From LSD to PCP to Ketamine, hallucinogens are widely used and abused drugs that produce profound disturbances in the user's perception of reality. There are naturally occurring hallucinogens as well, including peyote and psilocybin, better known as magic mushrooms.
Hallucinogens are drugs that cause hallucinations—profound distortions in a person's perceptions of reality, including delusions and false notions. In this state, people see images, hear sounds and feel sensations that seem real but do not exist.
Hallucinogens produce rapid, intense mood swings with transitions so fast the user may feel several emotions simultaneously. Hallucinogens cause physiological symptoms such as increased heart rate and blood pressure, and may induce convulsions and seizures when used at high doses. The effects of hallucinogens are more unpredictable than those of other drugs and vary greatly from person to person. The range of effects depends on a variety of factors: the amount ingested; the user's personality, mood and expectations; if the person is alone or with others; and whether more drugs or alcohol are taken.
There is no evidence that hallucinogens increase creativity or have therapeutic value. Hallucinogens are not generally life threatening, but the user may end up killing herself while under a hallucination.
Hallucinogenic drugs have played a role in human life for thousands of years. Various cultures from the tropics to the arctic have used plants to induce states of detachment from reality, to precipitate "visions," to provide mystical insight, as medicines, and during social and religious rituals. Included in these naturally occurring substances are: mescaline from the peyote cactus plant, as well as ibogaine, psilocybin or psilocin found in certain mushrooms, known as magic mushrooms. These plants contain chemical compounds that are structurally similar to serotonin, and they produce their effects by disrupting normal functioning of the serotonin system. After the development of LSD, a synthetic compound that can be manufactured anywhere, abuse of hallucinogens became more widespread, and from the 1960s on, it increased dramatically.
LSD is the abbreviation of the German words for lysergic acid diethylamide. It is the drug most commonly identified with the term hallucinogen and the most widely used in this class of drugs. It is considered the typical hallucinogen, and the characteristics of its action and effects apply to other hallucinogens. All LSD manufactured in this country is intended for illegal use, since LSD has no accepted medical use in the United States. Hallucinogens that are manufactured chemicals and not found in nature are:
All of these agents act as neurotransmitter mimics, often as agonists or antagonists at neurotransmitter receptors. These agents cause their effects by disrupting the neurotransmission and interaction of nerve cells.
Chemist Albert Hofmann, working at the Sandoz Corporation pharmaceutical laboratory in Switzerland, first synthesized LSD in 1938. He was conducting research on possible medical applications of various lysergic acid compounds derived from ergot, a fungus that grows on rye and other grains. Searching for compounds with therapeutic value, Hofmann created more than two dozen ergot-derived synthetic molecules. The twenty-fifth was called, in German, Lyserg-Säure-Diäthylamid 25, or LSD-25. Five years after he created the drug, Hofmann accidentally ingested a small amount and experienced a series of frightening sensory effects.
LSD is the most potent of all hallucinogens. It is a clear or white, odorless, water-soluble material with a slightly bitter taste. It is initially produced in crystalline form and sold in the streets as tablets, capsules or in liquid form. Generally, the pure crystal is crushed to powder and mixed with binding agents to produce tablets known as microdots or thin squares of gelatin called window panes; or more commonly, it is dissolved, diluted and applied to paper called blotter acid, sheets of paper soaked in LSD and perforated into 1/4-inch square dosage units. Each square represents one dose. Variations in manufacturing and the presence of contaminants can produce LSD in colors ranging from clear or white, in its purest form, to tan or even black. Even uncontaminated LSD begins to degrade and discolor soon after it is manufactured. Drug distributors often apply LSD to colored paper, making it difficult for a buyer to determine the drug's purity or age.
Users of LSD typically feel some something within 30 to 90 minutes of ingestion, and the effects may last as long as 12 hours. Users refer to LSD hallucinogenic experiences as "trips" and to the negative ones as "bad trips." Most LSD trips include both pleasant and unpleasant aspects.
A person on LSD may experience physiological effects, including raised blood pressure and heart rate, dizziness, loss of appetite, dry mouth, sweating and tremors; but the drug's major effects are emotional and sensory. The user's emotions may shift rapidly from fear to euphoria, with transitions so rapid that the user may feel several things simultaneously, including panic and extreme terror. Panic and terror can lead a user to run across a busy street. LSD also has dramatic effects on the senses. Colors, smells, sounds and other sensations appear highly intensified. In some cases, a user's senses may seem to get crossed or blend in a phenomenon known as synesthesia: the feeling of hearing colors and seeing sounds. Sensation and feelings change more rapidly than the physical effects.
