Advertisement

Current Psychiatry Reports

, Volume 5, Issue 5, pp 347–354 | Cite as

Hallucinogens: An update

  • John H. Halpern
Article

Abstract

Research of hallucinogen abuse rarely extends beyond epidemiology and observed pathology. Even less research has been completed on the special circumstances surrounding the religious use of hallucinogens or on potential therapeutic applications. Rather than offer another basic review on the well-known hazards of illicit hallucinogen use, this paper provides an overview and practice recommendations on compounds the clinician may be less familiar with, such as the botanical plant Salvia divinorum, the drug 3,4-methylenedioxymethamphetamine (“ecstasy”) and synthetic hallucinogen analogs. The often-warned, but rarely occurring, hazard of hallucinogen persisting perception disorder (“flashbacks”) is also reviewed with treatment recommendations provided. The current status of clinical research with the hallucinogens is presented, with case vignettes suggesting hallucinogens may have anti-addictive applications. The special circumstances surrounding the religious, nondrug use of hallucinogens as sacred sacraments in the US and elsewhere are also presented. It is hoped that the reader will gain a more nuanced understanding of how these physiologically nonaddictive drugs may offer legitimate benefits in modern society. By appreciating that such benefits may one day be borne out by careful, methodologically sound research, clinicians should be better armed in raising the topic of hallucinogen use and abuse with their patients.

