Hallucinogen Toxicity

Hallucinogens comprise a unique collection of substances that are ingested to induce alterations of consciousness. A variety of substances with differing chemical structures is known to induce hallucinations when ingested in nontoxic doses. Hallucinations are usually visual, auditory, and tactile, in varying combinations, depending on the substance ingested, the setting, and the experiences of the person using them. Hallucinogenic substances have been used worldwide for centuries to induce altered states for religious and spiritual purposes. Throughout history, abuse of such substances probably was limited because of the moral and religious significance of their uses. Hallucinogens can be classified and grouped by chemical structure and the compound from which they are derived. Chemically related substances tend to exhibit similar effects. Many other agents can be classified as pseudohallucinogens because they produce psychotic and delirious effects without the classic visual disturbances of true hallucinogens. One system groups hallucinogens into 4 major classes that include indole alkaloids, piperidines, phenylethylamines, and cannabinoids. The following is a partial list of the hallucinogens by chemical derivation: Indole alkaloids Lysergic acid diethylamide (LSD) Lysergic acid amide (LSA) Psilocin Psilocybin Piperidines Atropine and scopolamine Cocaine Phencyclidine (PCP) Ketamine Phenylethylamines Mescaline 3,4-methylene dioxymethamphetamine (MDMA) Methylene dioxyamphetamine (MDA) 3-methoxy-4,5-methylene dioxyamphetamine (MMDA) 3,5-dimethoxy-4-methylamphetamine (STP) 2,5-dimethoxy-4-methylamphetamine (DOM) Cannabinoids Delta-9-tetrahydrocannabinol (THC, the active substance in marijuana) A number of naturally occurring hallucinogens can be found in plants and mushrooms and grow in many locations in the United States. Many of these substances have been involved in ritualistic medicine for a long time, and some are emerging agents of abuse. Included in these naturally occurring substances are dimethoxytryptamine (DMT), psilocybin and psilocin, mescaline, salvinorin A, LSA, and atropine and scopolamine. LSD and LSA LSD first appeared in the United States in 1949. Because of its potent psychotomimetic effects, it was believed to be useful in producing model psychosis for evaluation. As an experimental drug in the 1950s, LSD was used by psychiatrists and psychologists for the treatment of alcoholism and many neuroses. LSD use also was believed to enhance creativity and promote well-being. By the late 1950s, use of LSD had been proposed as a way to achieve intellectual and spiritual awakening and enlightenment. Initial studies in the early 1960s concluded that the drug was safe. By the mid 1960s, reports of increasing illicit abuse and adverse effects in patients treated with LSD led the federal government to begin regulation and restriction of its use. Although overall hallucinogen use remains fairly constant, LSD use and street sales of many substances marketed as LSD have increased. Since LSD first appeared on the street, its use and popularity have risen and fallen cyclically. LSA is a naturally occurring hallucinogen that is a close analog to LSD. LSA is found in a variety of plants, most notably Ipomoea violacea (morning glory), Argyreia nervosa, and Stipa robusta. Phencyclidine and ketamine PCP and ketamine are piperidine derivatives with potent anesthetic properties and illusionogenic properties. PCP was initially marketed as an anesthetic but was withdrawn from use because of widespread reports of postanesthetic dysphoria, delirium, and psychotic behavior. PCP was introduced as a veterinary anesthetic in the late 1960s and, beginning in California, soon became a major drug of abuse. The "peace pill," as it was dubbed in San Francisco, began to be distributed as everything from THC to LSD and often was added to marijuana cigarettes. It commonly is referred to as "angel dust." Ketamine, a widely used anesthetic, increasingly has been found on the streets and often is ingested by large numbers of people at so-called raves. Psilocin and psilocybin These indole alkaloids are found worldwide in a variety of mushrooms and have been used by indigenous peoples of Central America for centuries in religious rites. Ingesting only a few mushrooms may produce hallucinogenic affect, but, generally, large numbers of mushrooms are required. Analysis of street samples of "psilocybin" found that less than one third of the samples actually contained the alkaloid. Mescaline Mescaline is a phenylethylamine-derived alkaloid that is found worldwide in a variety of cacti, the best known being the North American peyote cactus. Similar to the mushroom-derived hallucinogens, mescaline in the form of peyote cactus buttons has been used in rituals by many Native Americans for centuries. To achieve the desired effect, 5-10 buttons are chewed and ingested. Salvinorin A Salvinorin A is a naturally occurring hallucinogen that is found in a variety of plants but is named from Salvia divinorum, or diviners sage, a member of the mint family. Salvinorin A is unique, in that unlike other known hallucinogenic substances that interact with serotonin (5-HT2 receptors) metabolism, this substance has been identified as the first known naturally occurring kappa-opioid receptor agonist. This substance has been used by the Mazatec Indians in Mexico for ceremonial purposes. Although salvia remains uncontrolled, there are several states that have significantly restricted it, and the Drug Enforcement Agency (DEA) is looking into placing it as a Schedule I controlled substance. Atropine and scopolamine Atropine and scopolamine are found in a variety of plants, and overdoses can induce hallucinations as well as a variety of more serious effects. Both are found in Datura stamonium (Jimson weed), Atropa belladonna (Deadly nightshade), and Mandragora officinarum (Mandrake), and scopolamine alone in Hyoscyamus niger (Henbane). Designer drugs Designer drugs were originally described as such as they were derived from chemically altered legitimate parent compounds. These drugs were initially derived to circumvent prosecution by the Drug Enforcement Agency. However, changes to federal drug laws in 1986 made all such chemically altered compounds illegal. Most of these substances are chemically derived from methamphetamine, but increasing numbers of opioid-derived substances as well as new classes of agents are appearing in this category. The best known of the hallucinogenic amphetamine derivatives is MDMA, commonly known as "ecstasy." The following is a list of common designer drugs with hallucinogenic properties and the substances they are derived from: Amphetamine derivatives MDMA (ecstasy) MDA Methylenedioxyethylamphetamine (MDEA) R,S -1-(1',3'-benxodioxol-5'-yl)-2-butanamine (BDB) R,S-N -methylbenzodioxolylbutanamine (MBDB) Piperazine derivatives Benzylpiperazines - Benzylpiperazine (BZP), 1-(3,4-methylenedioxybenzyl)piperazine (MDBP) Phenylpiperazines -m -Chlorophenylpiperazine (mCPP), trifluoromethylphenylpiperazine (TFMPP), p -methoxyphenylpiperazine (MeOPP) Pyrrolidinophenone derivatives R,S -alpha-pyrrolidinopropiophenone (PPP) R,S -4'-methoxy-alpha-pyrrolidinopropiophenone (MOPPP) R,S -3',4'-methylenedioxy-alpha-pyrrolidinopropiophenone (MDPPP) R,S -4'-methyl-alpha-pyrrolidinopropiophenone (MPPP) R,S -4'-methyl-alpha-pyrrolidinohexanophenone (MPHP) Many of the newer designer drugs are also described as belonging to the hallucinogenic tryptamines, of which the naturally occurring agents psilocin, psilocybin, and dimethyltryptamine (DMT) belong. Two of the newest agents in the group are "foxy" (5-MeO-DIPT) and alpha-methyltryptamine (AMT). Other agents in this group include bufotenine, alpha-ethyltryptamine, diethyltryptamine (DET), and 5-MeO-DMT.