II. 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
- Salvia (Salvia divinorum)
- Herb in mint family found in southern Mexico
- Herb leaves are chewed for Hallucinogenic effect (duration 30 minutes)
III. Types: Other Hallucinogens
- Dissociative Agents
- Ketamine
- Phencyclidine (PCP)
- Delirium-Inducing Agents
IV. 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
V. Complications: Toxicity
- Serotonin Syndrome
-
Amphetamine-like reaction
- Hyperthermia
- Rhabdomyolysis
- Cerebral Infarction
-
Water Intoxication with severe Hyponatremia
- See Hyponatremia Management
- Most common with MDMA (Ecstasy)
- Observe for Seizures
VI. 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)
VII. References
- McCollum (2020) EMRap 20(4):9-10
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Related Studies
| Concepts | Mental or Behavioral Dysfunction (T048) |
| English | Hallucinogen Use Disorders |
Ontology: Lysergic Acid Diethylamide (C0024334)
| Definition (MSH) | Semisynthetic derivative of ergot (Claviceps purpurea). It has complex effects on serotonergic systems including antagonism at some peripheral serotonin receptors, both agonist and antagonist actions at central nervous system serotonin receptors, and possibly effects on serotonin turnover. It is a potent hallucinogen, but the mechanisms of that effect are not well understood. |
| Definition (CSP) | semisynthetic derivative of ergot; it has complex effects on serotonergic systems including antagonism at some peripheral serotonin receptors, both agonist and antagonist actions at central nervous system serotonin receptors, and possibly effects on serotonin turnover; it is a potent hallucinogen and psychotomimetic. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) , Hazardous or Poisonous Substance (T131) |
| MSH | D008238 |
| SnomedCT | 15698006 |
| LNC | LP16179-1, MTHU006728 |
| English | Diethylamide, Lysergic Acid, LSD, LSD 25, LSD-25, Lysergic Acid Diethylamide, Lysergide, Acid Diethylamide, Lysergic, lysergic acid diethylamide, Ergoline-8-carboxamide, 9,10-didehydro-N,N-diethyl-6-methyl-, (8beta)-, LSD - D-Lysergic acid, D-Lysergic acid, D-Lysergic Acid Diethylamide, Lysergic Acid Diethylamide [Chemical/Ingredient], lysergic acid diethylamide (LSD), lsd-25, lysergide, Lysergate diethylamide, LYSERGIDE, Lysergic acid diethylamide, Lysergic acid diethylamide (substance), LSD (Drug) |
| Swedish | LSD |
| Czech | diethylamid kyseliny lysergové, LSD |
| Finnish | Lysergihapon dietyyliamidi |
| Russian | LIZERGID, LIZERGINOVOI KISLOTY DIETILAMID, LSD, ЛИЗЕРГИД, ЛИЗЕРГИНОВОЙ КИСЛОТЫ ДИЭТИЛАМИД, ЛСД |
| French | LSD, Lysergide |
| Italian | LSD, Lisergide, LSD-25, Dietilammide dell'acido lisergico |
| Polish | Dietyloamid kwasu lizergowego, Dwuetyloamid kwasu lizergowego |
| Japanese | リセルギド, リセルグ酸ジエチルアミド, リゼルギン酸ジエチルアミド |
| Spanish | dietilamida de ácido lisérgico (sustancia), dietilamida de ácido lisérgico, lisergida, LSD, Lisergida, Dietilamida del Ácido Lisérgico |
| German | LSD, Lysergid, Lysergsäurediethylamid |
| Portuguese | LSD, Dietilamida do Ácido Lisérgico, Lisergida |
Ontology: Mescaline (C0025460)
