2. 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 in psychotherapy

3. Hallucinogens Types 1. Serotonergic hallucinogens –chem similar to serotonin 2. Methylated amphetamines –chem similar to norepinephrine...alterations in mood without much change in senses 3. Anticholinergic - (Ach) – found in plants: belladonna, mandrake, jimson weed –trance or dream-like states 4. Dissociative anesthetics –can remain conscious in surgery; causes euphoria, numbness, aggressive behavior, and tactile sense disturbances

4. 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

5. Methylated Amphetamines MDMA (Ecstacy; X)synthetic MDA (Love Drug)synthetic

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

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

8. Hallucinogens Effects Vary by Type

9. NHSADA Hallucinogen Use % (2004) LifetimePast yrPast mo Total14.31.6.4 12-174.63.0.8 18-2521.36.01.5 26 & older14.40.6.1 Male17.72.2.6 Female111.1.2

10. What do you know about the drug ECSTASY?

11. Methylenedioxymethamphetamine “MDMA” for short It is popularly called: Ecstasy X Adam Lover’s Speed XTC E Clarity (among other names)

12. Pharmacology & History MDMA is a synthetic norepinephrine-related hallucinogenic drug 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)

13. MDMA Appeal MDMA has the stimulant qualities of amphetamines and the hallucinogenic (psychedelic) qualities of mescaline It’s effects last approximately 3-6 hours

14. 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 –often used at dance parties called “raves” and on college campuses

15. 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

16. 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

17. 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)

18. 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)

19. Your 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

20. Prevalence Ecstasy tablets seized by the Drug Enforcement Administration increased from 13,342 in 1996 to 949,257 in 2000 MONITORING THE FUTURE STUDY Ecstasy Use by Students, 2000: Grade:8th10th 12th Ever Used4.3%7.3%11.0% Used in Past Year3.1%5.4%8.2% Used in Past Month1.4%2.6%3.6%

21. Prevalence

22. What are Raves? Clandestine dance parties (location usually kept quiet until 1-2 days before event) Held at abandoned warehouses… Advertised by flyers or word of mouth

23. What are they like? Only laser lights illuminate the darkened building Vigorous, all night dancing Loud, repetitive, synthesized electronic music at 80-120 beats per minute mixed by disk jockeys

24. 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)

25. Raves

26. 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.”

27. Raves –“The rave scene is great as an accepting environment, but it becomes problematic when it’s intrinsically tied to drug use. It can set up a pattern of lifelong drug use. Drug use can lead to unsafe sex and HIV transmission.” – “Anything goes at a rave, and that’s both its strongest asset and its biggest flaw.” –Caitlin Ryan, clinical social worker and co-author of Lesbian and Gay Youth: Care and Counseling.

28. 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

29. 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

30. 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