Follow-up
Further Inpatient Care
- Patients with anxiety or panic reactions who present following an uncomplicated hallucinogen ingestion can often be "talked down" and sent home with responsible family members.
- Observe stable patients in the emergency department if any doubt exists as to the diagnosis.
- Any patient who persists with confused or psychotic behavior should be admitted.
- Patients whose ingestion is complicated by seizures, hyperthermia, or rhabdomyolysis should be admitted for monitoring.
- Those who present following massive overdose or those who demonstrate severe hyperthermia or any hemodynamic instability should be admitted to an intensive care unit.
- Those who present with suicidal ideation, homicidal ideation, or command hallucinations should be admitted to a mental health facility if they are medically stable.
Further Outpatient Care
Patients who are discharged should receive follow-up care from their primary care physician, their psychiatrist, or a drug counseling facility.
Transfer
Stable patients with a persistent psychosis that does not wane as the hallucinogenic effect of the drug abates should be transferred to a mental health facility for evaluation and treatment.
Complications
- Long-term effects of LSD use may include prolonged psychotic reactions, severe depression, and flashbacks (ie, HPPD). Flashbacks are the recurrence of LSD-like effects several months to years after cessation of use. They may be triggered by stress or illness and may cause significant distress.
- Patients using LSD are more at risk for injuries and death from behavior-related trauma than from the toxicological effects of LSD.
- Rarely, massive overdoses of LSD may result in hyperthermia, hypertension, coma, respiratory arrest, and bleeding.
- Severe hyperthermia, rhabdomyolysis, myoglobinuric renal failure, and DIC may occur after PCP or MDMA use.
- MDMA use may cause permanent degradation of serotonergic neurons.
Patient Education
- Patient education
- Encourage changes in the patient's life-style. Emphasize the importance of avoiding people, places, and things related to hallucinogen use.
- Treatment emphasis should focus on the disease concept of addiction, the recognition of the negative consequences of hallucinogen abuse, and the construction of support systems.
- Patients should be encouraged to confront their denial and avoid any situational cues that may stimulate drug use.
- Offer referral to available psychiatric and community resources for follow-up.
- Users may benefit from referral to Narcotics Anonymous.
- Family education: Educate family members regarding the signs and symptoms of drug dependence. Enlist their help as a support system for the patient.
- Websites of value to the patient and family include the following:
- NIDA InfoFacts: Hallucinogens - LSD, Peyote, Psilocybin, and PCP
- NIDA InfoFacts: Marijuana
- NIDA InfoFacts: MDMA (Ecstasy)
- CenterSite.net, Alcohol and Substance Abuse - Hallucinogens
- Partnership for a Drug-Free America
- NIDA, Hallucinogens and Dissociative Drugs
- NIDA for Teens, Mind Over Matter: Hallucinogens
- U.S. Department of Health and Human Services and SAMHSA's National Clearinghouse for Alcohol & Drug Information, Tips for Teens: The Truth About Hallucinogens
- eMedicine's Substance Abuse Center
- eMedicine's patient education articles Club Drugs, Drug Dependence and Abuse, and Substance Abuse
Miscellaneous
Medicolegal Pitfalls
- Failure to appropriately use physical and chemical restraints to control violent and agitated patients places both the patient and staff at risk for physical injury.
- Another pitfall is the delay in diagnosis and treatment of hyperthermia. Many deaths in patients with hallucinogen ingestions occur as a result of severe hyperthermia, rhabdomyolysis, DIC, and cardiovascular collapse. Once hyperthermia has been diagnosed (preferably via a core temperature measurement), aggressively lower body temperature with fans and mist, ice packs, and even paralyzation and intubation if necessary.
- Do not assume that a patient who is quiet but who was violently agitated 5 minutes ago is just resting. Serial examinations and obtaining serial vital signs (especially temperature) are critical to diagnosing an ill patient before the patient becomes very ill.
More on Hallucinogens |
| Overview: Hallucinogens |
| Differential Diagnoses & Workup: Hallucinogens |
| Treatment & Medication: Hallucinogens |
 Follow-up: Hallucinogens |
| Multimedia: Hallucinogens |
| References |
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References
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Prisinzano TE. Psychopharmacology of the hallucinogenic sage Salvia divinorum. Life Sci. Dec 22 2005;78(5):527-31. [Medline].
SAMSHA. Ecstasy, Other Club Drugs, & Other Hallucinogens. Available at http://www.oas.samhsa.gov/ecstasy.htm.
Tucker JR, Ferm RP. Lysergic acid diethylamide and other hallucinogens. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Hoffman RS, eds. Goldfrank's Toxicological Emergencies. 6th ed. Stamford, Conn: Appleton & Lange; 1998:1111-9.
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Further Reading
Keywords
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