Skip to main content
SpringerLink
Log in

Clinical Features and Management of Intoxication Due to Hallucinogenic Drugs

  • Review Article
  • Toxicology Management Review
  • Published:
Medical Toxicology and Adverse Drug Experience Aims and scope Submit manuscript

Summary

Hallucinogenic drugs are unique in that they produce the desired hallucinogenic effects at what are considered non-toxic doses. The hallucinogenic drugs can be categorised into 4 basic groups: indole alkaloid derivatives, piperidine derivatives, phenylethylamines and the cannabinols. The drugs reviewed include lysergic acid diethylamide (LSD), phencyclidine (PCP), cocaine, amphetamines, opiates, marijuana, psilocybin, mescaline, and ‘designer drugs.’

Particularly noteworthy is that each hallucinogen produces characteristic behavioural effects which are related to its serotonergic, dopaminergic or adrenergic activity. Cocaine produces simple hallucinations, PCP can produce complex hallucinations analogous to a paranoid psychosis, while LSD produces a combination of hallucinations, pseudohallucinations and illusions. Dose relationships with changes in the quality of the hallucinatory experience have been described with amphetamines and, to some extent, LSD. Flashbacks have been described with LSD and alcohol.

Management of the intoxicated patient is dependent on the specific behavioural manifestation elicited by the drug. The principles involve differentiating the patient’s symptoms from organic (medical or toxicological) and psychiatric aetiologies and identifying the symptom complex associated with the particular drug. Panic reactions may require treatment with a benzodiazepine or haloperidol. Patients with LSD psychosis may require an antipsychotic. Patients exhibiting prolonged drug-induced psychosis may require a variety of treatments including ECT, lithium and l-5-hydroxytryptophan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aboul-Enein HY. Psilocybin: a pharmacologie profile. American Journal of Pharmacy 146: 91–95, 1974

    CAS  Google Scholar 

  • Abraham H. L-5-hydroxytryptophan for LSD-induced psychosis. American Journal of Psychiatry 140: 456–458, 1983

    PubMed  CAS  Google Scholar 

  • Abraham HD. Visual phenomenology of the LSD flashback. Archives of General Psychiatry 40: 884–889, 1983

    PubMed  CAS  Google Scholar 

  • Aggernaes A. The difference between the experienced reality of hallucinations in young drug abusers and schizophrenic patients. Acta Psychiatrica Scandinavica 48: 287–229, 1972

    PubMed  CAS  Google Scholar 

  • Aghajanian GK. Identifying middlemen hallucinogens by their preferential action on serotonin autoreceptors. In Hanin & Usdin (Ed.) Animal models in psychiatry and neurology, pp. 83–90, Pergamon Press, Oxford, 1977

    Google Scholar 

  • Agnew N, Hoffer A. Nicotinic acid modified lysergic acid diethylamide psychosis. Journal of Mental Science 101: 12–27, 1955

    PubMed  CAS  Google Scholar 

  • Agurell S, Halldin M, Lingren JE, Ohlsson A, Widman M, et al. Pharmacokinetics and metabolism of delta 1-tetrahydrocannabinol and other cannabinoids with emphasis on man. Pharmacology Reviews 38(1): 21–43, 1986

    CAS  Google Scholar 

  • Ahamad G. Abuse of phencyclidine (PCP): a laboratory experience. Clinical Toxicology 25: 341–346, 1987

    Google Scholar 

  • Akil H, Watson SJ, Young E, Lewis ME, Khachaturian H, et al. Endogenous opioids: biology and function. Annual Review of Neuroscience 7: 223–255, 1984

    PubMed  CAS  Google Scholar 

  • Alarcon AD, Dickinon WA, Dohn HH. Flashback phenomena: clinical and diagnostic dilemmas. Journal of Nervous and Mental Disease 170: 217–223, 1982

    PubMed  CAS  Google Scholar 

  • Allen RM, Young SJ. Phencyclidine-induced psychosis. American Journal of Psychiatry 135: 1081–1084, 1978

    PubMed  CAS  Google Scholar 

  • Altura BT, Altura BM. Phencyclidine, lysergic acid diethylamide, and mescaline: cerebral artery spasm and hallucinogenic activity. Science 212: 1051–1053, 1981

    PubMed  CAS  Google Scholar 

  • AMA Council on Drugs. AMA drug evaluations, 6th ed., American Medical Association, Chicago, 1988

    Google Scholar 

  • AMA Drug Evaluations, 3rd ed., American Medical Association, Publishing Sciences Group, Littleton, Massachusetts, 1983

  • Aronow R, Miceli J, Done A. A therapeutic approach to the acutely overdosed PCP patient. Journal of Psychedelic Drugs 12: 259–266, 1980

    PubMed  CAS  Google Scholar 

  • Ayres WA, Starsiak MJ, Sokolay P. The bogus drug, three methyl and alpha methyl fentanyl sold as “China White”. Journal of Psychoactive Drugs 13: 91–93, 1981

    PubMed  CAS  Google Scholar 

  • Badham ER. Ethnobotany of Psilocybin mushrooms, expecially Psilocybe cubensis. Journal of Ethnopharmacology 10: 249–254, 1984

    PubMed  CAS  Google Scholar 

  • Barkin RL. Substance and drug abuse. In Hahn et al. (Eds) Pharmacology in nursing, pp. 323–362, C.V. Mosby Co., St Louis, 1986

    Google Scholar 

  • Barton CH, Sterling ML, Vaziri ND. Phencyclidine intoxication: clinical experience in 27 cases confirmed by urine assay. Annals of Emergency Medicine 10: 243–246, 1981

    PubMed  CAS  Google Scholar 

  • Baselt RC. Unusually high cannabinol concentrations in urine. Journal of Analytical Toxicology 8: 16A, 1985

    Google Scholar 

  • Beck J, Morgan PA. Designer drug confusion: a focus on MDMA. Journal of Drug Education 16: 287–302, 1986

    PubMed  CAS  Google Scholar 

  • Becker CE. Phencyclidine, Poisondex ® Toxicologic Managements, 1989

  • Berlant JL. Reserpine and phencyclidine-associated psychosis: three case reports. Journal of Clinical Psychiatry 46: 542–544, 1985

