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Full text of "Research Report Series (2014): Hallucinogens and Dissociative Drugs Including LSD, PCP, Ketamine, Psilocybin, Salvia, Peyote, and Dextromethorphan"

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from the director: 

Hallucinogens and dissociative drugs— 
which have street names like acid, 
angel dust, and vitamin K—distort the 
way a user perceives time, motion, 
colors, sounds, and self. These drugs 
can disrupt a person's ability to think 
and communicate rationally, or even to 
recognize reality, sometimes resulting 
in bizarre or dangerous behavior. 
Hallucinogens such as LSD and psilocybin 
cause emotions to swing wildly and 
real-world sensations to appear unreal, 
sometimes frightening. Dissociative 


control and disconnected from their body Including LSD; PCP Ketamine; Esilocybin, 
and environment, oa 1F) Peyoter: and Dextromethorphan 

In addition to their short-term effects | “4 % 
on perception and mood, hallucinogenic 
drugs are associated with psychotic- 
like episodes that can occur long after 
a person has taken the drug, and 
dissociative drugs can cause respiratory 

depression, heart rate abnormalities, and allucinogens are a class of drugs that cause hallucinations—profound 

a withdrawal syndrome. The good news is distortions in a person’s perceptions of reality. Hallucinogens can be found in 
that use of hallucinogenic and dissociative some plants and mushrooms (or their extracts) or can be man-made, and they 
drugs among U.S. high school students, are commonly divided into two broad categories: classic hallucinogens (such as LSD) 

in general, has remained relatively low in and dissociative drugs (such as PCP). When under the influence of either type of drug, 
recent years. However, the introduction people often report experiencing rapid, intense emotional swings and seeing images, 

of new hallucinogenic/dissociative drugs, hearing sounds, and feeling sensations that seem real but are not. 

such as Salvia, is of particular concern. In 
fact, salvia is currently the most widely 
used drug In this class. 

While the exact mechanisms by which hallucinogens and dissociative drugs cause their 
effects are not yet clearly understood, research suggests that they work at least partially 
by temporarily disrupting communication between neurotransmitter systems throughout 

NIDA research is developing a clearer the brain and spinal cord that regulate mood, sensory perception, sleep, hunger, body 

picture of the dangers of hallucinogenic 
and dissociative drugs. We have compiled 
the scientific information in this report to 
inform readers and hopefully prevent the 
use of these drugs. 

temperature, sexual behavior, and muscle control. 

Nora D. Volkow, M.D. 
Director Psilocybin mushrooms, LSD, and Salvia divinorum are commonly 

| | used hallucinogenic and dissociative compounds 
National Institute on Drug Abuse Se ee 

Classic Hallucinogens* 

_ + > 

» LSD (d-lysergic acid 

; >’ 
—— known as acid, 
in blotter, doses, hits, 

microdots, sugar 

cubes, trips, tabs, 
or window panes—is one of the 
most potent mood- and perception- 
altering hallucinogenic drugs. It is a 
clear or white, odorless, water-soluble 
material synthesized from lysergic 
acid, a compound derived from a rye 
fungus. LSD is initially produced in 
crystalline form, which can then be 
used to produce tablets known as 
“microdots” or thin squares of gelatin 
called “window panes.” It can also 
be diluted with water or alcohol and 
sold in liquid form. The most common 
form, however, is LSD-soaked paper 
punched into small individual squares, 
known as “blotters.” 


known as magic 
mushrooms, shrooms, 
boomers, or little smoke—is extracted 
from certain types of mushrooms 
found in tropical and subtropical 
regions of South America, Mexico, 
and the United States. In the past, 
psilocybin was ingested during 
religious ceremonies by indigenous 

cultures from Mexico and Central 
America. Psilocybin can either be 
dried or fresh and eaten raw, mixed 
with food, or brewed into a tea, and 
produces similar effects to LSD. 