| Definition (MSH) | Hallucinogenic alkaloid isolated from the flowering heads (peyote) of Lophophora (formerly Anhalonium) williamsii, a Mexican cactus used in Indian religious rites and as an experimental psychotomimetic. Among its cellular effects are agonist actions at some types of serotonin receptors. It has no accepted therapeutic uses although it is legal for religious use by members of the Native American Church. |
| Concepts | Hazardous or Poisonous Substance (T131) , Organic Chemical (T109) |
| MSH | D008635 |
| SnomedCT | 229008008, 373780001, 83192000 |
| LNC | LP17987-6, MTHU003041 |
| English | Mescaline, Trimethoxyphenethylamine, Benzeneethanamine, 3,4,5-trimethoxy-, 3,4,5-Trimethoxyphenethylamine, Mescalin substance of abuse, Peyote extract, Mescalin, mescaline in any form, Mescaline [Chemical/Ingredient], mescalin, mescaline, Mescalin substance of abuse (substance), Mescaline (product), Mescaline (substance) |
| Swedish | Meskalin |
| Czech | meskalin |
| Finnish | Meskaliini |
| Russian | MEZKALIN, MESKALIN, PEIOT, TRIMETOKSIFENETILAMIN, МЕЗКАЛИН, МЕСКАЛИН, ПЕЙОТ, ТРИМЕТОКСИФЕНЕТИЛАМИН |
| Japanese | メズカリン, メスカリン, メッカリン, ペヨーテ, トリメトキシフェネチルアミン |
| Croatian | MESKALIN |
| Polish | Meskalina |
| Spanish | mescalina, sustancia de abuso (sustancia), extracto de peyote, mescalina, sustancia de abuso, Peyotl, mescalina (producto), mescalina (sustancia), mescalina, Mescalina, Trimetoxifenetil Amina |
| Portuguese | Peyote, Peyotl, Mescalina, Trimetoxifenetilamina |
| French | Mescaline |
| German | Mescalin, Trimethoxyphenethylamin |
| Italian | Mescalina |
Ontology: Psilocybine (C0033850)
| Definition (NCI_NCI-GLOSS) | A substance being studied in the treatment of anxiety or depression in patients with advanced cancer. It is taken from the mushroom Psilocybe mexicana. Psilocybin acts on the brain to cause hallucinations (sights, sounds, smells, tastes, or touches that a person believes to be real but are not real). |
| Definition (NCI) | A tryptamine alkaloid, isolated from various genera of fungi including the genus Psilocybe, with hallucinogenic, anxiolytic, and psychoactive activities. In vivo, psilocybine is rapidly dephosphorylated into the active compound psilocin, which activates serotonin 2A (5-HT2A) receptors in the central nervous system (CNS), mimicking the effects of serotonin. |
| Definition (MSH) | The major of two hallucinogenic components of Teonanacatl, the sacred mushroom of Mexico, the other component being psilocin. (From Merck Index, 11th ed) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D011562 |
| SnomedCT | 229007003, 53513007 |
| LNC | LP17245-9, MTHU007606 |
| English | Psilocybine, 1H-Indol-4-ol, 3-(2-(dimethylamino)ethyl)-, dihydrogen phosphate (ester), Psilocibin, psilocybin, 4-Phosphoryloxy-omega-N,N-dimethyltryptamine, Indocybin, 3-(2-(Dimethylamino)ethyl)-1H-indol-4-ol Dihydrogen Phosphate Ester, Psilocybine [Chemical/Ingredient], psilocibin, psilocybine, PSILOCYBINE, Psilocybin, Psilocybin (substance), Psilocybin [dup] (substance) |
| Swedish | Psilocybin |
| Czech | psilocybin |
| Finnish | Psilosybiini |
| Russian | PSILOTSIBIN, ПСИЛОЦИБИН |
| Japanese | サイロシビン |
| Polish | Psylocybina, Psylocyna |
| Spanish | psilocibina (sustancia), psilocibina, silocibina (sustancia), silocibina, Psilocibina |
| French | Psilocybine |
| German | Psilocybin |
| Italian | Psilocibina |
| Portuguese | Psilocibina |
