Hallucinogens

Perceptual distortions such as hallucinations or illusions, as well as thought disorders (e.g., paranoia), can be caused by many drugs when taken in toxic doses. Perceptual distortions and hallucinations may also occur during withdrawal from sedatives (e.g., alcohol or barbiturates). However, some drugs cause perceptual, thought, and affective disturbances even at low doses that do not significantly affect memory and orientation. Such drugs are often called hallucinogens (psychedelics). However, their use does not always result in hallucinations. In the United States, the most commonly used psychedelics include lysergic acid diethylamide (LSD), phencyclioine (PCP), methylenedioxymethamphetamine (MDMA, "ecstasy"), and various anticholinergic drugs (atropine, benzotropine). The use of these substances attracted public attention in the 1960s and 1970s, but then declined in the 1980s. In 1989, hallucinogen use in the United States began to increase again. In 1993, 11.8% of college students reported using one of these substances at least once. The upward trend in use was especially pronounced among adolescents, beginning in the 8th grade.

Although a variety of substances can produce psychedelic effects, the major psychedelic drugs belong to two groups. The indoleamine hallucinogens include LSD, DMT (N,N-dimethyltryptamine), and psilocybin. The phenethylamines include mescaline, dimethoxymethylamphetamine (DOM), methylenedioxyamphetamine (MDA), and MDMA. Drugs in both groups have a strong affinity for serotonin 5-HT 2 receptors (Titeler et al., 1988), but differ in their affinity for other 5-HT receptor subtypes. There is a strong correlation between the relative affinities of these compounds for 5-HT2 receptors and their ability to induce hallucinations in humans. The role of 5-HT 2 receptors in the development of hallucinations is also supported by the fact that antagonists of these receptors, such as ritanserin, effectively block the behavioral and electrophysiological responses induced by hallucinogens in experimental animals. Recent binding studies conducted with cloned 5-HT receptors have shown that LSD interacts with most of the 14 subtypes of these receptors at nanomolar concentrations. Thus, it is doubtful that the psychedelic effect is associated with an effect on any one of the serotonin receptor subtypes.

LSD is the most active drug of this group, causing significant psychedelic effects even in doses as low as 25-50 mcg. Consequently, LSD is 3000 times more active than mescaline.

LSD is sold on the underground market in a variety of forms. One popular modern form is postage stamps coated with an adhesive containing varying doses of LSD (from 50 to 300 mg or more). Although most samples sold as LSD do contain LSD, samples of poisonous mushrooms and other plant substances sold as psilocybin and other psychedelics rarely contain the claimed hallucinogen.

The effects of hallucinogens vary widely among people, even within the same person at different times. In addition to the dose of the substance, its effects depend on individual sensitivity and external conditions. LSD is rapidly absorbed after oral administration and begins to act within 40 minutes. The effect peaks in 2-4 hours and then regresses within 6-8 hours. At a dose of 100 mcg, LSD causes distortion of perception and hallucinations, as well as affective changes, including euphoria or depression, paranoia, intense excitement, and sometimes a feeling of panic. Signs of LSD use may include: dilated pupils, increased blood pressure, increased pulse, flushing of the skin, salivation, lacrimation, and increased reflexes. Distortion of visual perception is especially pronounced when using LSD. Colors seem more intense, the shape of objects may be distorted, a person pays attention to unusual nuances, such as the pattern of hair growth on the back of the hand. There have been reports that these substances may enhance the effectiveness of psychotherapy and help treat addiction and other mental disorders. However, these reports are not supported by controlled studies. There is currently no evidence to support the use of these drugs as treatments.

The so-called "bad trip" is characterized by intense anxiety, although severe depression and suicidal ideation are sometimes observed. Visual disturbances are usually prominent. The "bad trip" associated with LSD use is difficult to distinguish from reactions to anticholinergic drugs and phencyclidine. There are no documented cases of death caused by LSD use, but fatal accidents and suicides have been reported during the effects of LSD or shortly after its effects have worn off. Prolonged psychotic reactions lasting two days or more may occur after ingestion of a hallucinogen. In susceptible individuals, these substances may provoke schizophrenia-like episodes. In addition, according to some reports, long-term use of these substances may lead to the development of a persistent psychotic disorder. Frequent use of psychedelic substances is rare, and therefore tolerance does not usually develop. Tolerance to the behavioral changes caused by LSD develops if the substance is used 3-4 times a day, but withdrawal symptoms do not develop. Cross-tolerance between LSD, mescaline, and psilocybin has been demonstrated in experimental models.