Dissociative Drugs 

also known as 

ozone, rocket fuel, 
love boat, hog, 
embalming fluid, or 
superweed—was originally developed 
in the 1950s as a general anesthetic 
for surgery. While it can be found 

in a variety of forms, including 
tablets or capsules, it is usually sold 
as a liquid or powder. PCP can 

be snorted, smoked, injected, or 
swallowed. It is sometimes smoked 
after being sprinkled on marijuana, 
tobacco, or parsley. 


tx ee 
= Se =) knownasK, 
—~seeaeees Special K, or 
pe ee <= —cat ‘Valium—is 

a dissociative 
currently used as 
an anesthetic for humans as well as 
animals. Much of the ketamine sold 
on the street has been diverted from 
veterinary offices. Although it is 
manufactured as an injectable liquid, 
ketamine is generally evaporated 

to form a powder that is snorted 

Hallucinogens and 
Dissociative Drugs 

or compressed into pills for illicit use. 
Because ketamine 1s odorless and 
tasteless and has amnesia-inducing 
properties, it is sometimes added to 
drinks to facilitate sexual assault. 

also known as 
robo—is a cough 
suppressant and 
expectorant ingredient 
in some over-the-counter (OTC) cold 
and cough medications that are often 
abused by adolescents and young 
adults. The most common sources of 
abused DXM are “extra-strength” 
cough syrup, which typically contains 
around 15 milligrams of DXM per 
teaspoon, and pills and gel capsules, 
which typically contain 15 milligrams 
of DXM per pill. OTC medications 
that contain DXM often also contain 
antihistamines and decongestants. 

Salvia divinorum— 
also known as 
diviner’s sage, Maria 
Pastora, Sally-D, 

or magic mint—is a 
psychoactive plant 
common to Southern Mexico and 
Central and South America. Salvia 
divinorum (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. 

*In this report, the term “hallucinogen” will refer to the classic hallucinogenic drugs LSD and Psilocybin. 

~ ih 

Street Names for Select Hallucinogenic and Dissociative Drugs 

LSD Ketamine 

e acid e vitamin K 

e blotter e bump 

e dots e green 

e sugar e K/Special K 
e trips e purple 

® window pane 

How, Widespread 

Is the Abuse of 
Hallucinogens and 
Dissociative Drugs? 

According to the 2012 National 
Survey on Drug Use and Health, 
more than 180,000 Americans aged 
12 and older reported current (past- 
month) use of LSD and 32,000 
reported current use of PCP.'! New 
hallucinogenic/dissociative drugs 
have also emerged on the scene in 
recent years. Salvia, historically used 
by indigenous tribes of Southern 
Mexico during religious rituals, has 
replaced LSD and PCP as the most 
commonly used hallucinogenic drug. 
In fact, past-year use of salvia among 

the nation’s 12th-grade students is 
more than 1.5 times that of LSD (3.4 
percent versus 2.2 percent) and almost 
5 times that of PCP (3.4 percent 
versus 0.7 percent).” 

e super acid 


e angel/angel dust 
e boat/love boat 

® peace 

e killer weed 

e super grass 

® ozone 

Past-Year Use of Hallucinogenic and Dissociative 
Drugs Among 12th-Grade Students 

—O— Salvia 
“@ (SD 


Use in the Past Month (%) 


2007 2008 2009 2010 2011 2012 2013 

Source: Monitoring the Future National Survey Results on Drug Use, 2013 Overview 

While regular use of hallucinogenic and dissociative drugs in general has 
remained relatively low in recent years, a recent study reported that the United 
States ranks first among 36 nations in the proportion of high school students 
ever using LSD or other hallucinogens in their lifetime (6 percent versus 2 
percent in Europe).° 

Why Do People Take Hallucinogenic 
or Dissociative Drugs? 

Hallucinogenic and dissociative drugs have been used for a variety of reasons.*» 
Historically, hallucinogenic plants have been used for religious rituals to induce 
states of detachment from reality and precipitate “visions” thought to provide 
mystical insight or enable contact with a spirit world or “higher power.” More 
recently, people report using hallucinogenic drugs for more social or recreational 
purposes, including to have fun, help them deal with stress, or enable them 

to enter into what they perceive as a more enlightened sense of thinking or 
being. Hallucinogens have also been investigated as therapeutic agents to treat 
diseases associated with perceptual distortions, such as schizophrenia, obsessive- 
compulsive disorder, bipolar disorder, and dementia. 

