24. Marihuana, Hallucinogens, Phencyclidine, And Inhalants

8/12/2019 24. Marihuana, Hallucinogens, Phencyclidine, And Inhalants

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24. MARIJUANA, HA LLUC INOG ENS ,PHENCYCLIDINE, AN D INHALANTS

lane A. K e m e d y D.O.

1. What is marijuana?Marijuana is obtained f rom the cut an d dried upper leaves, flowers, and stem s of the cannabis

plant. Its main psychoactive ingredient is delta-9-tetrahydrocannabinol (THC). The potency of THCin marijuana cigarettes varies greatly(1-1.5 ), but has increased 1.5-to 30-fold sin ce the 1970s.Hashish is obtained fr om dried resin secreted on the flowering tops(10-20 TH C), and hashish oilis extracted with the use of organic solvents (15-30 TH C).

2. Who uses marijuana?Marijuana, the most widely used illicit drug in theU.S. , is often said to be a gateway drug for

teens, but it also has been used socially fo r many years by adults. About o ne-third of theU.S. popu-lation has used marijuana, and in the ag e range of18-2.5 years, about 60 have used itat least once.

3 How is marijuana taken?Marijuana usually is prepared from dried leaves and flowers and smoked as a cigarette or ina

pipe, although in some parts of the world it is taken in tea. It also may be eaten orally, comm only inbrownies; the euphoria is less intense but longer lasting. Because extracts are not water-soluble, mar-ijuana is not used intravenously.

4. What are the psychological and physical effects of marijuana?A person m ay feel euphoric, giddy with uncontrollable laughter, talkative, or sedated, and sensory

perceptions may be enh anced. Short-term mem ory, attention span, and judgm ent are impaired; di ff -culty with abstract thinking and time distortion also occur. Anxiety, panic, paranoia, and dysphoria canresult, and daily users may have chronic depression, irritability, and lethargy. Cannabis-induced psy-chosis has been reported but may be secondaryto underlying psychotic disorder. Red eyes or con -junctival injection are a good clue of recent marijuana use. Com mon physical sym ptoms are increasedheart rate, increased appetite, and dry m outh. Motor performance m ay be impaired forup to 10 hoursafter use. Th e effect of sm oking marijuana peaks within 10-30 minu tes, and intoxication may last sev-eral hours, dependingon the dose. The effect of oral ingestion peaks w ithin45-60 minutes.

5. What are the medical consequences of marijuana use?Decreases in sperm cou nt, testosterone levels, and luteinizing horm one have been reported.

Pulmonary co mp lications , such as chronic cough , bronchitis, and chron ic obstructive pulmonarydisease, are seen; how ever, because most m arijuana smo kers also are cigarette sm okers, it is difficultto lay blame on marijuana. The c arcino gens in cigarettes also are present in marijuana, but inincre sed amo unts; thus the risk for malignancy may be increased.

6. What are the medical uses for THC?THC has been used to treat glaucoma (by lowering intraocular pressure), nausea and vomiting

caused by chemotherapy, weightloss problems in patien ts with acquired immunodeficiency syn-drome, and muscle spasm in multiple sclerosis. In general, TH C has not been shown to be more ef f -cacious than available prescription m edications, and many patients d o not like the psychoactiveeffect. Medical use of ca nnabinoid s is an active focus of research, including a delivery system otherthan smoking, w hich has known harmful effects.

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I16 Mari juana, Ha ucinog ens , Phencycl id ine, an dn h a l a n t s

16. Is tolerance or withdrawal associated with LSD?Tolerance to euphoria and p erceptual experiences occurs rapidly (withina few days) w ith daily

use, and most users report that they must wait several days between trips because of tolerance.Cross-tolerance exists with m escaline and psilocybin, but not w ith PCP. A withdrawal syndrome h as

not been identified, and animal s tudies show that LSD is nota highly reinforcing drug. Users rarelyreport compulsion or loss of control with LSD .

17. What are flashbacks?Called hallucinogen persisting perception disorder in DSM-IV, flashback s are transient, dis-

tressful reexperiencing of hallucinogenic effects during abstinence. Usually the flashback is a visualdistortion (illusion) or actual hallucination, suchas shadows, colored o r geometric objects, macrop-sia or micropsia, intensified color, halos, or afterimages. It generally is unpleasant and frightening.Flashbacks usually stop after several months of abstinence, but can last for years in some patients.

18 What are the adverse effects of LSD?Overdose has not been a problem, but patients may p resent to the emergency department witha

bad trip (agitation and fear) or with injuries secondary to im paired judgm entor delusions, suchastrying to fly out ofa second-story window. Bad trips usually are treated w ith a quiet room, low sen-sory stimulation, and talking down with support and reassuran ce. A ben zodiazepine may beuseful, especially with extrem e anxiety and panic.

A prolonged psychotic state may be associated w ith hallucinogens such as LS D and PCP,aswell as with stimulants and even cannabis. Whether this state is drug-induced or an unmaskingofpreexisting psychotic illness remains controversial; som etimes it responds to antipsy chotic medica-tion. Persistent auditory o r visual hallucinations also may respond to carbamazep ine.

