

Physical effects

• Nausea.
• Vomiting.
• Muscle Weakness.
• Lack of coordination.

Psychological effects

• Hallucinations.
• Inability to discern fantasy from reality.
• Panic reactions.
• Psychotic type episodes, particularly if a high dose was ingested.

Peyote & Mescaline

Peyote (Lophophora williamsii) is a spineless cactus native to the southwestern United States and northern Mexico. Archeologic evidence suggests that peyote has been used by Native Americans for thousands of years as a religious sacrament. Peyote use is legal for the 300,000 members of the Native American Church for ceremonial or religious purposes or to promote physical and mental well-being.

Only licensed representatives of the Native American Church may legally harvest peyote cactus.¹³

Common street names

Buttons, Cactus, Mesc, and PeyotoThe 1- to 4-inch diameter top portion of the cactus, referred to as the peyote button, is the section of the plant with the highest mescaline concentration. The peyote button can be eaten fresh or dried, steeped, ground into a powder or smoked with a leaf material such as cannabis or tobacco.¹⁴A typical dose is 6 to 12 buttons, with each button containing 45 mg of mescaline.

Physical effects

Mescaline is absorbed well in the gastrointestinal tract and within one hour of ingestion induces^14,16:

• Nausea.
• Vomiting.
• Abdominal cramps.
• Dizziness.
• Sweating.
• Restlessness.
• Palpitations.

Psychological effects

The second phase of the drug effect begins within 1 to 3 hours of ingestion.¹⁶ It is characterized by:

• Visual imagery.
• Altered perceptions.
• Psychologic insight.

The psychoactive effects typically last 6 to 12 hours.¹⁶

Nutmeg

Nutmeg is the kernel inside the fruit of the evergreen tree Myristica fragrans, indigenous to the Maluku Islands in Indonesia. Historically, nutmeg has been used medicinally for various afflictions, including gastrointestinal disorders, musculoskeletal problems, and psychiatric conditions, and has a long history of recreational use.Although nutmeg use often results in unpleasant side effects, it is preferred by some users in search of a legal and easily obtainable euphoric drug with hallucinogenic effects. Ground nutmeg is ingested in 5–20 g doses, or approximately 2 tablespoons of powder.^16,17

Physical effects

These occur within one hour of ingestion:

• Nausea and vomiting.
• Blurred vision.
• Dizziness.
• Drowsiness.
• Xerostomia (dry mouth).
• Flushing.
• Palpitations.
• Paresthesias (tingling or pricking sensations as in “pins and needles”).
• Numbness.
• Hypotension (low blood pressure).
• Tachycardia (rapid heartbeats).

Psychological effects

• CNS (Central Nervous System) intoxication.
• Hallucinations.^16,17

Salvia Divinorum

Salvia divinorum is a hallucinogenic plant in the mint family used by the Mazatecs of Oaxaca, Mexico, in traditional spiritual practices for its psychoactive properties.The plant gained popularity in the mid-1990s as a recreational hallucinogen, advertised and sold by various internet based botanic companies as a legal high. The plants can be grown successfully outside of Oaxaca, Mexico. They can be grown indoors and outdoors, especially in humid semitropical climates.¹⁹The plant has spade shaped variegated green leaves that look similar to mint. The plants themselves grow to more than three feet high, have large green leaves, hollow square stems, and white flowers with purple calyces. Salvinorin A is the principal ingredient responsible for the psychoactive effects of Salvia Divinorum.^20,21

Common street names

Maria Pastora, Sally-D, and Salvia

Physical effects

• Loss of coordination.
• Dizziness.
• Slurred speech.

Psychological effects

• Perceptions of bright lights, vivid colors, shapes and body movement.^19,20
• Body and object distortions.
• Fear and panic.
• Uncontrollable laughter.^19,20
• Sense of overlapping realities.
• Paranoia.
• Rapid and intense onset of hallucinations that impair judgment, disrupt sensory, and cognitive functions.²⁰

Treatment of Hallucinogen Dependence

A withdrawal syndrome associated with cessation of classical hallucinogen use has not been clearly defined and may not occur.²¹To date, no treatment modalities specific to hallucinogen abuse or dependence have been published in peer-reviewed literature.²¹Persons with a desire to stop using hallucinogens should be referred to a 12-step program, such as Narcotics Anonymous. Information on Narcotics Anonymous may be obtained at https://www.na.org