NIDA Research Report Series 3 

What are the Short- 
Term Effects of 

Ingesting hallucinogenic drugs 

can cause users to see images, hear 
sounds, and feel sensations that 

seem real but do not exist. Their 
effects typically begin within 20 to 

90 minutes of ingestion and can last 
as long as 12 hours. Experiences are 
often unpredictable and may vary 
with the amount ingested and the 
user’s personality, mood, expectations, 
and surroundings. The effects of 
hallucinogens like LSD can be 
described as drug-induced psychosis— 
distortion or disorganization of a 
person’s capacity to recognize reality, 
think rationally, or communicate with 
others. Users refer to LSD and other 
hallucinogenic experiences as “trips” 
and to acute adverse or unpleasant 
experiences as “bad trips.” On some 
trips, users experience sensations 

that are enjoyable and mentally 
stimulating and that produce a sense 
of heightened understanding. Bad 


How Do Hallucinogens Work? 

trips, however, include terrifying 
thoughts and nightmarish feelings of 
anxiety and despair that include fears 
of losing control, insanity, or death. 
Specific short-term effects of LSD and 
psilocybin include: 

¢ Increased blood pressure, heart rate, 
and body temperature 

¢ Dizziness and sleeplessness 

¢ Loss of appetite, dry mouth, 
and sweating 

¢ Numbness, weakness, and tremors 

¢ Impulsiveness and rapid emotional 
shifts that can range from fear to 
euphoria, with transitions so rapid 
that the user may seem to experience 

several emotions simultaneously 

¢ Feelings of relaxation (similar to 
effects of low doses of marijuana) 

¢ Nervousness, paranoia, and panic 

¢ Introspective/spiritual experiences 

Ingesting hallucinogenic drugs can cause users 

to see images, hear sounds, and feel sensations 

that seem real but do not exist. 

How Do Hallucinogens (LSD and 
Psilocybin) Affect the Brain and Body? 

Classic hallucinogens are thought to produce their perception-altering 

effects by acting on neural circuits in the brain that use the neurotransmitter 
serotonin.®’ Specifically, some of their most prominent effects occur in the prefrontal 
cortex—an area involved in mood, cognition, and perception—as well as other 
regions important in regulating arousal and physiological responses to stress and 

General Effects of 


Sensory Effects 

e Hallucinations, including 
seeing, hearing, touching, or 
smelling things in a distorted 
way or perceiving things that 
do not exist 

e Intensitied feelings and 
sensory experiences (brighter 
colors, sharper sounds) 

e Mixed senses (“seeing” 
sounds or “hearing” colors) 

e Changes In sense or 
perception of time (time goes 
by slowly) 

Physical Effects 

e Increased energy and 
heart rate 

e Nausea 

"Misidentification of poisonous mushrooms resembling psilocybin could lead to unintentional, potentially fatal poisoning 

Ak NIDA Research Report Series 

LSD users quickly develop a high degree of tolerance 
to the drug’s effects, such that repeated use requires 
increasingly larger doses to produce similar effects. 

What are the Long- 
Term Effects of 

LSD users quickly develop a high 
degree of tolerance to the drug’s 
effects, such that repeated use requires 
increasingly larger doses to produce 
similar effects. Use of hallucinogenic 
drugs also produces tolerance to 
other drugs in this class, including 
psilocybin and mescaline.* Use 
of classic hallucinogens does not, 
however, produce tolerance to drugs 
that do not act directly on the same 
brain cell receptors (in other words, 
there is no cross-tolerance to drugs that 
act on other neurotransmitter systems, 
such as marijuana, amphetamines, or 
PCP, among others). Furthermore, 
tolerance for hallucinogenic drugs is 
short-lived—it 1s lost if the user stops 
taking the drugs for several days—and 
physical withdrawal symptoms are 
typically not experienced by users when 
chronic use 1s stopped. 