Keywords

Heroin Social Anxiety Disorder Ecstasy MDMA Case Vignette 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Strassman RJ: Adverse reactions to psychedelic drugs: a review of the literature. J Nerv Ment Dis 1984, 172:577–595. This paper is the “gold-standard” review of adverse reactions from hallucinogens and takes great care in discussing the extensive clinical research with hallucinogens that occurred primarily from the 1950s through early 1970s. Strassman went on to publish original research on the dose-response effects of the hallucinogen dimethyltryptamine (see Strassman RJ, Qualls C: Dose-response study of N,N-dimethyltryptamine in humans, I: neuroendocrine, autonomic, and cardiovascular effects. Arch Gen Psychiatry 1994, 51:85–97.).PubMedCrossRefGoogle Scholar
  2. 2.
    El-Mallakh RS, Halpern JH, Abraham HD: Substance abuse: hallucinogen and MDMA-related disorders. In Psychiatry. Edited by Tasman A, Lieberman J, Kay J. London: John Wiley & Sons, Ltd.; 2003:1046–1065. This is the most recent textbook review on hallucinogens and is the first to discuss how hallucinogens are drugs of abuse while remaining bona fide religious sacraments in traditional societies and some religions.Google Scholar
  3. 3.
    Siebert D: Salvia divinorum and salvinorin A: new pharmacologic findings. J Ethnopharmacol 1994, 43:53–56.PubMedCrossRefGoogle Scholar
  4. 4.
    Valdes LJ: Salvia divinorum and the unique diterpene hallucinogen, Salvinorin (divinorin) A. J Psychoactive Drugs 1994, 26:277–283.PubMedGoogle Scholar
  5. 5.
    Roth BL, Baner K, Westkaemper R, et al.: Salvinorin A: a potent naturally occurring nonnitrogenous kappa opioid selective agonist. PNAS 2002, 99:11934–11939.PubMedCrossRefGoogle Scholar
  6. 6.
    Halpern JH, Pope HG: Hallucinogens on the Internet: a vast new source of underground drug information. Am J Psychiatry 2001, 158:481–483. This paper provides an extensive review of the types of information available on hallucinogens via the Internet.PubMedCrossRefGoogle Scholar
  7. 7.
    Cole JC, Sumnall HR: Altered states: the clinical effects of Ecstasy. Pharmacol Ther 2003, 98:35–58.PubMedCrossRefGoogle Scholar
  8. 8.
    Office of Applied Studies: Results from the 2001 National Household Survey on Drug Abuse: Volume I. Summary of national findings. (DHHS Publication No. SMA 02-3758, NHSDA Series H-17). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2002.Google Scholar
  9. 9.
    Johnston LD, O’Malley PM, Bachman JG: Monitoring the future national results on adolescent drug use: overview of key findings (National Institutes of Health Publication No. 03-5374). Bethesda: National Institute on Drug Abuse; 2003.Google Scholar
  10. 10.
    Pope HG, Ionescu-Pioggia M, Pope KW: Drug use and lifestyle among college undergraduates: a 30-year longitudinal study. Am J Psychiatry 2001, 158:1519–1521.PubMedCrossRefGoogle Scholar
  11. 11.
    Klitzman RL, Pope HG, Hudson JI: MDMA (“Ecstasy”) abuse and high-risk sexual behaviors among 169 gay and bisexual men. Am J Psychiatry 2000, 157:1162–1164.PubMedCrossRefGoogle Scholar
  12. 12.
    Colfax GN, Mansergh G, Guzman R, et al.: Drug use and sexual risk behavior among gay and bisexual men who attend circuit parties: a venue-based comparison. J Acquir Immune Defic Syndr 2001, 28:373–379.PubMedGoogle Scholar
  13. 13.
    Breslau K: The ‘sextasy’ craze. Clubland’s dangerous party mix: Viagra and ecstasy. Newsweek 2002, 139:30.PubMedGoogle Scholar
  14. 14.
    Parrott AC: Human research on MDMA (3,4-methylenedioxymethamphetamine) neurotoxicity: cognitive and behavioral indices of change. Neuropsychobiology 2000, 42:17–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Thomasius R, Petersen K, Buchert R, et al.: Mood, cognition and serotonin transporter availability in current and former ecstasy (MDMA) users. Psychopharmacology (Berl) 2003, 167:85–96. This recent study is one of the few to attempt careful control for most of the mentioned methodologic limitations. Findings did not corroborate earlier studies claiming residual functional deficits on verbal measures.Google Scholar
  16. 16.
    Kish SJ: How strong is the evidence that brain serotonin neurons are damaged in human users of ecstasy? Pharmacol Biochem Behav 2002, 71:845–855.PubMedCrossRefGoogle Scholar
  17. 17.
    Soar K, Turner JJ, Parrott AC: Psychiatric disorders in Ecstasy (MDMA) users: a literature review focusing on personal predisposition and drug history. Hum Psychopharmacol 2001, 16:641–645.PubMedCrossRefGoogle Scholar
  18. 18.
    Versiani M: A review of 19 double-blind placebo-controlled studies in social anxiety disorder (social phobia). World J Biol Psychiatry 2000, 1:27–33.PubMedCrossRefGoogle Scholar
  19. 19.
    Henry JA, Fallon JK, Kicman AT, et al.: Low-dose MDMA (“ecstasy”) induces vasopressin secretion. Lancet 1998, 351:1784.PubMedCrossRefGoogle Scholar
  20. 20.
    Shulgin A, Shulgin A: Tihkal: The Continuation. Berkeley: Transform Press; 1997.Google Scholar
  21. 21.
    Shulgin A, Shulgin A: Pihkal: A Chemical Love Story. Berkeley: Transform Press; 1991.Google Scholar
  22. 22.
    2-C-T-7: Intent to Schedule. Federal Register 2002, 67:47343–47345.Google Scholar
  23. 23.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Press, Inc; 1994.Google Scholar
