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, X in psychotherapy

Hallucinogens Types 1. Serotonergic hallucinogens (Phantastica) –chem similar to _______________ 2. Methylated amphetamines (Phantastica) –chem similar to ________________________...alterations in mood without much change in senses 3. Anticholinergic - (Deliriants) – _________________ receptor sites central mechanism – found in plants: belladonna, mandrake, jimson weed – can produce trance or dream-like states 4. Dissociative anesthetics (Deliriants) –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 MescalinePeyote cactus Harmaline, HarmineAyahuasca vine Ergine, Isoerginemorning glory Lysergic Acid Amidemorning glory

Methylated Amphetamines MDMA (Ecstacy)synthetic MDA (Love Drug)synthetic DOM (STP) serenity, tranquility, pax?

Acetylcholinergic Hallucinogens Atropinebelladonna plant Scopolamineroots of mandrake, herbane Hyoscyamineroots of mandrake, herbane IbogaineIboga plant

Dissociative Anesthetic Hallucinogens Phencyclidine (PCP, Angel Dust)synthetic KetaminePCP-like drug

NHSDUH Hallucinogen Use % (2004) LifetimePast yrPast mo Total & older Male Female

What do you know about ECSTASY?

Methylenedioxymethamphetamine “MDMA” for short MDMA is a synthetic norepinephrine-related hallucinogenic drug It is popularly called: Ecstasy X Adam Lover’s Speed XTC E Clarity (among other names)

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

History 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)

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 of MDMA 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)

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

What are Raves? Clandestine dance parties (location usually kept quiet until 1-2 days before event) Held at abandoned warehouses, other locations 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 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 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.”

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