[ 1 ]

Treatment for hallucinogen abuse

Because of the unpredictability of the effects of psychedelic substances, each use carries a certain risk. Although dependence and addiction do not develop, medical assistance may be required for "bad trips." Sometimes it seems that severe excitement requires the use of drugs, but in this situation, the necessary effect in this situation can be achieved with a simple calming conversation. Antipsychotics (dopamine receptor antagonists) can intensify unpleasant experiences. Diazepam, 20 mg orally, can be effective. A particularly unfavorable aftereffect of LSD and other similar drugs is the occurrence of episodic visual disturbances, which are observed in a small proportion of people who have used LSD in the past. This phenomenon has been called a "flashback" and resembles the sensations that arose during the action of LSD. Currently, in official classifications, it is designated as persistent perceptual disorder caused by hallucinogens. This phenomenon is manifested by false images in the peripheral field of vision, a stream of color geometric pseudohallucinations, positive trace images. In half of the cases, this visual disorder remains stable and thus represents a persistent disorder of the visual analyzer. Provoking factors include stress, fatigue, being in a dark room, taking marijuana, neuroleptics, and anxiety.

MDMA (ecstasy)

MDMA and MDA are phenylethylamines that have both stimulant and psychedelic effects. MDMA became popular in the 1980s on some college campuses for its ability to heighten sensory abilities and introspection. The drug has been recommended by some psychotherapists to enhance treatment, but there is no evidence to support this claim. Acute effects are dose-dependent and include tachycardia, dry mouth, jaw clenching, muscle pain, and, at higher doses, visual hallucinations, agitation, hyperthermia, and panic attacks.

MDA and MDMA cause degeneration of serotonergic neurons and their axons in rats. Although this effect has not been demonstrated in humans, low levels of serotonin metabolites have been found in the cerebrospinal fluid of chronic MDA users. Thus, this substance may have neurotoxic effects, while the purported benefits of MDMA are unproven.

Phencyclidine

In its pharmacological action, it differs from other psychedelics, the prototype of which is LSD. Phencyclidine was initially proposed as an anesthetic in the 1950s, but was not used due to the high incidence of delirium and hallucinations in the postoperative period. It was classified as a dissociative anesthetic, since patients retain consciousness under anesthesia, they have an unblinking gaze, a frozen face and rigid muscles. The abuse of this drug began in the 1970s. At first, it was taken orally, and then they began to smoke it, which ensured better control over the dose. The effect of the drug was studied on healthy volunteers. At a dose of 0.05 mg / kg, phencyclidine causes emotional dullness, impoverishment of thinking, bizarre reactions in projective tests. Phencyclidine can also cause a catatonic pose and schizophrenia-like syndrome. Individuals using high doses of the drug may actively respond to hallucinations, display hostility and aggressive behavior. The anesthetic effect increases with increasing dose. They may experience stupor or coma, accompanied by muscle rigidity, rhabdomyolysis, hyperthermia. In case of intoxication, patients may experience progressive deterioration of the condition from aggressive behavior to the development of coma with the presence of wide non-reactive pupils and high blood pressure.

Phencyclidine has a high affinity for the structures of the cortex and limbic system, leading to blockade of the N-methyl-D-aspartate (NMDA) type of glutamate receptors. Some opioids and other drugs have the same effect as phencyclidine in laboratory models and specifically bind to these same receptors. According to some data, stimulation of NMDA receptors by a large number of excitatory amino acids is one of the links in the "ischemic cascade" leading to neuronal death. In this regard, there is interest in creating analogues of phencyclidine that would also block NMDA receptors but would not have a psychotogenic effect.

