II. Types: Hallucinogens

  1. Psychedelic Agents (Classic Hallucinogens)
    1. Lysergic Acid Diethylamide (LSD)
      1. Street Names: Acid, Sugar, Cubes, Trips, Windowpane, Blotter
    2. Mescaline
      1. Street Names: Buttons, beans, Cactus
    3. Psilocybin
      1. Street Names: Magic Mushrooms, Mushrooms, Los Ninos
  2. Dissociative Agents
    1. Ketamine
    2. Phencyclidine (PCP)
  3. Delirium-Inducing Agents
    1. See Medication Causes of Delirium in the Elderly
    2. See Medication Causes of Psychosis
    3. Anticholinergic Toxicity (e.g. Diphenhydramine)

III. Background: Classic Hallucinogens (Psychedelics)

  1. Derivations
    1. LSD semisynthetically derived from ergot alkaloids
    2. Mescaline naturally derived from peyote
    3. Psilocybin naturally derived from Psilocybe
  2. Pharmacokinetics
    1. LSD (50-400 ug): 8-12 hour duration
    2. Mescaline (250-600 mg): 8-12 hour duration
    3. Psilocybin (10-50 mg): 6-8 hour duration
  3. Mechanism
    1. Classic Hallucinogens (Psychedelic agents) act at 5-HT2A receptors
    2. Decreases brain blood flow to the default mode network, that in part differentiates self from non-self
      1. Results in dissociation effects of Hallucinogens

IV. Signs

  1. See Intentional Drug Overdose
  2. Varies widely based on substance used (which is often unknown)
    1. Polysubstance ingestion is common
    2. Adulterated drugs, variable street names and unique designer drugs are common
  3. Hyper-suggestible state

V. Complications: Toxicity

  1. Serotonin Syndrome
    1. Lysergic Acid Diethylamide (LSD) has high affinity for Serotonin receptors
    2. NBOMe has even higher Serotonin receptor affinity than LSD
  2. Amphetamine-like reaction
    1. Hyperthermia
    2. Rhabdomyolysis
    3. Cerebral Infarction
  3. Water Intoxication with severe Hyponatremia
    1. See Hyponatremia Management
    2. Most common with MDMA (Ecstasy)
    3. Observe for Seizures

VI. Management: Hallucinogen Intoxication

  1. See Calming the Agitated Patient
  2. Benzodiazepines (e.g. Midazolam, Lorazepam) are first-line agents
  3. Avoid Neuroleptics (e.g. Haloperidol) in most cases
    1. Risk of Drug Interaction with Hallucinogens used (esp. Anticholinergic Agents)
  4. Provide calm and supportive environment
    1. Isolated room with minimal stimuli and dim lighting
  5. Disposition
    1. Stable patients may be discharged after 1-2 hours of observation with a sober adult
    2. Persistent Psychedelic effects warrant longer observation (higher risk of death related to Traumatic Injury)

VII. References

  1. McCollum (2020) EMRap 20(4):9-10

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Related Studies

Ontology: Hallucinogen Use Disorders (C0018532)

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