Two long-term effects—persistent 
psychosis and hallucinogen persisting 
perception disorder (HPPD; also 

often referred to as “flashbacks” )— 
have been associated with use of 
classic hallucinogens (see sidebar). 
Although occurrence of either 1s 

rare, it is also unpredictable and may 
happen more often than previously 
thought, and sometimes both 
conditions occur together. While 

the exact causes are not known, 

both conditions are more often 

seen in individuals with a history 

of psychological problems but can 
happen to anyone, even after a single 
exposure. There 1s no established 
treatment for HPPD, in which 
flashbacks may occur spontaneously 
and repeatedly although less intensely 
than their initial occurrence. Some 
antidepressant and antipsychotic 
drugs can be prescribed to help 
improve mood and treat psychoses, 
however. Psychotherapy may also 
help patients cope with fear or 
confusion associated with visual 
disturbances or other consequences 
of long-term LSD use. More research 
on the causes, incidence, and long- 
term effects of both disorders is being 

Long-Term Effects 
of Hallucinogens 

Persistent psychosis 

e Visual disturbances 
e Disorganized thinking 
e Paranoia 

e Mood disturbances 

Hallucinogen Persisting 

Perception Disorder (HPPD) 

e Hallucinations 

e Other visual disturbances 
(such as seeing halos or trails 
attached to moving objects) 

e Symptoms sometimes 
mistaken tor neurological 
disorders (Such as stroke or 
brain tumor) 

What are the Effects of Common Dissociative Drugs 
on the Brain and Body? 
How Do Dissociative Drugs Work ? 

Laboratory studies suggest that dissociative drugs, including PCP, ketamine, and DXM, 
cause their effects by disrupting the actions of the brain chemical glutamate at certain 
types of receptors—called N-methyl-D-aspartate (NMDA) receptors—on nerve cells 
throughout the brain.!"'' Glutamate plays a major role in cognition (including learning and 
memory), emotion, and the perception of pain (the latter via activation of pain-regulating 

cells outside of the brain). PCP also alters the actions of dopamine, a neurotransmitter 
responsible for the euphoria and “rush” associated with many abused drugs. 

Salvia divinorum works differently. While classified as a dissociative drug, salvia causes its effects by activating a specific 
type of opioid receptor (the kappa opioid receptor) on nerve cells.'*!? These receptors differ from those activated by the more 
commonly known opioids such as heroin and morphine. 

* Mescaline is not described in this report. 

NIDA Research Report Series Le. 

What are the Short-Term Effects of Dissociative Drugs? 

Dissociative drugs can produce visual and auditory distortions and a sense of floating and dissociation (feeling 
detached from reality) in users. Use of dissociative drugs can also cause a user to experience anxiety, memory loss, 
and impaired motor function, including body tremors and numbness. These effects, which depend on the amount of 
the drug taken, are also unpredictable—typically beginning within minutes of ingestion and lasting tor several hours 
(although some users report feeling the drug's effects for days). See text box for general effects of dissociative drugs. 

‘CT=Jal-1e-]mOvolonlaalolaM =sni-.eun-meoy mm DIl-t-Lelert- na hV.-m Dig eler- 

Low to Moderate Doses 


Loss of coordination, disorientation, and confusion 
Dizziness, nausea, vomiting 

Changes in sensory perceptions (Such as 
sight, sound, shapes, time, and body image) 

Feelings of detachment trom self and environment 

Increase in blood pressure, heart rate, respiration, 

High Doses 
Memory loss 

Physical distress, including dangerous changes In blood 
pressure, heart rate, respiration, and body temperature 

Marked psychological distress, including feelings of extreme 
panic, fear, anxiety, paranoia, invulnerability, exaggerated 
strength, and aggression 

Use with high doses of alcohol or other central nervous 
system depressants can lead to respiratory distress or 
arrest, resulting in death 

and body temperature 

In addition to these general 
effects, different dissociative 
drugs can produce a variety of 
distinct and dangerous effects. 
For example, at moderate to high 
doses, PCP can cause a user to 
have seizures or severe muscle 
contractions, become aggressive 
or violent, or even experience 
psychotic symptoms similar to 
schizophrenia. At moderate to high 
doses, ketamine can cause sedation, 
immobility, and amnesia. At high 