19. What other hallucinogens are abused?Similar symptoms and problems are seen with other hallucinogens; many have both ampheta-

mine and hallucinogenic actions. Morning glory seeds and Hawaiian baby woo drose contain LSDderivatives, and the spices nutmeg an d mace con tain a substance related to methylene dioxy amp het-amine (MDA). Mescaline from the peyote cactus, psilocybin from Mexican m ushroom s (magicmushroom s), and bufotenin from toad skin are other natural hallucinogens.

20. What is ecstasy?3,4-Methylene dimethylamphetamine (MD MA ) isa synthetic substance called ecstasy,E, XTC,

X, or Adam. Along with other designer drugs, ecstasy has been p opular at raves, which are all-night dances in large warehouses w ith high-tech m usic and videos. MD MA may be takenas a pill orsuppository, snorted as powder, or injected intravenously. Physically it has amphetamine-like ef-fects; psychoactive effects include feelings of eu phoria, spirituality, personal insight, and desire forintimacy. Fatal overdose has occurred as wellas severe psychotic reactions, and animal studies sug-gest direct toxicity to serotonergic neurons.

21. What is phencyclidine?Phencyclidine (PCP ), also called angel dust, sherm, or embalming fluid, w as synthesized fo r use

as a general anesthetic in the1950s but was discontinued because of side effects suchas delirium,agitation, hallucinations, and psychotic reactions. Italso was used as an anesthetic for animals (thusthe street names animal or horse tranquilizer), but this usealso has been discontinued.

22. Who uses PCP?

Washington, DC. It is mo st popular with black or H ispanic men in their20s.

23. How is PCP used? What are its effects?Most frequently cigarettes (tobacco, marijuana, m int, oregano) are dropped in PC P and sm oked,

but PCP also may be taken orally, intravenously, or by nasal insufflation. Physical sym ptoms inc lude

PCP is most com mon ly used in large cities such as Lo s Angeles, St. Louis, NewYork, and


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Marijuana, Hallucinogens, Phencyclidine, and Inhalants 7

elevation in blood pressure and body temperature, muscle rigidity, decreased pain sensation, and di-lated pupils with both horizontal and vertical nystagmus. The psychoactive effect is euphoria andsometimes aggressive behavior. Bad trips are best treated w ith diazepam or neuroleptics w ith lowanticholinergic profiles; restraints should be avoided because rhabdomyolysis has been reported.

24. What is ketamine?Ketamine is a dissociative anesthetic that is used medically; it is a derivative of PCP with simi-

lar chemical structure and activity. Ketamine is occasionally abused, usually by health professionalswith easy access.

25. What are inhalants?

(sniffed, huffed). They are inexpensive, easily accessible, and legal.

26. Who uses inhalants?

About 20 of high school seniors in theU.S. have tried inhalants, and increasing nu mbers ofchildren age9-12 have been reported to experiment with their use. Although inhalant abusers areusually under 20 years old, emergency department visits am ong people26 years and older have in-creased to 38 of total visits for inhalants. Whites, Native Americans, and Hispanics tend to use in-halants more than African Americans, and users are predominantly male. Although many inhalantusers are experimenters or polysubstance abusers, a recent study showed that inhalant abusers weremore than 5 times m ore likely to become intravenous drug users than non-inhalant users.

27. What are the effects of inhalants?A rapid-onset (sec onds to minutes) and short-lived eupho ria occurs with inhalation of volatile

substances. The user feels excitement, disinhibition, light-headedness, and confusion. Hallucinationsmay occur as well as nausea, vomiting, headache, and blurred vision. There may be a rash aroundthe nose and mo uth, and the persons clothes, skin, or breath may sm ell of solvents.

28. What are the complications of inhalants?

Volatile substances suc h as gasoline, glue, spray paint, solvents, and lighter fluids are inhaled

Risk of sudd en death due to cardiac arrhythmia, laryngospasm or asphyxiationNeurologic damage (in chronic users), with abnormal electroencephalogram, cerebellar de-

Impaired motor responsesMemory lossRenal and hepatic toxicityBone marrow supp ressionPulmonary complications (chemical pneumonitis and emphy sema in chronic users)

generation, intellectual impairment, and dementia

29. What is GHB?Gamma hydroxybutyrate isa neurotransmitter that affects a variety of systems, including sleep

cycles, temperature regulation, and mem ory. Outsideof the U S ., it has been used therapeuticallyinanesthesia, for narcolepsy, and to treat alcohol and opioid dependence. It also is a drug of abuse, asin low doses it gives mild euphoria, disinhibition, and increased libido, and in high doses, feeling s ofsedation. Aggre ssion, judgm ent impairm ent, and violent combativeness have been seen , as well asataxia, dizziness, nystagmus, respiratory depression, apnea, coma, and death.

30. Describe the treatment for abuse of marijuana hallucinogens PCP, inhalants ecstasy orGHB.

Treatments have not been well studied. Users rarely seek treatment on their own and are usuallyunder court order. Curren tly, little knowledge is available to guide treatment of these drug disorders.Most patien ts are young , and family participation is strongly enco urag ed. M ost treatmen t ap-proaches have aimed at achieving abstinence through support, limit-setting, and reinforcement tech-niques, Relapse prevention includes decreasing availability and acceptabilityof drug use.


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24. Marihuana, Hallucinogens, Phencyclidine, And Inhalants