Phencyclidine causes a reinforcement phenomenon in primates, as evidenced by self-administration experiments that lead to intoxication. Humans most often use phencyclidine episodically, but in about 7% of cases, according to some studies, daily use is observed. According to some data, tolerance to the behavioral effects of PCP develops in animals, but this phenomenon has not been systematically studied in humans. In primates, after interruption of daily administration, withdrawal symptoms are observed - drowsiness, tremors, epileptic seizures, diarrhea, piloerection, bruxism, vocalizations.

[ 2 ], [ 3 ], [ 4 ]

Treatment of Phencyclidine Abuse

In case of overdose, only supportive measures are necessary, since there is no drug that blocks the action of phencyclidine, and the effectiveness of measures to accelerate the elimination of phencyclidine has not been proven. Although there are recommendations for acidifying urine. Coma with an overdose of phencyclidine can last from 7 to 10 days. Agitation or psychosis caused by phencyclidine can be stopped by the administration of diazepam. Persistent psychotic disorders require the administration of neuroleptics, such as haloperidol. Since phencyclidine has an anticholinergic effect, neuroleptics with a similar effect, such as chlorpromazine, should be avoided.

Inhalants

Inhalants include several different categories of chemicals that evaporate at room temperature and can cause dramatic changes in mental status when inhaled. Examples include toluene, kerosene, gasoline, carbon tetrahydrochloride, amyl nitrate, and nitrous oxide. Solvents (e.g., toluene) are commonly used by children as young as 12 years of age. The substance is usually placed in a plastic bag and inhaled. Dizziness and intoxication occur within minutes. Aerosols containing fluorocarbon solvents are also widely used. Long-term or daily use can cause damage to several body systems: abnormal heart rhythms, bone marrow suppression, brain degeneration, liver damage, kidney damage, and peripheral nerve damage. Death is possible, probably related to abnormal heart rhythms, especially with physical exertion or upper airway obstruction.

Amyl nitrate (poppers) is a smooth muscle relaxant and has been used in the past to treat angina. It is a yellow, volatile, flammable liquid with a fruity odor. In recent years, amyl nitrate and butyl nitrate have been used to relax smooth muscles and enhance orgasm, especially by male homosexuals. It is available as a room deodorant. It can cause arousal, a feeling of flushing, and dizziness. Side effects include palpitations, orthostatic hypotension, headache, and in severe cases, loss of consciousness.

Gaseous anesthetics such as nitrous oxide or halothane are sometimes used to produce intoxication by health care workers. Nitrous oxide is also abused by food service workers because it comes in small disposable aluminum containers used for whipping cream. Nitrous oxide produces euphoria, analgesia, and then unconsciousness. Compulsive use and chronic intoxication are rarely reported, but there is a risk of overdose associated with abuse of this anesthetic.

Addiction Treatment

Treatment of substance abuse and dependence should be tailored to the nature of the substance and the individual characteristics of each individual patient. The algorithm takes into account various therapeutic options. Available drug treatment is presented for each category of psychoactive substances. Treatment is impossible without knowledge of the pharmacological properties of the substances or combinations of substances used by the patient. This is especially important when treating an overdose or detoxifying a patient with withdrawal symptoms. It is important to understand that addiction treatment requires many months and years of rehabilitation. Behavioral patterns developed over thousands of drug administrations will not disappear after detoxification or even after a typical 28-day inpatient rehabilitation program. Long-term outpatient treatment is necessary. Although it is preferable to strive for complete abstinence, in practice many patients are tempted to start using the drug again, which may require repeated courses of treatment. In this case, maintenance therapy, such as long-term methadone treatment for opioid dependence, can be effective. This process can be compared with the treatment of other chronic diseases, such as diabetes, asthma or hypertension, which require long-term medication and are unlikely to fully recover. If we consider addiction in the context of a chronic disease, then the existing treatment for addiction can be considered quite effective. Long-term treatment is accompanied by an improvement in physical and mental status, as well as social and professional activity. Unfortunately, due to the general pessimism in the medical community regarding the effectiveness of treatment, therapeutic efforts are mainly directed at correcting complications - pulmonary, cardiovascular, liver, rather than correcting behavioral changes associated with addiction. Meanwhile, by directing efforts to treating the addiction itself, somatic complications can be prevented, and this requires a long-term rehabilitation program.