6 NIDA Research Report Series 

doses, ketamine users also report 
experiencing terrifying feelings of 
almost complete sensory detachment 
likened to a near-death experience 
(called a “K-hole,” similar to a 
bad LSD trip). Salvia users report 
intense but short-lived (up to 30 
minutes) effects, including emotional 
mood swings (ranging from sadness 
to uncontrolled laughter). 

DXM, which is safe and 
effective as a cough suppressant 
and expectorant when used at 

recommended doses (typically 15—30 
milligrams), can lead to serious side 
effects when abused. For example, 
use of DXM at doses from 200 

to 1,500 milligrams can produce 
dissociative effects similar to PCP 
and ketamine and increase the risk 
of serious central nervous system 
and cardiovascular effects such as 
respiratory distress, seizures, and 
tachycardia (increased heart rate) 
from the antihistamines found in 
cough medicines. 

What are the Long-Term Effects of 
Dissociative Drugs? 

While the long-term use of most dissociative drugs has not been investigated 
systematically, research shows that repeated use of PCP can lead to tolerance 
and the development of a substance use disorder that includes a withdrawal 
syndrome (including craving for the drug, headaches, and sweating) when drug 
use is stopped. Other effects of long-term PCP use include persistent speech 
difficulties, memory loss, depression, suicidal thoughts, anxiety, and social 
withdrawal that may persist for a year or more after chronic use stops. 

Central Nervous System: The brain and spinal cord. 

Cerebral cortex: The region of the brain responsible 
for cognitive functions including reasoning, mood, 
and perception of stimuli. 

Dissociative: a type of compound, such as 
phencyclidine or ketamine, that produces an 
anesthetic effect characterized by a feeling of being 
detached from the physical self. 

DXM: A common street name for dextromethorphan. 

Kappa opioid receptor: A receptor on nerve cells 
that is activated by certain opioid-like compounds 
produced in the body. These receptors differ from 
those activated by the more commonly known 
opioids, such as heroin and morphine. 

Neurotransmitter: A chemical compound that acts as 
a messenger to carry signals from one nerve cell to 

NMDA receptors: N-methyl-D-aspartate receptors, 
a type of glutamate receptor that is important for 

Flashback: A sudden but temporary recurrence 

learning and memory; it is the target of drugs such 

of aspects of a drug experience (including sights, 

sounds, and feelings) that may occur days, weeks, or 
even more than a year after hallucinogenic drug use. 

Glutamate: An excitatory neurotransmitter found 

as PCP and ketamine. 

Persistent psychosis: Unpredictable and long-lasting 
visual disturbances, dramatic mood swings, and 

hallucinations experienced by some LSD users after 

throughout the brain that influences the reward 

system and is involved in learning and memory, 

among other functions. 

Hallucinogen: A drug that produces hallucinations — 

they have discontinued use of the drug. 

Serotonin: A neurotransmitter involved in a broad 

range of effects on perception, movement, and 
emotions. Serotonin and its receptors are the targets 

distortions in perception of sights and sounds—and 
disturbances in emotion, judgment, and memory. 

HPPD: Hallucinogen persisting perception disorder; 
the spontaneous and sometimes continuous 

recurrence of perceptual effects of LSD long after an 
individual has ingested the drug. 