    PubMed  CAS  Google Scholar 

  • Black D, Woollacott S. Acute toxic psychosis in two children treated with benzhexol hydrocholoride (Artane). British Journal of Psychiatry 125: 483–484, 1974

    PubMed  CAS  Google Scholar 

  • Bloodworth RC. Medical problems associated with marijuana abuse. Psychiatric Medicine 3(3): 173–184, 1985

    PubMed  CAS  Google Scholar 

  • Bowers MB. Psychoses precipitated by psychotomimetic drugs: a follow-up study. Archives of General Psychiatry 34: 832–835, 1973

    Google Scholar 

  • Bozarth MA, Wise RA. Anatomically distinct opiate receptor fields mediate reward and physical dependence. Science 244: 516–517, 1984

    Google Scholar 

  • Brizer DA. Psychopharmacology and the management of violent patients. Psychiatric Clinics of North America 11: 551–568, 1988

    PubMed  CAS  Google Scholar 

  • Brown MJ, Salmon D, Rendell M. Clonidine hallucinations. Annals of Internal Medicine 93: 456–457, 1980

    PubMed  CAS  Google Scholar 

  • Buchanan JF, Brown CR. Designer drugs: a problem in clinical toxicology. Medical Toxicology 3: 477–501, 1976

    Google Scholar 

  • Burns RS, Lerner SE. Perspectives: acute phencyclidine intoxication. Clinical Toxicology 9: 477–501, 1976

    PubMed  CAS  Google Scholar 

  • Caridland JS, Rottanburg D, Robins AH. Apparent half-life of excretion of cannabinoids in man. Human Toxicology 2: 641–644, 1983

    Google Scholar 

  • Castellanni S, Giannini J, Adams P. Physostigmine and haloperidol treatment of acute phencyclidine intoxication. American Journal of Psychiatry 139: 508–510, 1982

    Google Scholar 

  • Chan GL, Matzke GR. Effects of renal insufficiency on the pharmacokinetics and pharmacodynamics of opioids analgesics. Drug Intelligence and Clinical Pharmacy 21(10): 773–783, 1987

    PubMed  CAS  Google Scholar 

  • Chang KJ, Cuatrecasas P. Heterogeneity and properties of opiate receptors. Federation Proceedings 40: 2729–2734, 1981

    PubMed  CAS  Google Scholar 

  • Clark WG. Changes in body temperature after administration of antipyretic, LSD, delta 9-THC and related agents: II. Neuroscience and Behavioral Reviews 11(1): 35–96, 1987

    CAS  Google Scholar 

  • Climko RP, Roehrich H, Sweeney DR, Al-Razi J. Ecstasy: a review of MDMA and MDA. International Journal of Psychiatry in Medicine 16: 359–372, 1986-87

    PubMed  Google Scholar 

  • Clouet DH, Yonehara N. Biochemical reactions between opiate receptor binding and inhibition of neurotransmission. National Institute of Drug Abuse Research Monograph Series 54: 95–108, 1984

    CAS  Google Scholar 

  • Cohen S. The hallucinogens and the inhalants. Psychiatric Clinics of North America 7: 681–8, 1984

    PubMed  CAS  Google Scholar 

  • Dackis CA, Gold MS. Psychopharmacology of cocaine. Psychiatric Annals 18: 528–530, 1988

    Google Scholar 

  • Dahlstrom B, Tamsen A, Paalzow L, Hartvig P. Multiple and single-dose kinetics of morphine in patients with postoperative pain. Acta Anesthesiologica Scandinavica 74 (Suppl.): 44, 1982

    CAS  Google Scholar 

  • Darc G, Goldney R. Fenfluramine abuse. Medical Journal of Australia 2: 537–538, 1976

    Google Scholar 

  • Davies DJ. An assessment of pindolol in the general practice management of hypertension. British Journal of Clinical Practice 30: 200–201, 1976

    PubMed  CAS  Google Scholar 

  • Davis GC, Williams AC, Markey SP, Ebert MH, Caine ED, et al. Chronic Parkinsonism secondary to intravenous injection of meperidine analogues. Psychiatry Research 1: 249–254, 1979

    PubMed  CAS  Google Scholar 

  • Drug Abuse Warning Network (DAWN), National Institute on Drug Abuse. Statistical Series Annual Data, Series I, Number 7, 1987 DAWN Briefings, Vol. V, No. II, pp. 1–2, National Institute of Drug Abuse, 1989

  • Derlet RW, Albertson TE. Emergency department presentation of cocaine intoxication. Annals of Emergency Medicine 18: 182–186, 1989

    PubMed  CAS  Google Scholar 

  • Dewey WL. Cannabidiol pharmacology. Pharmacology Reviews 38(2): 151–178, 1986

    CAS  Google Scholar 

  • Dixon R, Crews T, Inturrisi C, Foley K. Levophanol: pharmacokinetics and steady-state plasma concentrations in patients with pain. Research Communications in Chemical Pathology and Pharmacology 41: 3–17, 1983

    PubMed  CAS  Google Scholar 

  • Domino EF. Comparison of phencyclidine and related substances with various indole, phenethylamine and other psychotomimetics. Psychopharmacology Bulletin 22: 973–976, 1986

    PubMed  CAS  Google Scholar 

  • Domino EF, Luby ED. Abnormal mental states induced by phencyclidine as a model of schizophrenia. In Domino (Ed.) PCP (phencyclidine): historical and current perspective pp. 401–418, NPP Books, Ann Arbor, 1981

    Google Scholar 

  • Dorland’s Illustrated Medical Dictionary, 27th ed., WB Saunders Co, Philadelphia, 1988

  • Dowling GP, McDonough ET, Bost RO. ‘Eve’ and ‘Ecstasy’, a report of five deaths associated with the use of MDEA and MDMA. Journal of the American Medical Association 257: 1615–1617, 1987

    PubMed  CAS  Google Scholar 

  • Drummond L. Cannabis psychosis: a case report. British Journal of Addiction 81: 139–140, 1986

    PubMed  CAS  Google Scholar 

  • Dukes MNG. Meyler’s side effects of drugs, Vol. 9, Excerpta Medica, New York, 1980