Conclusion

1. There is some overlap with the effects of club drugs known to also be hallucinogenic.
2. Many drugs in these groups are considered to have lower toxicities, but not all.
3. The drugs typically produce “altered states” of consciousness where there are changes in visual and auditory perceptions.
4. There are changes in mood, thoughts, and feelings.
5. The danger of these drugs is that the perceptual changes that are not real may cause distortions in judgment about environmental dangers and result in accidents.
6. Concern arises about extended experiences such as persistent psychosis and flashbacks
7. In most cases, these drugs are not well studied in humans. Some produce tolerance and are suspected of being addictive.
8. Interestingly, however, some of the drugs are being carefully tested for use in psychotherapy.²²
9. Every year, approximately 1.2 million individuals in the United States use a hallucinogen for the first time.
10. Because hallucinogens elicit different responses and are highly variable, even among the same user at different times, predicting the effects of these drugs is difficult.
11. Some individuals will experience “bad trips” and other adverse effects as a result of ingestion of a hallucinogen.
12. It is imperative that these individuals are appropriately diagnosed and treated to avoid adverse mental health outcomes.²³

References

1. Abraham HD, Aldridge AM, Gogia P. The psychopharmacology of hallucinogens. Neuropsychopharmacology. 1996;14:285-298.
2. National Institute on Drug Abuse. Hallucinogens and Dissociative Drugs. Available at https://www.drugabuse.gov/publications/ research-reports/hallucinogens-dissociative-drugs/director.
3. Dyck E. Flashback: psychiatric experimentation with LSD in historical perspective. Can J Psychiatry. 2005;50:381-388.
4. Radenkova J, Saeva E, Saev V. Psychoactive substances in different cultures and religious practices. Acta Medica Bulgarica. 2011;38(1):122-130. Abstract available at Psychoactive substances in different cultures and religious practices | Request PDF (researchgate.net)
5. Khatchadourian R. High Anxiety: LSD in the Cold War. Available at https://www.newyorker.com/news/news-desk/high-anxiety-lsd-in-the-cold-war
6. U.S. Drug Enforcement Administration. DEA Drug Fact Sheet:Halluciinogens. Available at Drug Fact Sheet: Hallucinogens (dea.gov).
7. Psychedelics – Alcohol and Drug Foundation (adf.org.au)
8. Monitoring the Future Study. 2019 Overview: Key Findings on Adolescent Drug Use. Available at http://www.monitoringthefuture. org/pubs/monographs/mtf-overview2019.pdf.
9. U.S. Drug Enforcement Administration. DEA Drug Fact Sheet:LSD. Available at Drug Fact Sheet: LSD (dea.gov)
10. U.S. Drug Enforcement Administration. DEA Drug Fact Sheet: Psilocybin. Available at Drug Fact Sheet: Psilocybin (dea.gov)
11. https://adf.org.au/drug-facts/psilocybin/
12. Passie T, Seifert J, Schneider U, Emrich HM. The pharmacology of psilocybin. Addict Biol. 2002;7:357-64
13. Halpern JH, Sewell RA. Hallucinogenic botanicals of America: a growing need for focused drug education and research. Life Sci. 2005;78:519-526.
14. U.S. Drug Enforcement Administration. DEA Drug Fact Sheet: Peyote & Mescaline. Available at Peyote & Mescaline 2022 Drug Fact Sheet_0.pdf (dea.gov)
15. https://adf.org.au/drug-facts/mescaline/
16. Richardson WH 3rd, Slone CM, Michels JE. Herbal drugs of abuse: an emerging problem. Emerg Med Clin North Am. 2007;25:435- 457.
17. Shah AM, Calello DP, Quintero-Solivan J, Osterhoudt KC. The not-so-nice spice: a teenage girl with palpitations and dry mouth. Pediatr Emerg Care. 2011;27(12):1205-1207.
18. Johnson MW, MacLean KA, Reissig CJ, Prisinzano TE, Griffiths RR. Human psychopharmacology and dose-effects of salvinorin A, a kappa opioid agonist hallucinogen present in the plant Salvia divinorum. Drug Alcohol Depend. 2011;115(1-2):150-155.
19. U.S. Drug Enforcement Administration. DEA Drug Fact Sheet: Salvia Divinorum. Available at Salvia Divinorum 2022 Drug Fact Sheet_0.pdf (dea.gov)
20. https://adf.org.au/drug-facts/salvia/
21. Giannini AJ. An approach to drug abuse, intoxication and withdrawal. Am Fam Physician. 2000;61:2763-2774.
22. Barber GS, Aaronson ST. The Emerging Field of Psychedelic Psychotherapy. Curr Psychiatry Rep. 2022;24(10):583-590. doi:10.1007/s11920-022-01363-y
23. https://www.samhsa.gov/find-help/atod

Cynthia Blair RN MA–April 2024