Hallucinogens•Where do they come from?

–Organic and synthesized origins

•History –plants used in religious ceremonies and as part of indian rituals

–LSD discovered in 1938; Hoffman absorbed it

–became widely recognized and used in 1960s

–e.g., cultish subculture: T. Leary--turn on, tune in, drop out

–reemergence of LSD in rave subculture in 1990s

–uses of LSD in psychotherapy

Hallucinogens Types•1. Serotonergic hallucinogens

–chem similar to serotonin

•2. Methylated amphetamines–chem similar to norepinephrine...alterations in mood without much change in senses

•3. Anticholinergic - (Ach)– found in plants: belladonna, mandrake, jimson weed

–trance or dream-like states

•4. Dissociative anesthetics–can remain conscious in surgery; causes euphoria, numbness, aggressive behavior, and tactile sense disturbances

Serotonergic Hallucinogens

• Lysergic acid diethylamide (LSD) Ergot fungus• Psilocybin (mushrooms) mushrooms• Dimethyltryptamine (DMT) Virola trees• Mescaline Peyote cactus• Harmaline, Harmine Ayahuasca vine• Ergine, Isoergine morning glory• Lysergic Acid Amide morning glory

Methylated Amphetamines

• MDMA (Ecstacy; X) synthetic• MDA (Love Drug) synthetic

Acetylcholinergic Hallucinogens

• Atropine belladonna plant• Scopolamine roots of mandrake, herbane• Hyoscyamine roots of mandrake, herbane• Ibogaine Iboga plant

Dissociative Anesthetic Hallucinogens

• Phencyclidine (PCP, Angel Dust) synthetic• Ketamine PCP-like drug

Hallucinogens

Effects Vary by Type

NHSADA Hallucinogen Use % (2004)

Lifetime Past yr Past mo

Total 14.3 1.6 .4

12-17 4.6 3.0 .8

18-25 21.3 6.0 1.5

26 & older 14.4 0.6 .1

Male 17.7 2.2 .6

Female 11 1.1 .2

What do you know about the drug

ECSTASY?

Methylenedioxymethamphetamine

• “MDMA” for short

• It is popularly called:

EcstasyXAdamLover’s Speed

XTCEClarity(among other names)

Pharmacology & History• MDMA is a synthetic norepinephrine-related

hallucinogenic drug

• Not to be confused with “Herbal ecstasy” containing ephedrine and other herbs

• Reputed to be a safe “recreational” or “therapeutic” drug in a dose of 1 to 2 mg.

• At least 68 deaths have been attributed to the use of MDMA (mostly from symptoms resembling heatstroke). Pediatrics vol 100 (1997)

MDMA Appeal

MDMA has the stimulant qualities of amphetamines and the hallucinogenic (psychedelic) qualities of mescaline

It’s effects last approximately 3-6 hours

History• First synthesized in Germany in 1914• First used in the 1970s in the U.S. as an adjunct to

psychotherapy

– to enhance empathy, introspection, communication

– to induce positive mood states & feelings of intimacy and tranquility

• At the same time animal studies showed it produced permanent brain damage

• Popular with young people since the late 1980s

– often used at dance parties called “raves” and on college campuses

History

• In 1989 the Drug Enforcement Administration placed MDMA on the Schedule I drug list

• Interestingly, the Multidisciplinary Association for Psychedelic Study continues to lobby to legalize MDMA for research

• Has undeserved reputation as being safe

Methods of Use• Distributed in tablet form for oral ingestion

• In New York, 100 mg. tablet costs approx. $20

• Many “rave-goers” report experimenting with “stacking” --– taking 3 or more tablets at once and/or– mixing MDMA with herbal ecstasy, LSD, alcohol,

marijuana, and other drugs of abuse

Signs and Symptoms ofMDMA Intoxication:

Most Common Symptoms and Signs:• Muscle tension and aches• jaw clenching• sweating• fatigue• difficulty concentrating & retaining newly learned material• Confusion or delirium even weeks after drug use

Occasional Symptoms:• Intense dysphoria (depression, anxiety)

Common Serious Adverse Effects of MDMA

Serious Illness and Death have occurred from:

• Dehydration• Hyperthermia• Cardiac arrhythmia• Hypertensive crises• Disseminated intravascular coagulation (blood clot)• Acute renal failure• Hepatic toxicity (liver)

Your Brain on Ecstasy• The brain scan on the right belongs to

an individual who used Ecstasy many times, but had not used any drugs in the last 3 weeks before the scan.

• The bright red spots on the left “normal” brain scan are serotonin receptor sites.

• Whereas, the dark spots at the top of the right scan are serotonin receptor sites which are not active

Prevalence

Ecstasy tablets seized by the Drug Enforcement Administration increased from 13,342 in 1996

to 949,257 in 2000

MONITORING THE FUTURE STUDY

Ecstasy Use by Students, 2000:

Grade: 8th 10th 12th

Ever Used 4.3% 7.3% 11.0%

Used in Past Year 3.1% 5.4% 8.2%

Used in Past Month 1.4% 2.6% 3.6%

Prevalence

What are Raves?

• Clandestine dance parties (location usually kept quiet until 1-2 days before event)

• Held at abandoned warehouses…

• Advertised by flyers or word of mouth

What are they like?

•Only laser lights illuminate the darkened building

•Vigorous, all night dancing

•Loud, repetitive, synthesized electronic music at 80-120 beats per minute mixed by disk jockeys

Raves• Rave attendees are usually high school and college

students (some junior high students)

• Because alcohol may not be served at some raves, water and power drinks are served to help to replenish fluid losses from vigorous dancing and MDMA use

• Carnival-like atmosphere with sales of:

– drug paraphernalia and drugs– brightly-colored nitrous oxide filled balloons– baby bottles and pacifiers (used to help mediate

adverse effects of jaw-clenching)

Raves

Raves

• PLUR Philosophy (Peace, love, unity, and respect)plus the focus on drugs (ecstasy, LSD, GHB, speed & pot) has earned ravers the name “techno-hippies”

• According to rave-goers, PLUR is what Raves are all about.

Quote from a rave attendee:“We have unconditionally-accepting ‘freaks are us’ love.”

Raves– “The rave scene is great as an accepting

environment, but it becomes problematic when it’s intrinsically tied to drug use. It can set up a pattern of lifelong drug use. Drug use can lead to unsafe sex and HIV transmission.”

– “Anything goes at a rave, and that’s both its strongest asset and its biggest flaw.”

– Caitlin Ryan, clinical social worker and co-author of Lesbian and Gay Youth: Care and Counseling.

Screening & Emergency Treatment of Acute Toxicity

• MDMA can be detected by drug screening for amphetamines

• but test sensitivity is reduced by about 50%

• Treatment:

– Rapid Cooling

– Rehydration

– Monitoring electrolytes

– Monitoring organ function

Risk Factors of MDMA Usage

Adolescents who have aggregates of the following:

– Have close friends who use drugs

– Frequently attend raves

– Early use of nicotine

– Frequent use of marijuana

– May have interpersonal issues with parents and authority figures

Diagnosis and Treatment• The diagnosis is complicated by comorbidity

• Least intrusive method is outpatient after-school drug treatment and education

• Most drug treatment programs recommend:

– abstinence from drugs and alcohol– severing ties with drug-using friends– Self-help groups– Unscheduled monitoring by urine toxicology tests