    Google Scholar 

  • Edwards DJ, Sevensson CK, Visco JP, Lalka D. Clinical pharmacokinetics of pethidine: 1982. Clinical Pharmacokinetics 7: 421–433, 1982

    PubMed  CAS  Google Scholar 

  • Ellenhorn MJ. Cocaine. In Ellehorn & Barcelous (Eds) Medical toxicology: diagnosis and treatment of human poisoning, pp. 644–661, Elsevier Press, New York, 1988

    Google Scholar 

  • Ellinwood Jr EH, Sudilovsky A, Nelson LM. Evolving behavior in the clinical and experimental amphetamine (model) psychosis. American Journal of Psychiatry 13: 1088–1093, 1973

    Google Scholar 

  • Fehr KO, Kalant H (Eds) Cannabis and health hazards. The Addiction Research Foundation, Toronto, 1983

    Google Scholar 

  • Fellman JH, Nutt JN. MPTP-like molecules and Parkinson’s disease. Lancet 1: 924, 1985

    PubMed  CAS  Google Scholar 

  • Fellows EJ, Bernheim F. The effect of a number of aralkylamines on the oxidation of tyramine by amine oxidase. Journal of Pharmacology and Experimental Therapeutics 100: 94–99, 1950

    PubMed  CAS  Google Scholar 

  • Finnegan LP, Fehr KO’B. The effects of opiates, sedative-hypnotics, amphetamines, cannabis, and other psychoactive drugs on the fetus and newborn. In Kalant (Ed.) Research advances in alcohol and drug problems, Vol. 5, pp. 653–723, Plenum Press, New York, 1980

    Google Scholar 

  • Francis J, Murray VSG. Review of enquiries made to the NPIS concerning psilocybe mushroom ingestion. 1978–1981. Human Toxicology 2: 349–352, 1983

    PubMed  CAS  Google Scholar 

  • Gelman CR, Rumack BH (Eds). Drugdex, Micromedex, 1989

  • Ghodse AH. Cannabis psychosis. British Journal of Addiction 81(4): 473–478, 1986

    PubMed  CAS  Google Scholar 

  • Giannini AJ, Loiselle RH, Giannini MC, Price WA. Comparison of atimanic efficacy of donidine and verapamil. Journal of Clinical Pharmacology 25: 307–308, 1985

    PubMed  CAS  Google Scholar 

  • Giannini AJ, Loiselle RH, Giannini MC, Price WA. Phencyclidine and the dissociative. Psychiatric Medicine 3: 198–217, 1987

    Google Scholar 

  • Glennon RA, Rosecrans JA. Indolealkylamine and phenalkylamine hallucinogens: a brief overview. Neuroscience and Biobehavioral Reviews 6: 489–497, 1982

    PubMed  CAS  Google Scholar 

  • Glennon RA, Young R. MDA: an agent that produces stimulus effects similar to those of 3, 4-DMS, LSD, and cocaine. European Journal of Pharmacology 99: 249–250, 1984

    PubMed  CAS  Google Scholar 

  • Glynn CJ, Mather LE. Clinical pharmacokinetics applied to patients with intractable pain; studies with pethidine. Pain 13: 237–246, 1982

    PubMed  CAS  Google Scholar 

  • Goldstein A. Opioid peptides: function and significance. In Collier et al. (Eds) Opioids: past, present and future, pp. 127–143, Tayler & Frances Ltd., London, 1984

    Google Scholar 

  • Goodman and Gilman’s The pharmacological basis of therapeutics, 2nd ed., MacMillan Publication Company 1985

  • Gourlay GK, Wilson PR, Glynn CJ. Methadone produces prolonged postoperative analgesia. British Medical Journal 284: 630–631, 1982

    PubMed  CAS  Google Scholar 

  • Greer G, Tolbert R. Subjective reports of the effects of MDMA in a clinical setting. Journal of Psychoactive Drugs 18: 319–327, 1986

    PubMed  CAS  Google Scholar 

  • Grover D, Yergani UK, Keshavan MS. Improvement of phencyclidine-associated psychosis with ECT. Journal of Clinical Psychiatry 47: 477–478, 1986

    PubMed  CAS  Google Scholar 

  • Gustafsson LL, Wiesenfeld-Hallin Z. Spinal opioid analgesia: a critical update. Drugs 35(6): 597–603, 1988

    PubMed  CAS  Google Scholar 

  • Haddad LM. Management of hallucinogen abuse. American Family Physician 14: 82–87, 1976

    PubMed  CAS  Google Scholar 

  • Haddad LM. Cocaine. In Haddad & Winchester (Eds) Clinical management of poisoning and drug overdose, pp. 443–447, WB Saunders, Philadelphia, 1983

    Google Scholar 

  • Halikas J, Weiler R, Morse C. Effects of regular marijuana use on sexual performance. Journal of Psychoactive Drugs 14: 59–70, 1982

    PubMed  CAS  Google Scholar 

  • Harris LS. The stimulants and hallucinogens under consideration: a brief overview of their chemistry and pharmacology. Drug and Alcohol Dependence 17: 107–118, 1986

    PubMed  CAS  Google Scholar 

  • Herridge C, A’Brook M. Ephedrine psychosis. British Medical Journal 2: 160, 1968

    PubMed  CAS  Google Scholar 

  • Hoffer A. LSD-induced psychosis and vitamine B3. American Journal of Psychiatry 128: 1155, 1972

    PubMed  CAS  Google Scholar 

  • Hoffman A. Psychotomimetic drugs: chemical and pharmacological aspects. ACTA Physiology Pharmacology 86: 134–138, 1975

    Google Scholar 

  • Hollister LE, Hartman AM. Mescaline, lysergic acid diethylamide and psilocybin: comparison of clinical syndromes, effects on color perception and biochemical measures. Comprehensive Psychiatry 3: 235–241, 1962

    PubMed  CAS  Google Scholar 

  • Hollister LE, Gillespie HK, Ohlsson A, Lindren J-E, Wahlen A, et al. Do plasma concentrations of 9-tetrahydrocannabinol reflect the degree of intoxication? Journal of Clinical Pharmacology 21: 171S–177S, 1981