LSD users quickly develop a high degree of tolerance for the drug's effects: Larger doses become needed as usage increases. LSD use also produces tolerance for other hallucinogenic drugs such as psilocybin (found in magic mushrooms) and mescaline, but not to drugs such as marijuana, amphetamines and PCP, which do not act directly on the serotonin receptors affected by LSD. Tolerance for LSD is short-lived it is lost if the user stops taking the drug for several days. There is no evidence that LSD produces physical withdrawal symptoms when chronic use is stopped.
The precise mechanism by which LSD alters perceptions is still unclear. Evidence from laboratory studies suggests that LSD acts on certain groups of serotonin receptors (5-HT2 receptors) and that its effects are most prominent in two brain regions: the cerebral cortex and the locus coeruleus.
PCP, Ketamine and DXM
PCP (angel dust), Ketamine (an anesthetic), and DXM (the active ingredient in cough syrup) are commonly classified as dissociative anesthetic hallucinogens. A dissociative hallucinogen is a drug, which reduces (or blocks) signals to the conscious mind from other parts of the brain. Users report trancelike experience, as well as a feeling of being "out of body" and detached from their environment. Long-term use of dissociative anesthetics such as PCP and Ketamine (and possibly DXM) has been suspected to cause Olney's lesions.
PCP, developed in the 1950s as an intravenous surgical anesthetic, is a dissociative drug. PCP was used in veterinary medicine but is not approved for human use because of problems it causes, such as delirium, psychotic behavior and extreme agitation in patients emerging from anesthesia.
PCP is normally a white crystalline powder; sometimes it is colored with water-soluble or alcohol-soluble dyes. It is sold in powder form, tablets or capsulets. In the late 1960s, PCP in pill form became a majorly abused drug. The surge in illicit pill use rapidly receded as users became dissatisfied with the long delay between taking the drug and feeling its effects, and because of the unpredictable and often violent behavior associated with its use. In the 1970s, powdered PCP—known as ozone, rocket fuel, love boat, hog, embalming fluid, angel dust or superweed—became popular. A powdered form of the drug can be sprinkled on marijuana, tobacco or parsley, and then smoked, and the onset of effect is rapid. Users sometimes ingest PCP by snorting the powder.
PCP's effects are typically felt within minutes of ingestion and last for several hours, with some users reporting the drug's effects lasting for days. The effects of PCP are unpredictable: One drug-taking episode may produce feelings of detachment from reality, including distortions of space, time and body image; another may produce hallucinations, panic and fear. Some users report feelings of invulnerability and exaggerated strength. PCP users may become severely disoriented, violent or suicidal.
At low PCP doses (5 mg or less) physical effects include shallow, rapid breathing, elevated temperature and increased blood pressure and heart rate. Doses of 10 mg or more cause dangerous changes in blood pressure, heart rate and respiration, which are often accompanied by nausea, blurred vision, dizziness and decreased awareness of pain. Muscle contractions may cause uncoordinated movements and bizarre postures. When severe, the muscle contractions can break down muscle cells, causing bone fracture or kidney damage.
Repeated use of PCP can result in addiction, and recent research suggests that repeated or prolonged use of PCP can cause withdrawal syndrome when drug use is stopped.
When snorted or smoked, PCP rapidly passes to the brain to disrupt the functioning of sites known as NMDA (N-methyl-D-aspartate) receptor complexes, which are receptors for the neurotransmitter glutamate. Glutamate receptors play a major role in the perception of pain, in cognition—including learning and memory—and in emotion. In the brain, PCP also alters the actions of dopamine, a neurotransmitter responsible for the euphoria and "rush" associated with many abused drugs.
Ketamine ("K," "Special K," "Cat Valium," "Vitamin K") is a dissociative anesthetic developed in 1963 to replace PCP. Ketamine is currently used in human anesthesia and veterinary medicine. Much of the ketamine sold on the street has been illicitly diverted from veterinarians' offices. Although it is manufactured as an injectable liquid, in illicit use ketamine is generally evaporated to form a powder that is snorted or compressed into pills. Ketamine is odorless, tasteless and induces amnesia. Because of these properties, the drug is sometimes added to beverages of unsuspecting victims and used in the commission of sexual assaults referred to as drug rape. Ketamine is also usually ingested by large numbers of people at so-called raves.
Ketamine's chemical structure and mechanism of action are similar to those of PCP, and its effects are similar, but ketamine is much less potent than PCP, with effects of much shorter duration. Users report sensations ranging from a pleasant feeling of floating to being separated from their bodies. Some ketamine experiences involve a terrifying feeling of almost complete sensory detachment that is likened to a near-death experience. These experiences, similar to a bad trip on LSD, are called the K-hole.