  24. 24.
    Halpern JH, Pope HG: Hallucinogen persisting perception disorder: what do we know after 50 years? Drug Alcohol Depend 2003, 69:109–119.PubMedCrossRefGoogle Scholar
  25. 25.
    Abraham HD: Visual phenomenology of the LSD flashback. Arch Gen Psychiatry 1983, 40:884–889.PubMedGoogle Scholar
  26. 26.
    Abraham H: Hallucinogen persisting perception disorder. Pract Rev Psychiatry 1998, 22:1–2.Google Scholar
  27. 27.
    Lerner AG, Finkel B, Oyffe I, et al.: Clonidine treatment for hallucinogen persisting perception disorder. Am J Psychiatry 1998, 155:1460.PubMedGoogle Scholar
  28. 28.
    Vastag B: Addiction treatment strives for legitimacy. JAMA 2002, 288:3096–3101.PubMedCrossRefGoogle Scholar
  29. 29.
    Pope HG: Tabernanthe iboga: an African narcotic plant of social importance. Economic Botany 1969, 23:174–184.Google Scholar
  30. 30.
    Glick SD, Maisonneuve IM, Szumlinski KK: 18-Methoxycoronaridine (18-MC) and ibogaine: comparison of anti-addictive efficacy, toxicity, and mechanisms of action. Ann N Y Acad Sci 2000, 914:369–386.PubMedCrossRefGoogle Scholar
  31. 31.
    Cappendijk SLT, Dzoljic MR: Inhibitory effects of ibogaine on cocaine self-administration in rats. Eur J Pharmacol 1993, 241:261–265.PubMedCrossRefGoogle Scholar
  32. 32.
    Glick SD, Rossman KL, Rao NC, et al.: Effects of ibogaine on acute signs of morphine withdrawal in rats: independence from tremor. Neuropharmacology 1992, 31:497–500.PubMedCrossRefGoogle Scholar
  33. 33.
    Szumlinski KK, Haskew RE, Balogun MY, et al.: Iboga compounds reverse the behavioral disinhibiting and corticosterone effects of acute methamphetamine: implications for their anti-addictive properties. Pharmacol Biochem Behav 2001, 69:485–491.PubMedCrossRefGoogle Scholar
  34. 34.
    Halpern JH: The use of hallucinogens in the treatment of addiction. Addict Res 1996, 4:177–189. This paper carefully reviews this topic and concludes that hallucinogens remain possible therapeutic agents for addiction. Research ended not because of negative findings but because investigators were no longer willing to continue working with compounds blamed for contributing to the social upheaval of the 1960s.Google Scholar
  35. 35.
    Greer G, Tolbert R: Subjective reports of the effects of MDMA in a clinical setting. J Psychoactive Drugs 1986, 18:319–327.PubMedGoogle Scholar
  36. 36.
    Kurland AA: LSD in the supportive care of the terminally ill cancer patient. J Psychoactive Drugs 1985, 17:279–290.PubMedGoogle Scholar
  37. 37.
    Grof S, Goodman LE, Richards WA, Kurland AA: LSD-assisted psychotherapy in patients with terminal cancer. Int Pharmacopsychiatry 1973, 8:129–144.PubMedGoogle Scholar
  38. 38.
    Pahnke WN, Kurland AA, Goodman LE, Richards WA: LSDassisted psychotherapy with terminal cancer patients. Curr Psychiatr Ther 1969, 9:144–152.PubMedGoogle Scholar
  39. 39.
    Kast E: Attenuation of anticipation: a therapeutic use of lysergic acid diethylamide. Psychiatr Q 1967, 41:646–657.PubMedCrossRefGoogle Scholar
  40. 40.
    Krupitsky EM, Grinenko AY: Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoactive Drugs 1997, 29:165–183.PubMedGoogle Scholar
  41. 41.
    Krupitsky E, Burakov A, Romanova T, et al.: Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up. J Subst Abuse Treat 2002, 23:273–283.PubMedCrossRefGoogle Scholar
  42. 42.
    Moreno FA, Delgado PL: Hallucinogen-induced relief of obsessions and compulsions. Am J Psychiatry 1997, 154:1037–1038.PubMedGoogle Scholar
  43. 43.
    Doblin R: A clinical plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD): partnering with the FDA. J Psychoactive Drugs 2002, 34:185–194.PubMedGoogle Scholar
  44. 44.
    Heffter Research Institute progress report: Available at http:// www.heffter.org/pages/activities/prog2002.html. Accessed July 10, 2003.Google Scholar
  45. 45.
    Albaugh BJ, Anderson PO: Peyote in the treatment of alcoholism among Native Americans. Am J Psychiatry 1974, 131:1247–1250.PubMedGoogle Scholar
  46. 46.
    Bergman RL: Navajo peyote use: its apparent safety. Am J Psychiatry 1971, 128:695–699.PubMedGoogle Scholar
  47. 47.
    Halpern JH, Pope HG, Sherwood A, et al.: Neuropsychological effects of long-term hallucinogen use vs alcoholism in Native Americans: cultural limitations of tests. Drug Alcohol Depend 2002, 66:S73-S74.Google Scholar
  48. 48.
    Halpern JH, Pope HG, Sherwood A, et al.: Neuropsychological effects of long-term hallucinogen use in Native Americans. Drug Alcohol Depend 2001, 63:S62.Google Scholar
  49. 49.
    Dorrance DL, Janiger O, Teplitz RL: Effect of peyote on human chromosomes: cytogenic study of the Huichol Indians of northern Mexico. JAMA 1975, 234:299–302. Although from 1975, this paper dispelled the erroneous contention that hallucinogens cause chromosomal damage.PubMedCrossRefGoogle Scholar
  50. 50.
    Horgan J: Peyote on the brain: is the secret to alcoholism and other addictions locked up in hallucinogenic drugs? Discover Magazine 2003, 24:68–74.Google Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • John H. Halpern
    • 1
  1. 1.Biological Psychiatry Laboratory, Alcohol and Drug Abuse Research CenterMcLean HospitalBelmontUSA

Personalised recommendations