    PubMed  CAS  Google Scholar 

  • Honec WG, Gewirtz G, Turey M. Psychosis and violence in cocaine smokers. Lancet 2: 451, 1987

    Google Scholar 

  • Horowitz HA. The use of lithium in the treatment of the drug-induced psychotic reaction. Diseases of the Nervous System 36: 159–163, 1975

    PubMed  CAS  Google Scholar 

  • Horowitz MJ. Flashbacks: recurrent intrusive images after the use of LSD. American Journal of Psychiatry 126: 565, 1969

    PubMed  CAS  Google Scholar 

  • Hunt CA, Jones RT. Tolerance and disposition of tetrahydrocannabinol in man. Journal of Pharmacology and Experimental Therapeutics 215: 35–44, 1980

    PubMed  CAS  Google Scholar 

  • Hunt DE, Strug DL, Goldsmith DS, Lipton DS, Spunt B, et al. An instant shot of ‘aah’: cocaine use among methadone clients. Journal of Psychoactive Drugs 16: 217–227, 1984

    PubMed  CAS  Google Scholar 

  • Institute of Medicine, National Academy of Sciences. Marijuana and health: report of study, National Academy Press, Washington, DC, 1982

    Google Scholar 

  • Inturrisi CE, Colburn WA, Verebey K, Dayton HE, Woody GE, et al. Propoxyphene and norpropoxyphene kinetics after single and repeated doses of propoxyphene. Clinical Pharmacology and Therapeutics 31: 157–167, 1982

    PubMed  CAS  Google Scholar 

  • Jeffrey D, Whitfield M. Lorazepam poisoning. British Medical Journal 4: 719, 1974

    Google Scholar 

  • Jellema JG. Hallucination during sustained-release morphine and methadone administration. Correspondence. Lancet 2: 392, 1987

    CAS  Google Scholar 

  • Johnson MW, Mitch WE, Wilcox CS. The cardiovascular actions of morphine and the endogenous opioid peptides. Progress in Cardiovascular Disease 47(6): 435–50, 1985

    Google Scholar 

  • Jones RT. Cannabis and health. Annual Review of Medicine 34: 247–258, 1983

    PubMed  CAS  Google Scholar 

  • Jones RT. Drug of abuse profile: cannabis. Clinical Chemistry 33 (11 Suppl.): 72B–81B, 1987

    PubMed  CAS  Google Scholar 

  • Kandel DB. Marijuana users in young adulthood. Archives of General Psychiatry 41: 200–209, 1984

    PubMed  CAS  Google Scholar 

  • Kapadia GJ, Fayez M. Peyote consituents: chemistry, biogenesis, and biological effects. Journal of Pharmaceutical Sciences 59: 1699–1727, 1970

    PubMed  CAS  Google Scholar 

  • Keeler MH. Kluver’s mechanisms of hallucinations as illustrated by the paintings of Max Ernst. In Keup (Ed.) Origin and mechanisms of hallucinations, Plenum Press, New York, 1970

    Google Scholar 

  • Keeler MJ, Reifler CB, Liptzin MB. Spontaneous reoccurrence of marijuana effects. American Journal of Psychiatry 125: 384–386, 1968

    Google Scholar 

  • Keup W. Use, indications and distribution in different countries of the stimulant and hallucinogenic amphetamine derivatives under consideration by WHO. Drug and Alcohol Dependence 17: 169–192, 1986

    PubMed  CAS  Google Scholar 

  • King DL, Martel PA, Odonnell CM. Laboratory detection of cannabinoids. Clinics in Laboratory Medicine 7(3): 641–653, 1987

    PubMed  CAS  Google Scholar 

  • Klein-Schwartz W, Oderda GM. Jimsonweed intoxication in adolescents and young adults. American Journal of Diseases of Children 138: 737–739, 1984

    PubMed  CAS  Google Scholar 

  • Klepfisz A, Racey J. Homicide and LSD. Journal of the American Medical Association 223: 429–430, 1973

    PubMed  CAS  Google Scholar 

  • Klüver H. Mescal visions and eidetic vision. American Journal of Psychiatry 37: 502–515, 1926

    Google Scholar 

  • Klüver H. Mechanisms of hallucinations. In McNemar & Merrill (Eds) Studies in personality, McGraw Hill, New York, 1942

  • Koob GF, Bloom FE. Cellular and molecular mechanisms of drug dependence. Science 242: 715–723, 1988

    PubMed  CAS  Google Scholar 

  • Kristen G, Schaefer A, Von Schlichtegroll A. Fenetylline: therapeutic use, misuse and/or abuse. Drug and Alcohol Dependence 17: 259–271, 1986

    PubMed  CAS  Google Scholar 

  • Kulberg A. Substance abuse: clinical identification and management. Pédiatric Clinics of North America 33: 325–361, 1986

    PubMed  CAS  Google Scholar 

  • LaBarbera M, Wolfe T. Characteristics, attitudes and implications of fentanyl use based on reports from self-identified fentanyl users. Journal of Psychoactive Drugs 15: 293–301, 1983

    PubMed  CAS  Google Scholar 

  • La Barre W. Peyotl and mescaline. Journal of Psychedelic Drugs 11: 33–39, 1979

    PubMed  Google Scholar 

  • Laitinen L, Kanot J, Vapaavuori M, Vilijanen MK. Morphine concentrations in plasma after intramuscular administration. British Journal of Anesthesia 47: 1265, 1975

    CAS  Google Scholar 

  • Lampe KF. Toxic fungi. Annual Review of Pharmacology and Toxicology 19: 85–104, 1979

    PubMed  CAS  Google Scholar 

  • Law B, Mason PA, Moffat AC, King LJ, Marvs V. Passive inhalation of cannabis smoke. Journal of Pharmacy and Pharmacology 36: 578–581, 1984

    PubMed  CAS  Google Scholar 

  • Leverant R. MDMA Reconsidered. Journal of Psychoactive Drugs 18: 373–379, 1986

    PubMed  CAS  Google Scholar 

  • Lisansky J, Strassman RJ, Janowsky D, Risch SC. Drug-induced psychosis. In Tupin et al (Eds) Transient psychosis: diagnosis, management, evaluation, pp. 80–110, Brunner/Mazel, New York, 1984