Dextromethorphan (sometimes called DXM or robo) is a cough-suppressing ingredient in a variety of over-the-counter cold and cough medications. The most common source of abused dextromethorphan is the "extra-strength" cough syrup, which typically contains 3 milligrams of the drug per milliliter of syrup. At the doses recommended for treating coughs (1/6 to 1/3 ounce of medication, containing 15 mg to 30 mg dextromethorphan), the drug is safe and effective. At much higher doses (4 or more ounces), dextromethorphan produces dissociative effects similar to those of PCP and ketamine.
The effects vary with dose, and dextromethorphan users describe a set of distinct dose-dependent "plateaus" ranging from a mild stimulant effect with distorted visual perceptions at low doses of approximately 2 ounces to a sense of complete dissociation from one's body at doses of 10 ounces or more. The effects typically last for 6 hours. Over-the-counter medications that contain dextromethorphan often contain antihistamine and decongestant ingredients as well, and high doses of these mixtures can seriously increase risks of dextromethorphan abuse.
Like PCP and ketamine, dextromethorphan acts as an NMDA receptor antagonist.
Hallucinogens powerfully affect the brain. The drugs induce a distorted sense of sight, hearing and touch, changing the users' impressions of time and space, and the user may feel that his or her body is changing shape. On some trips, users experience sensations that are enjoyable and mentally stimulating with a sense of heightened understanding. Bad trips, however, include terrifying thoughts, nightmarish feelings of anxiety and despair that include fears of insanity, death or losing control. Users are also prone to flashbacks—unsolicited repetitions of the drug experience up to one year after no further intake of the drug. People who use hallucinogen drugs may show symptoms of:
Physical symptoms that include:
LSD users may also show additional symptoms of:
In addition, two long-term symptoms associated with LSD use include persistent psychosis and hallucinogen persisting perception disorder (HPPD), more commonly known as flashbacks. The causes of these effects, which in some users occur after a single experience with the drug, are not known.
The psychosis effects of LSD are described as drug-induced psychosis—distortion or disorganization of a person's capacity to recognize reality, think rationally or communicate with others. Some LSD users experience devastating psychological effects that persist after the trip has ended, producing a long-lasting psychotic-like state. LSD-induced persistent psychosis may include dramatic mood swings from mania to profound depression, vivid visual disturbances and hallucinations. The effects may last for years and can affect people who have no history or other symptoms of psychological disorder.
Hallucinogen Persisting Perception Disorder
Some former LSD users report experiences known as flashbacks and called HPPD by physicians. These episodes are spontaneous, repeated recurrences of sensory distortions originally produced by LSD. The flashbacks can range from being pleasant to feelings of anxiety. The experience may include hallucinations, though usually the flashbacks are visual disturbances such as seeing false motion, trails attached to moving objects, or bright or colored flashes. Flashbacks generally last a minute or two. The condition is persistent and, in some cases, remains for years after the individual has stopped using the drug.
PCP and ketamine users show typical hallucinogen symptoms, and may show additional symptoms of
Large doses may cause convulsions, coma, hyperthermia and death.
Chronic users report symptoms for as long as a year after he or she stops taking these drugs.
Psilocin and psilocybin (from magic mushrooms) users may experience symptoms similar to those of LSD and mescaline, and may manifest additional symptoms of
Mescaline users may have the typical hallucinogen symptoms, and may also show
Larger ingestions may produce hypotension and respiratory depression.
Hallucinogenic drugs have played a role in human life for thousands of years. Cultures from the tropics to the arctic have used naturally occurring hallucinogens in plants to induce states of detachment from reality, to precipitate "visions" and thoughts to provide mystical insight, as medical agents, and were largely used during social and religious ritual. After the development of LSD, however abuse of hallucinogens became more widespread, and from the 1960s onward, it increased dramatically.
LSD and other hallucinogens became very fashionable in the United States and Europe in the 1960s, when many young people were pursuing greater personal freedom and questioning old values and ideas. Many of these individuals wanted to see into their own minds, and wanted to create spiritual or religious experiences.
There is no evidence that hallucinogens increase creativity, have therapeutic values or provide the user with spiritual insights. In general, very few people use hallucinogens today. Those who do usually don't take them on a regular basis, but weeks or months apart instead. This may be because the effects require a long recovery time or because the pleasurable effects are unpredictable.
Other causes of drug abuse
Other proposed causes of drug abuse include a biological cause, such as having a family history of drug or alcohol abuse; peer pressure by drug-abusing peers; a belief that drug use leads to group affiliation; poor social skill and academic failure; a lack of attachment or nurturing by parents or caregivers; ineffective parenting; drug availability; the belief that drug abuse is generally tolerated; and major transitions such as leaving the security of home.