1. Substance Abuse and Mental Health Bogenschutz, M.P; and Pommy, J.M. 9. Lee, H.M.; and Roth, B.L. 
Services Administration. Results Therapeutic mechanisms of classic Hallucinogen actions on human brain 
from the 2012 National Survey on hallucinogens in the treatment of revealed. Proc Natl Acad Sci USA 
Drug Use and Health: Summary of addictions: From indirect evidence to 109(6): 1820-1821, 2012. 
National Findings, NSDUH Series H-44, testable hypotheses. Drug Test Anal 
HHS Publication No. (SMA) 12-4713. 4(7-8): 543-555, 2012. 10. Morgan, C.J.; Curran, H.V.; and 
Rockville, MD: U.S. Department of Independent Scientific Committee 
Health and Human Services, Substance Bonson, K.R. Hallucinogenic Drugs. In on Drugs. Ketamine use: A review. 
Abuse and Mental Health Services Encyclopedia of Life Sciences, Nature Addiction 107(1): 27-38, 2012. 
Administration, 2012. Publishing Group, 2001. 
11. Morris, B.J.; Cochran, S.M.; and Pratt, 
2. Johnston, L.D.; O'Malley, PM.; Passie, I.; Halpern, J.H.; Stichtenoth, J.A. PCP: From pharmacology to 
Bachman, J.G.; and Schulenberg, J.E. D.O.; Emrich, H.M.; and Hintzen, A. modelling schizophrenia. Curr Opin 
Monitoring the Future national results The pharmacology of lysergic acid Pharmaco 5(1):101-106, 2005. 
on adolescent drug use: Overview of diethylamide: A review. CNS Neurosci 
key findings, 2013. Ann Arbor: Institute Ther 14(4): 295-314, 2008. 12. Cunningham, C.VW.; Rothman, 
for Social Research, the University of R.B.; and Prisinzano, T-E. 
Michigan, 2014. Nichols, D.E. Hallucinogens. Pharmacol Neuropharmacology of the naturally 
Ther 101(2): 131-181, 2004. occurring kappa-opioid hallucinogen 
3. Hibell, B.; Guttormsson, U.; Ahlstrom, salvinorin A. Pharmacol Rev 63(2): 
S.; Balakireva, O.; Bjarnason, T.; Schindler, E.A.; Dave, K.D.; Smolock, 316-347, 2011. 
Kokkevi, A.; and Kraus, L. The 20717 E.M.; Aloyo, V.J.; and Harvey, J.A. 
ESPAD Report: Substance Use Among Serotonergic and dopaminergic 13. MacLean, K.A.; Johnson, M.W; 

Students in 36 European Countries. 
Stockholm, Sweden: The Swedish 
Council for Information on Alcohol and 
Other Drugs (CAN), 2012. 

distinctions in the behavioral 
pharmacology of (+/-)-1-(2,5-dimethoxy- 
4-iodophenyl)-2-aminopropane (DO!) 
and lysergic acid diethylamide (LSD). 
Pharmacol Biochem Behav 101(1): 
69-76, 2012. 

of most hallucinogens. 

Reissig, C.J.; Prisinzano, T-E.; and 
Griffiths, R.R. Dose-related effects of 
salvinorin A in humans: Dissociative, 
hallucinogenic, and memory effects. 
Psychopharmacology (Berl). 226(2): 
381-392, 2013. 

NIDA Research Report Series J 

Where can | get further information about hallucinogens? 

To learn more about hallucinogens 
and other drugs of abuse, 

visit the NIDA Web site at or 

contact the DrugPubs Research 
Dissemination Center at 
877-NIDA-NIH (877-643-2644; 
TTY/TDD: 240-645-0228). 




What's on the NIDA Web Site 

¢ Information on drugs of abuse and 
related health consequences 

¢ NIDA publications, news, and 

Resources for health care 

¢ Funding information (including 
program announcements and 

International activities 

e Links to related Web sites (access 
to Web sites of many other 
organizations in the field) 

NIDA Web Sites 
term/160/DrugF acts 

For Physician Information 


on Drug Abuse 

National Institute 

Other Web Sites 

Information on hallucinogens and 
dissociative drugs is also available 
through these other Web sites: 

¢ Substance Abuse and Mental 
Health Services Administration 
Health Information Network: 

¢ Drug Enforcement Administration: 

¢ Monitoring the Future: 

¢ The Partnership at Drug 
www. drugfree. org/drug-guide 

NIH Publication Number 14-4209 ¢ Revised January 2014 

S NIDA Research Report Series 

Feel free to reprint this publication.