    Google Scholar 

  • Litovitz T. Hallucinogens. In Haddad & Winchester (Eds) Clinical management of poisoning and drug overdose, pp. 455–466, WB Saunders Company, Philadelphia, 1983

    Google Scholar 

  • Lowenstein DH, Massa SM, Towbotham M, Collins SD, McKinney HE, et al. Acute neurologic and psychiatric complications associated with cocaine abuse. American Journal of Medicine 83: 841–846, 1987

    PubMed  CAS  Google Scholar 

  • Luisada PV, Brown BI. Clinical management of the phencyclidine psychosis. Clinical Toxicology 9: 539–545, 1976

    PubMed  CAS  Google Scholar 

  • Lyon R, Titeler M, Siegal MR, Glennon RA. Indoleaklylamine analogs share 5-HTz binding characteristics with phenylalkylamine hallucinogens. European Journal of Pharmacology 145: 291–297, 1988

    PubMed  CAS  Google Scholar 

  • Maayani S, Winstein H, Been-Zui N, Cohen S, Sokolowsky M. Psychotomimetic as anticholinergic agents I: 1-cyclo-hexyl-piperidine derivatives: anticholinesterase activity and antagonist activity to acetylcholine. Biochemical Pharmacology 23: 1263–1281, 1974

    PubMed  CAS  Google Scholar 

  • Mack RB. Marching to a different cactus: peyote (mescaline) intoxication. North Carolina Medical Journal 47: 137–138, 1986

    PubMed  CAS  Google Scholar 

  • Malitz S, Wilkens B, Esecover H. A comparison of drug induced hallucinations with those seen in spontaneously occuring psychoses. In West (Ed.) Hallucinations, Grune and Stratton, New York, 1962

  • Manara L, Bianchetti A. The central and peripheral influences of opioids on gastrointestinal propulsion. Annual Review of Pharmacology and Toxicology 25: 249–273, 1985

    PubMed  CAS  Google Scholar 

  • Manoguerra AS, Shaw RF, Normann SA. Fentanyl derivative fatalities in San Diego County. Veterinary and Human Toxicology 28: 295, 1985

    Google Scholar 

  • Martin BR. Cellular effects of cannabinoids. Pharmacology Reviews 38: 45–74, 1986

    CAS  Google Scholar 

  • Martin WR, Solan JW. Relationship of CNS tryptaminergic processes and the action of LSD-like hallucinogens. Pharmacology, Biochemistry and Behavior 24: 392–399, 1986

    Google Scholar 

  • Mazoit JX, Sandouk P, Zetlaoui P, et al. Pharmacokinetics of unchanged morphine in normal and cirrhotic subjects. Anesthesia and Analgesia 66: 293–298, 1987

    PubMed  CAS  Google Scholar 

  • McCann DJ, Smith CM, Winter JC. A caution against the use of verapamil in phencyclidine intoxication. American Journal of Psychiatry 143: 679, 1986

    PubMed  CAS  Google Scholar 

  • McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA. Acute phencyclidine intoxication: incidence of clinical finding in 1000 cases. Annals of Emergency Medicine 10: 237–242, 1981a

    PubMed  CAS  Google Scholar 

  • McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA, et al. Acute phencyclidine intoxication: clinical patterns complications and treatment. Annals of Emergency Medicine 10: 290–297, 1981b

    PubMed  CAS  Google Scholar 

  • McCawley EL, Brummett RE, Dana GW. Convulsions from Psilocybe mushroom poisoning. Proceedings of the Western Pharmacologic Society 5: 27–33, 1962

    CAS  Google Scholar 

  • McFadden I. The ionic mechanisms underlying opioid actions. Neuropeptides 11(4): 173–180, 1988

    Google Scholar 

  • McGee R. Flashbacks and memory phenomena: a comment on flashback phenomena — clinical and diagnostic dilemas. Journal of Nervous and Mental Disease 172: 273–278, 1984

    PubMed  CAS  Google Scholar 

  • Mechoulam R, Feigenbaum JJ. Towards cannabinoid drugs. Progress in Medical Chemistry 24: 159–207, 1987

    CAS  Google Scholar 

  • Mendelson JH. Marijuana. In Meltzer (Ed.) Psychopharmacology, the third generation of progress, pp. 1565–1571, Raven Press, New York, 1987

    Google Scholar 

  • Mendelson JH, Mello NK. Effects of marijuana on neuroendocrine hormones in human males and females. National Institute of Drug Abuse Research Monograph Series 44: 97–114, 1984

    CAS  Google Scholar 

  • Mills PR, Lesinkas D, Watkinson G. The danger of hallucinogenic mushrooms. Scottish Medical Journal 24: 316–317, 1979

    PubMed  CAS  Google Scholar 

  • Misra AL. Metabolism of opiates. In Adler & Samanin (Eds) Factors affecting the action of narcotics, pp. 297–343, Raven Press, New York, 1978

    Google Scholar 

  • Mokier DJ, Staudt KW, Sherman LC, Rech RH. The effects of intercranial administration of hallucinogens on operant behavior in the rat. I lysergic acid diethylamide. Pharmacology Biochemistry and Behavior 25: 717–725, 1986

    Google Scholar 

  • Montgomery PT, Mueller ME. Treatment of PCP intoxication with verapamil. Correspondence. American Journal of Psychiatry 142: 882, 1985

    PubMed  CAS  Google Scholar 

  • Moreau (de Tours) J. Du hachish et de palienation metale, etudes psychologiques. Libraire de Fortin, Masson, Paris, 1845

    Google Scholar 

  • Morgan JP. Marijuana metabolism in the context of urine testing for cannabinoid metabolite. Journal of Psychoactive Drugs 20(1): 107–115, 1988

    PubMed  CAS  Google Scholar 

  • Morishima A. Effects of cannabis and natural cannabinoids on chromosomes and ova. National Institute of Drug Abuse Research Monograph Series 44: 25–45, 1984

    CAS  Google Scholar 

  • Morland J, Bugge A, Skuterud B, et al. Cannabinoids in blood and urine after passive inhalation of cannabis smoke. Journal of Forensic Sciences 30: 997–1002, 1985

