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Hallucinogen
Aka: Hallucinogen, Lysergic Acid Diethylamide, Lysergic Acid, LSD, Mescaline, Psilocybin, Psychedelic, Psychotomimetic
- See Also
- Chemical Dependency
- Substance Abuse Evaluation
- Methoxetamine
- Ketamine Abuse
- NBOMe (N-Benzylated Phenylethylamine, N-Bomb)
- Phencyclidine (PCP)
- Synthetic Marijuana
- Synthetic Cathinone (Bath Salts)
- Chemical Dependency
- Substance Abuse Evaluation
- Agitated Delirium
- Unknown Ingestion
- Types: Classic Hallucinogens (Psychedelics)
- Mechanism
- Classic Hallucinogens (Psychedelic agents) act at 5-HT2A receptors
- Decreases brain Blood Flow to the default mode network, that in part differentiates self from non-self
- Results in dissociation effects of Hallucinogens
- Lysergic Acid Diethylamide (LSD)
- Street Names: Acid, Sugar, Cubes, Trips, Windowpane, Blotter
- LSD is semisynthetically derived from ergot alkaloids
- LSD (50-400 ug): 8-12 hour duration
- Mescaline
- Street Names: Buttons, beans, Cactus
- Mescaline naturally derived from peyote
- Mescaline (250-600 mg): 8-12 hour duration
- Psilocybin
- Street Names: Magic Mushrooms, Mushrooms, Los Ninos
- Psilocybin naturally derived from Psilocybe
- Psilocybin (10-50 mg): 6-8 hour duration
- Dimethyltryptamine (DMT)
- Street Names: Business Trip
- Substituted tryptamine found naturally in plants and animals
- Rapid onset with 5-15 minute duration when inhaled or injected
- Duration prolonged with ingestion and when taken with MAO inhibitor (e.g. ayahuasca brew)
- Resources
- https://en.wikipedia.org/wiki/N,N-Dimethyltryptamine
- Salvia (Salvia divinorum)
- Herb in mint family found in southern Mexico
- Herb leaves are chewed for Hallucinogenic effect (duration 30 minutes)
- Types: Other Hallucinogens
- Dissociative Agents
- Ketamine
- Phencyclidine (PCP)
- Delirium-Inducing Agents
- See Medication Causes of Delirium in the Elderly
- See Medication Causes of Psychosis
- Anticholinergic Toxicity (e.g. Diphenhydramine)
- Signs
- See Intentional Drug Overdose
- Varies widely based on substance used (which is often unknown)
- Polysubstance ingestion is common
- Adulterated drugs, variable street names and unique designer drugs are common
- Hyper-suggestible state
- Complications: Toxicity
- Serotonin Syndrome
- Lysergic Acid Diethylamide (LSD) has high affinity for Serotonin receptors
- NBOMe has even higher Serotonin receptor affinity than LSD
- Amphetamine-like reaction
- Hyperthermia
- Rhabdomyolysis
- Cerebral Infarction
- Water Intoxication with severe Hyponatremia
- See Hyponatremia Management
- Most common with MDMA (Ecstasy)
- Observe for Seizures
- Management: Hallucinogen Intoxication
- See Calming the Agitated Patient
- Benzodiazepines (e.g. Midazolam, Lorazepam) are first-line agents
- Avoid Neuroleptics (e.g. Haloperidol) in most cases
- Risk of Drug Interaction with Hallucinogens used (esp. Anticholinergic Agents)
- Provide calm and supportive environment
- Isolated room with minimal stimuli and dim lighting
- Disposition
- Stable patients may be discharged after 1-2 hours of observation with a sober adult
- Persistent Psychedelic effects warrant longer observation (higher risk of death related to Traumatic Injury)
- References
- McCollum (2020) EMRap 20(4):9-10