Immediate treatment during a crisis
If someone is going through a bad trip or an adverse reaction while using hallucinogens, it is very important that they receive professional help as soon as possible. Quick responses can save lives. In the meantime,
Drug addiction treatment options
Drug addiction is a serious, though treatable disorder, requiring both physiological and psychological treatment. Success in becoming "drug free" is best achieved through formal programs that recognize abstinence may not be possible or realistic for everyone. The ultimate goal of all treatment programs is to enable the patient to achieve lasting abstinence; and the immediate goals are to reduce drug use, improve the patient's ability to function and minimize the medical and social complications of drug abuse.
In general, the more treatments that are given, the better the results. Many patients require other services as well, such as medical and mental-health services and HIV-prevention services. Patients who stay in treatment longer than three months usually have better outcomes than those who stay for a shorter time. Patients who go through medically assisted withdrawal to minimize discomfort but do not receive any further treatment perform about the same in terms of their drug use as those who were never treated. Over the last 25 years, studies have shown that treatment works to reduce drug intake and crimes committed by drug-dependent people. Researchers also have found that drug abusers who have been through treatment are more likely to have jobs.
Through treatment that is tailored to individual needs, patients can learn to control their condition and live normal, productive lives. Like people with diabetes or heart disease, people in treatment for drug addictions learn behavioral changes and often take medications as part of their treatment regimen.
Types of Treatment Programs
There are several types of drug abuse treatment programs. Short-term treatment programs that last less than six months include residential therapy, medication therapy and drug-free outpatient therapy. Longer-term treatment may involve withdrawal (detoxification), pharmacotherapy and residential therapeutic community treatment. Most outpatient treatment options combine counseling and community-based support programs, and do not include medications.
Short-term residential programs, often referred to as chemical-dependency units, are often based on the "Minnesota Model" of treatment for alcoholism. These programs involve a three- to six-week inpatient treatment phase followed by extended outpatient therapy or participation in 12-step self-help groups, such as Narcotics Anonymous or Cocaine Anonymous. Chemical dependency programs for drug abuse arose in the private sector in the mid-1980s with insured alcohol-cocaine abusers as their primary patients. Today, as private provider benefits decline, more programs are extending their services to publicly funded patients. Residential programs monitor and address potential withdrawal symptoms and behavior; incorporate behavior recognition and behavioral modification therapy; and offer counseling, psychotherapy and support groups for the person, and sometimes for their family as well. Medications help with suppressing the withdrawal syndrome and drug craving and with blocking the effects of drugs.
Longer term treatment includes Therapeutic Communities (TCs). TCs are highly structured programs in which patients stay at a residence, typically for six to 12 months. Patients in TCs include those with relatively long histories of drug dependence, involvement in serious criminal activities and seriously impaired social functioning. The focus of the TC is on resocialization of the patient to a drug-free, crime-free lifestyle.
Drug treatment programs in prisons can succeed in preventing a patient's return to criminal behavior, particularly if they are linked to community-based programs that continue treatment when the client leaves prison. Some of the more successful programs have reduced the rearrest rate by one-fourth to one-half. For example, the "Delaware Model," an ongoing study of comprehensive treatment of drug-addicted prison inmates, shows that prison-based treatment including a therapeutic community setting, a work release therapeutic community and community-based aftercare reduces the probability of rearrest by 57 percent and reduces the likelihood of returning to drug use by 37 percent.
Outpatient drug-free treatment does not include medications and encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group counseling. Patients entering these programs are abusers of drugs other than hallucinogens or are drug abusers for whom maintenance therapy is not recommended, such as those who have stable, well-integrated lives and only brief histories of drug dependence.
Drug abuse has a great economic impact on society—an estimated $67 billion per year. This figure includes costs related to crime, medical care, drug abuse treatment, social welfare programs and time lost from work. Treatment of drug abuse can reduce those costs. Studies have shown that from $4 to $7 are saved for every dollar spent on treatment. It costs approximately $3,600 per month to leave a drug abuser untreated in the community, and incarceration costs approximately $3,300 per month. In contrast, methadone maintenance therapy costs about $290 per month.
Treatment of HPPD or flashbacks
Because HPPD symptoms may be mistaken for those of other neurological disorders such as stroke or brain tumors, sufferers may consult a variety of clinicians before the disorder is accurately diagnosed. There is no established treatment for HPPD, although some antidepressant drugs may reduce the symptoms. Psychotherapy may help patients adjust to the confusion associated with visual distraction and to minimize the fear, expressed by some, that they are suffering brain damage or psychiatric disorder.