    PubMed  CAS  Google Scholar 

  • Moskowitz D. Use of haloperidol to reduce LSD flashbacks. Military Medicine 136: 754–755, 1971

    PubMed  CAS  Google Scholar 

  • Moskovitz RA, Byrd T. Rescuing the angel within: PCP related self-enucleation. Psychosomatics 24: 402–406, 1983

    PubMed  CAS  Google Scholar 

  • Muller DJ. ECT in LSD psychosis: a report of three cases. American Journal of Psychiatry 128: 351–353, 1971

    PubMed  CAS  Google Scholar 

  • National Institute on Drug Abuse. Student drug use, attitudes and beliefs: national trends 1975–1982. DHHS Publication N. (ADM) 83-1260, US Government Printing Office, Washington, DC, 1982

    Google Scholar 

  • Nichols DE. Difference between the mechanism of action of MDMA, MBDB, and the classic hallucinogens. Identification of a new therapeutic class: entactogens. Journal of Psychoactive Drugs 18: 305–313, 1986

    PubMed  CAS  Google Scholar 

  • Onayango RS. Cannabis psychosis in young psychiatric inpatients. British Journal of Addiction 81: 419–423, 1986

    Google Scholar 

  • Owens SM, Mayersohn M. Phencyclidine-specific fab fragments alter phencyclidine disposition in dogs. Drug Metabolism and Disposition 14: 52–58, 1986

    PubMed  CAS  Google Scholar 

  • Pasternak GW. Multiple morphine and enkephalin receptors and the relief of pain. Journal of the American Medical Association 259: 1362–1367, 1988

    PubMed  CAS  Google Scholar 

  • Pasternak GW, Childers SR, Snyder SH. Opiate analgesia: evidence for mediation by a subpopulation of opiate receptors. Science 208: 514–516, 1980

    PubMed  CAS  Google Scholar 

  • Peden NR, Macaulay KEC, Bissett AF, Crooks J, Pelosi AJ. Clinical toxicology of magic mushroom ingestion. Postgraduate Medical Journal 57: 543–545, 1981

    PubMed  CAS  Google Scholar 

  • Perez-Reyes M, Di Giuseppi S, Mason AP, Davis KH. Passive inhalation of marijuana smoke and urinary excretion of cannabinoids. Clinical Pharmacology and Therapeutics 34: 36–41, 1983

    PubMed  CAS  Google Scholar 

  • Perez-Reyes M, Di Giuseppi S, Davis KH, Schnidler VH, Cook CE. Comparison of effects on marijuana cigarettes of three different potencies. Pharmacology and Therapeutics 31: 617–624, 1982

    CAS  Google Scholar 

  • Perez-Reyes M, Owens SM, DiGiuseppi S. The clinical pharmacology and dynamics of marijuana cigarette smoking. Journal of Clinical Pharmacology 21: 201–297S, 1981

    CAS  Google Scholar 

  • Petersen RC (Ed.). Marijuana research findings 1980. National Institute on Drug Abuse Research Monograph Series, Department of Health and Human Services Publication No. (ADM) 80-1001, US Government Printing Office, Washington, DC 1980

  • Petwee RG. The central neuropharmacology of psychotropic cannabinoids. Pharmacology and Therapeutics 36(2–3): 189–261, 1988

    Google Scholar 

  • Pfaus JG, Gorzalka BB. Opioids and sexual behavior. Neuroscience and Biobehavioral Reviews 11(1): 1–34, 1987

    PubMed  CAS  Google Scholar 

  • Piacente GJ. Agression. Psychiatric Clinics of North America 9: 329–339, 1986

    PubMed  CAS  Google Scholar 

  • Post RM. Cocaine psychosis: a continuum model. American Journal of Psychiatry 132: 225–231, 1975

    PubMed  CAS  Google Scholar 

  • Pickens R, Thompson T. Cocaine-reinforced behavior in rats: effects of reinforcement magnitude and fixed-ratio size. Journal of Pharmacology and Experimental Therapeutics 161: 122–129, 1968

    PubMed  CAS  Google Scholar 

  • Polchert S, Morse R. Pemoline abuse. Journal of the American Medical Association 254: 946–947, 1985

    PubMed  CAS  Google Scholar 

  • Poster DS, Penta JS, Bruno S, MacDonald JS. 9-tetrahydrocannabinol in clinical oncology. Journal of the American Medical Association 245: 2047–2051, 1981

    PubMed  CAS  Google Scholar 

  • Price WA, Giannini AJ, Krishen A. Management of acute PCP intoxication with verapamil. Correspondence. Clinical Toxicology 24: 85–87, 1986

    CAS  Google Scholar 

  • Price WA, Giannini AJ, Loiselle RH. Verapamil in the treatment of schizophrenia. Journal of Clinical Pharmacology 25: 461, 1985

    Google Scholar 

  • Razdan RK. Structure-activity relationships in cannabinoids. Pharmacology Reviews 38(2): 75–149, 1986

    CAS  Google Scholar 

  • Roth R, Roehrs T, Zorick F, Conway W. Pharmacological effects of sedative-hypnotics, narcotic analgesics, and alcohol during sleep. Medical Clinics of North America 69(6): 1281–1288, 1985

    PubMed  CAS  Google Scholar 

  • Sawe J, Dahlstrom B, Paazlow L, Rane A. Morphine kinetics in cancer patients. Clinical Pharmacology and Therapeutics 30: 629–635, 1981

    PubMed  CAS  Google Scholar 

  • Schulz R, Herz A. Opioid tolerance and dependence in light of the multiplicity of opioids receptors. National Institute Drug Abuse Research Monograph Series 54: 239–259, 1984

    Google Scholar 

  • Schwartz RH, Smith DE. Hallucinogenic mushrooms. Clinical Pediatrics 27: 70–73, 1988

    PubMed  CAS  Google Scholar 

  • Schwartz RH, Comerci GD, Meeks JE. Clinical and laboratory observations LSD: patterns of use by chemically dependent adolescents. Journal of Pediatrics 111: 936–938, 1987

    PubMed  CAS  Google Scholar 

  • Schwartz RH. Mescaline: a survey. American Family Physician 37: 122–124, 1988

    PubMed  CAS  Google Scholar 

  • Sicuteri F. Endorphins, opiate receptors and migraine headache. Headache 17(6): 253–257, 1978

