Hallucinogens

Hallucinogens

Hallucinogens are a diverse group of drugs that alter a person’s awareness of their surroundings as well as their own thoughts and feelings. They are commonly split into two categories: classic hallucinogens (such as LSD) and dissociative drugs (such as PCP). Both types of hallucinogens can cause sensations and images that seem real though they are not. 

Some hallucinogens are extracted from plants or mushrooms, and some are synthetic (human-made). Historically, people have used hallucinogens for religious or healing rituals. More recently, people report using these drugs for social or recreational purposes.

Common classic hallucinogens include the following:

• LSD (D-lysergic acid diethylamide) is one of the most powerful mind-altering chemicals. It is a clear or white odorless material made from lysergic acid, which is found in a fungus that grows on rye and other grains. 
• Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) comes from certain types of mushrooms found in tropical and subtropical regions of South America, Mexico, and the United States. 
• Peyote (mescaline) is a small, spineless cactus with mescaline as its main ingredient. Peyote can also be synthetic. 
• DMT (N,N-dimethyltryptamine) is a powerful chemical found naturally in some Amazonian plants. Ayahuasca is a tea made from such plants, and when taken in this form it is also known as hoasca, aya, and yagé. People can also make DMT in a lab. Synthetic DMT usually takes the form of a white crystalline powder that is smoked.
• 251-NBOMe is a synthetic hallucinogen with similarities both to LSD and MDMA (see DrugFacts: MDMA) but that is much more potent. Developed for use in brain research, when sold illegally it is sometimes called N Bomb or 251.

Common examples of dissociative drugs include the following:

• PCP (Phencyclidine) was developed in the 1950s as a general anesthetic for surgery, but it is no longer used for this purpose due to serious side effects. PCP can be found in a variety of forms, including tablets or capsules; however, liquid and white crystal powder are the most common.
• Ketamine is used as a surgery anesthetic for humans and animals. Much of the ketamine sold illegally come from veterinary offices. It mostly sells as a powder or as pills, but it also available as an injectable liquid. Ketamine is snorted or sometimes added to drinks as a date-rape drug. 
• Dextromethorphan (DXM) is a cough suppressant and mucus-clearing ingredient in some over-the-counter cold and cough medicines (syrups, tablets, and gel capsules). 
• Salvia (Salvia divinorum) is a plant common to southern Mexico and Central and South America. Salvia is typically ingested by chewing fresh leaves or by drinking their extracted juices. The dried leaves of salvia can also be smoked or vaporized and inhaled. 

Halluinogens as Medicine

Ketamine was approved many years ago as an anesthetic for painful medical procedures. In March 2019, the medicine esketamine (called “Spravato” by the manufacturer) was approved by the Food and Drug Administration as a treatment for severe depression in patients that do not respond to other treatments. Esketamine is closely related to the drug ketamine which is used illicitly and so there are concerns about the potential for misuse of this newly approved medication. In response, esketamine will be limited to administration in medical facilities.

Unlike a prescription that can be taken home and might be diverted into recreational use, esketamine will be administered in a medical office as a nasal spray. Patients must wait at least 2 hours under medical supervision to ensure proper management of potential side effects. It is a rapid acting medication, so improvements may be seen immediately or within the first few weeks of treatment (unlike most other antidepressants which can take weeks to begin to show an effect). Traditional antidepressants target the neurotransmitters serotonin, norepinephrine or dopamine. Esketamine affects the receptor for a different brain chemical called glutamate and so it represents a new approach to treating depression.

There is also some evidence that psilocybin may be effective in treating depression and anxiety. The FDA has granted “Breakthrough Therapy” designation for two formulations of psilocybin being studied for safety and efficacy as a medical treatment for depression. It’s important to note that during such studies, psilocybin is always taken under medical supervision.

Effects of Classic Hallucinogens

Short-Term Effects

Classic hallucinogens can cause users to see images, hear sounds, and feel sensations that seem real but do not exist. The effects generally begin within 20 to 90 minutes and can last as long as 12 hours in some cases (LSD) or as short as 15 minutes in others (synthetic DMT). Hallucinogen users refer to the experiences brought on by these drugs as "trips." If the experience is unpleasant, users sometimes call it a "bad trip."

Along with hallucinations, other short-term general effects include:

• increased heart rate
• nausea
• intensified feelings and sensory experiences (such as seeing brighter colors)
• changes in sense of time (for example, the feeling that time is passing by slowly)

Specific short-term effects of some hallucinogens include:

• increased blood pressure, breathing rate, or body temperature
• loss of appetite
• dry mouth
• sleep problems
• spiritual experiences
• feelings of relaxation
• uncoordinated movements
• excessive sweating
• panic
• paranoia—extreme and unreasonable distrust of others
• psychosis—disordered thinking detached from reality
• bizarre behaviors

Long-Term Effects

Two long-term effects have been associated with use of classic hallucinogens, although these effects are rare.

• Persistent Psychosis—a series of continuing mental problems, including:
  • visual disturbances
  • disorganized thinking
  • paranoia
  • mood changes
• Hallucinogen Persisting Perception Disorder (HPPD)—recurrences of certain drug experiences, such as hallucinations or other visual disturbances. These flashbacks often happen without warning and may occur within a few days or more than a year after drug use. These symptoms are sometimes mistaken for other disorders, such as stroke or a brain tumor.

Both conditions are seen more often in people who have a history of mental illness, but they can happen to anyone, even after using hallucinogens one time. For HPDD, some antidepressant and antipsychotic medications can be used to improve mood and treat psychosis. Behavioral therapies can be used to help people cope with fear or confusion associated with visual disturbances.

Effects of Dissociative Hallucinogens

Dissociative drug effects can appear within a few minutes and can last several hours in some cases; some users report experiencing drug effects for days.

Effects depend on how much is used. In low and moderate doses, dissociative drugs can cause:

• numbness
• disorientation and loss of coordination
• hallucinations
• increase in blood pressure, heart rate, and body temperature

In high doses, dissociative drugs can cause the following effects:

• memory loss
• panic and anxiety
• seizures
• psychotic symptoms
• amnesia
• inability to move
• mood swings
• trouble breathing

Long-Term Effects of Dissociative Drugs

More research is needed on the long-term effects of dissociative drugs. Researchers do know repeated use of PCP can result in addiction. Other long-term effects may continue for a year or more after use stops, including:

• speech problems
• memory loss
• weight loss
• anxiety
• depression and suicidal thoughts

Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.