    PubMed  CAS  Google Scholar 

  • Sherer MA. Intravenous cocaine psychiatric effects, biological mechanisms. Biological Psychiatry 24: 865–885, 1988

    PubMed  CAS  Google Scholar 

  • Shulgine AT. Psychotimimetic drugs: structure-activity relationships. In Iversen et al (Eds) Handbook of psychology and pharmacology, Vol. II, Plenum, New York, 1978

    Google Scholar 

  • Siegel RK. Cocaine: recreational use and intoxication. In Petersen et al. (Eds) Cocaine, pp. 128–129, 1977 NIDA Research Monograph 13 US Government Priority Office, Rockville, 1977

    Google Scholar 

  • Siegel RK. Cocaine hallucinations. American Journal of Psychiatry 135: 309–314, 1978

    PubMed  CAS  Google Scholar 

  • Siegel RK. Cocaine smoking. Journal of Psychoactive Drugs 14: 271–343, 1982

    PubMed  CAS  Google Scholar 

  • Siegel RK. MDMA — nonmedical use and intoxication. Journal of Psychoactive Drugs 18: 349–354, 1986

    PubMed  CAS  Google Scholar 

  • Siegel RK. LSD hallucinations from ergot to electric Kool-Aid. Journal of Psychoactive Drugs 17: 247–256, 1985

    PubMed  CAS  Google Scholar 

  • Siegel RK, Jarvik ME. Drug-induced hallucinations in animals and man. In Siegel et al. (Eds) Hallucinations: behavior, experience, and theory, pp. 81–161, John Wiley and Sons, Los Angeles, 1975

    Google Scholar 

  • Simon EJ, Hiller JM. The opiate receptor. Annual Review of Pharmacology and Toxicology 18: 371–394, 1978

    PubMed  CAS  Google Scholar 

  • Sioris L, Krenzelok E. Phencyclidine intoxication: a literature review. American Journal of Hospital Pharmacy 35: 1362–1366, 1978

    PubMed  CAS  Google Scholar 

  • Smilkstein MJ, Smolinske SC, Rumack BH. A case of MAO inhibitor/MDMA interaction: agony after ectasy. Clinical Toxicology 25: 149–159, 1987

    PubMed  CAS  Google Scholar 

  • Smith DE, Wesson DR, Burton ME, Seymour R, Kramer HM. The diagnosis and treatment of the PCP abuse syndrome. In Petersen & Stillman (Eds) Phencyclidine (PCP) abuse: an appraisal, pp. 229–240. National Institute on Drug Abuse, Rockville, 1978

    Google Scholar 

  • Smith DE. A clinical approach to the treatment of PCP abuse. In Domino (Ed.) PCP (phencyclidine): historical and current perspective, pp. 471–485, NPP Books, Ann Arbor 1981

    Google Scholar 

  • Smith RC, Heltzer HY, Arora RC. Effects of phencyclidine on catecholamine and serotonin uptake. Biochemical Pharmacology 26: 1435–1439, 1979

    Google Scholar 

  • Smith RC, Lee Lavathi DE, Hsu L, Ho BT, Tansy W, et al. Acute versus chronic administration of phencyclidine: effects on behavior and brain biochemistry. In Domino (Ed.) PCP (phencyclidine): historical and current perspective, pp. 243–291, NPP Books, Ann Arbor, 1981. Snyder SH. The opiate receptor and morphine-like peptides in the brain. American Journal of Psychiatry 135: 645–652, 1978

    Google Scholar 

  • Snyder SH. Drug and neurotransmitter receptors in the brain. Science 224: 22–31, 1984

    PubMed  CAS  Google Scholar 

  • Snyder SH, Pert, CB, Psternak GW. The opiate receptor. Annals of Internal Medicine 81: 534–540, 1974

    PubMed  CAS  Google Scholar 

  • Solursh LP, Clement WR. Hallucinogenic drug abuse: manifestations and managements. Canadian Medical Association Journal 98: 407–410, 1968a

    PubMed  CAS  Google Scholar 

  • Solursh LP, Clement WR. Use of diazepam in hallucinogenic drug crisis. Journal of the American Medical Association 205: 644–645, 1968b. Stafford P. Psychedelics encyclopedia, And/or press, Berkeley, 1977

    Google Scholar 

  • Strassman RJ. Adverse reactions to psychedelic drugs: a review of the literature. Journal of Nervous and Mental Disease 172: 577–595, 1984

    PubMed  CAS  Google Scholar 

  • Swerolow BN, Holley FO. Intravenous anaesthetic agents. Pharmacokinetic-pharmacodynamic relationships. Clinical Pharmacokinetics 12(2): 79–110, 1987

    Google Scholar 

  • Taber WA, Heacock RA. Location of ergot alkaloid and fungi in the seed of Rivea corymbosa (L) Hall ‘fololiugui’. Canadian Journal of Microbiology 81: 137–143, 1962

    Google Scholar 

  • Taylor D, Ho BT. Neurochemical effects of cocaine following acute and repeated injection. Journal of Respiratory Neuroscience 3: 95–101, 1977

    CAS  Google Scholar 

  • Taylor RL, Maurer JI, Tinkleberg JR. Management of ‘bad trips’ in an evolving drug scene. Journal of the American Medical Association 213: 422–425, 1970

    PubMed  CAS  Google Scholar 

  • Tennes K. Effects of marijuana on pregnancy and fetal development in the human. National Institute of Drug Abuse Research Monograph Series 44: 115–123, 1984

    CAS  Google Scholar 

  • Thomas M, Malmcrona R, Fillmore S, Shillingford J. Haemo-dynamic effects of morphine in patients with acute myocrdial infarction. British Heart Journal 27: 863, 1965

    PubMed  CAS  Google Scholar 

  • Thompson DM, Moerschlbaecher JM. Differential effects of phencyclidine and MDA on complex opérant behavior in monkeys. Pharmacology Biochemistry and Behavior 21: 453–457, 1984

    CAS  Google Scholar 

  • Thurlow HJ, Girven JP. Use of anti-epileptic medication in treatment ‘flashbacks’ from hallucinogenic drugs. Canadian Medical Association Journal 105: 947–948, 1971

    PubMed  CAS  Google Scholar 

  • Titeler M, Lyon RA, Glennon RA. Radioligand binding evidence implicates the brain 5-HT2 receptor as a site of action for LSD and phenylisopropylamine hallucinogens. Psychospharmacology 94: 213–216, 1988

    CAS  Google Scholar 

  • Toinson CR, Goodship T, Roger R. Psychiatric side effects of acyclovir in patients with chronic renal failure. Lancet 2: 385–380, 1985

    Google Scholar 

  • Tunving K. Psychiatric effects of cannabis use. Acta Psychiatricia Scandinavica 72(3): 209–217, 1985

    CAS  Google Scholar 

  • Ungerleider J, Frank I. Management of acute panic reactions and drug flashbacks resulting from LSD ingestion. In Bourne (Ed.) Acute drug emergencies, pp 133–138, Academic Press, New York, 1976

    Google Scholar 

  • Van Der Auwera D, Verborgh C, Camu F. Analgesic and cardiorespiratory effects of epidural sufentanil and morphine in humans. Anesthesia and Analgesia 66: 999–1003, 1987

    PubMed  Google Scholar 

  • Vieweg WV, Hillard JR. Adverse interactions of ‘cannabis’ with psychotropic medicines. Psychiatric Medicine 4(1): 69–77, 1986

    PubMed  CAS  Google Scholar 

  • Viguera MG. Narcotics; the latest chapter in a long story: a review. Journal of Medicine 17(2): 121–134, 1986

    PubMed  CAS  Google Scholar 

  • Vogel S, Leikin JB. What’s up (and down) in drug abuse: street drugs. Topics in Emergency Medicine 8: 57–71, 1986

    Google Scholar 

  • Waller SL, Bailey M. Hallucinations during morphine administration. Correspondence. Lancet 2: 801, 1987

    PubMed  CAS  Google Scholar 

  • Ward A, Holmes B. Nabilone: a preliminary review of its pharmacological properties and therapeutic use. Drugs 30(2): 127–122, 1985

    PubMed  CAS  Google Scholar 

  • Way EL. Sites and mechanisms of basic narcotic receptor function based on current research. Annals of Emergency Medicine 15(9): 1021–1025, 1986

    PubMed  CAS  Google Scholar 

  • Weintraub M, Standish R. Nabilone: an antiemetic for patients undergoing cancer chemotherapy. Hospital Forumlary 18: 1033–1035, 1983

    Google Scholar 

  • Wert RC, Raulin ML. The chronic cerebral effects of cannabis use. II Psychological findings and conclusions. International Journal of Addictions 21(6): 629–642, 1986

    CAS  Google Scholar 

  • Weil JV, McCullough RE, Kline JS, Sodal IE. Diminished ventilatory response to hypoxia and hypercapnia after morphine in normal man. New England Journal of Medicine 292: 1103–1106, 1975

    PubMed  CAS  Google Scholar 

  • West LJ. A clinical and theoretical overview of hallucinatory phenomena. In Siegel et al. (Eds) Hallucinations: behavior, experience, and theory, pp 287–311, John Wiley and Sons, Los Angeles, 1975

    Google Scholar 

  • White MC, Silverman JJ, Harbison JW. Psychosis associated with clonazepam therapy for blepharospasm. Journal of Nervous and Mental Disease 170: 117–119, 1983

    Google Scholar 

  • White FJ. Comparative effects of LSD and lisuride: clues to specific hallucinogenic drug actions. Pharmacology, Biochemistry and Behavior 24: 365–379, 1986

    CAS  Google Scholar 

  • Wiebal W, Horan H. Nature and scope of substance abuse in Chicago II, University of Illinois at Chicago, School of Public Health, 1988

  • Winter JC. Effects of the phenethylamine derivates, BL-3912, fenfluramine and SCH-12679 in rats trained with LSD as a discriminative stimulus. Psychopharmacology 68: 159–169, 1980

    PubMed  CAS  Google Scholar 

  • Wise RA, Bozarth MA. Brain mechanisms of drug reward and euphoria. Psychiatric Medicine 3(4): 445–460, 1985

    PubMed  CAS  Google Scholar 

  • Wish ED. PCP and crime: just another illicit drug? In Clovet (Ed.) Phencyclidine: an update, NIDA. no. 64, 1986

  • Wyatt RJ, Karoum F, Suddath R, Fawcett R. Persistently decreased brain dopamine levels and cocaine. Journal of American Medical Association 259: 2996, 1988b

    CAS  Google Scholar 

  • Wyatt RJ, Karoum F, Suddath R, Hitri A. The role of dopamine in cocaine use and abuse. Psychiatric Annals 18: 531–534, 1988a

    Google Scholar 

  • Yago KB, Pitts FN, Burgoyne RW. The urban epidemic of PCP use: clinical and laboratory evidence from a public hospital emergency service. Journal of Clinical Psychiatry 42: 193–196, 1981

    PubMed  CAS  Google Scholar 

  • Young T, Lawson GW, Gacono CB. Clinical aspects of phencyclidine (PCP). International Journal of Addictions 22: 1–15, 1987

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Rush-Presbyterian-St Luke’s Medical Center, Chicago, USA

    Jerrold B. Leikin

  2. Division of Occupational Medicine, Section of Clinical Toxicology, Toxikon, Cook County Hospital, Karl Meyer Hall, 720 S. Wolcott, Room 13A, Chicago, IL, 60612, USA

    Anne J. Krantz, Michele Zell-Kanter & Daniel O. Hryhorczuk

  3. Department of Pharmacy and Pharmacology, Rush-Presbyterian-St Luke’s Medical Center, Chicago, USA

    Robert L. Barkin

Authors
  1. Jerrold B. Leikin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne J. Krantz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Zell-Kanter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert L. Barkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel O. Hryhorczuk
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leikin, J.B., Krantz, A.J., Zell-Kanter, M. et al. Clinical Features and Management of Intoxication Due to Hallucinogenic Drugs. Med Toxicol Adverse Drug Exp 4, 324–350 (1989). https://doi.org/10.1007/BF03259916

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03259916

Keywords

Search

Navigation