Sections

Medication

Medication Summary

The goals of pharmacotherapy are to neutralize the effects of the toxic agent, to reduce morbidity, and to prevent complications.

Class Summary

Lorazepam and diazepam, in particular, are the DOCs for hallucinogen ingestion. Anxiolytic and sedating properties calm agitated patients and help blunt coexisting hypertension and tachycardia.

Lorazepam (Ativan)

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Sedative hypnotic with short onset of effects and relatively long half-life. Increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. When patients need to be sedated for longer than a 24-h period, this medication is excellent.

Diazepam (Valium)

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Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

Class Summary

For severe agitation and/or psychosis. May decrease seizure threshold.

Haloperidol (Haldol)

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Butyrophenone noted for high potency and low potential for causing orthostasis. Downside is high potential for EPS/dystonia.

Class Summary

Basic approach to treat patients with altered mental status includes administration of dextrose (or demonstration of normal blood glucose level), thiamine, and naloxone.

Dextrose (D-glucose)

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Monosaccharide absorbed from the intestine and then distributed, stored, and used by the tissues.

Thiamine (Thiamilate)

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To correct thiamine deficiency.

Naloxone (Narcan)

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Prevents or reverses opioid effects (hypotension, respiratory depression, sedation), possibly by displacing opiates from their receptors.

Follow-up

Hermle L, Simon M, Ruchsow M, Geppert M. Hallucinogen-persisting perception disorder. Ther Adv Psychopharmacol. 2012 Oct. 2(5):199-205. [QxMD MEDLINE Link]. [Full Text].
Martinotti G, Santacroce R, Pettorruso M, Montemitro C, Spano MC, Lorusso M, et al. Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives. Brain Sci. 2018 Mar 16. 8 (3):[QxMD MEDLINE Link].
Erritzoe D, Frokjaer VG, Holst KK, et al. In Vivo Imaging of Cerebral Serotonin Transporter and Serotonin2A Receptor Binding in 3,4-Methylenedioxymethamphetamine (MDMA or "Ecstasy") and Hallucinogen Users. Arch Gen Psychiatry. 2011 Jun. 68(6):562-76. [QxMD MEDLINE Link].
de la Torre R, Farre M. Neurotoxicity of MDMA (ecstasy): the limitations of scaling from animals to humans. Trends Pharmacol Sci. 2004 Oct. 25(10):505-8. [QxMD MEDLINE Link].
Roberts CA, Quednow BB, Montgomery C, Parrott AC. MDMA and brain activity during neurocognitive performance: An overview of neuroimaging studies with abstinent 'Ecstasy' users. Neurosci Biobehav Rev. 2018 Jan. 84:470-482. [QxMD MEDLINE Link].
Wilcox JA, Wilcox AH. Movement disorders and MDMA abuse. J Psychoactive Drugs. 2009 Jun. 41(2):203-4. [QxMD MEDLINE Link].
Kosentka P, Sprague SL, Ryberg M, Gartz J, May AL, Campagna SR, et al. Evolution of the toxins muscarine and psilocybin in a family of mushroom-forming fungi. PLoS One. 2013. 8(5):e64646. [QxMD MEDLINE Link]. [Full Text].
SAMHSA. 2003 National Survey on Drug Use and Health. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Available at http://www.oas.samhsa.gov/nhsda/2k3nsduh/2k3Results.htm. Accessed: October 30, 2009.
Lin DL, Liu HC, Liu RH. Methylenedioxymethamphetamine-related deaths in Taiwan: 2001-2008. J Anal Toxicol. 2009 Sep. 33(7):366-71. [QxMD MEDLINE Link].
Krebs TS, Johansen PØ. Psychedelics and mental health: a population study. PLoS One. 2013 Aug 19. 8(8):e63972. [QxMD MEDLINE Link]. [Full Text].
Wong SS, Zhou B, Goebert D, Hishinuma ES. The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009. Soc Psychiatry Psychiatr Epidemiol. 2013 Oct. 48(10):1611-20. [QxMD MEDLINE Link].
US Department of Health and Human Services. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Substance Abuse and Mental Health Services Administration. Available at http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf. 2014;
Erowid. The Vaults of Erowid: Documenting the Complex Relationship Between Humans and Psychoactives [Web site]. [Full Text].
Greene SL, Kerr F, Braitberg G. Review article: amphetamines and related drugs of abuse. Emerg Med Australas. 2008 Oct. 20(5):391-402. [QxMD MEDLINE Link].
Halpern JH, Sewell RA. Hallucinogenic botanicals of America: a growing need for focused drug education and research. Life Sci. 2005 Dec 22. 78(5):519-26. [QxMD MEDLINE Link].
Ompad DC, Galea S, Fuller CM, et al. Club drug use among minority substance users in New York City. J Psychoactive Drugs. 2004 Sep. 36(3):397-9. [QxMD MEDLINE Link].
Passie T, Halpern JH, Stichtenoth DO, Emrich HM, Hintzen A. The pharmacology of lysergic acid diethylamide: a review. CNS Neurosci Ther. 2008. 14(4):295-314. [QxMD MEDLINE Link].
Prisinzano TE. Psychopharmacology of the hallucinogenic sage Salvia divinorum. Life Sci. 2005 Dec 22. 78(5):527-31. [QxMD MEDLINE Link].
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. 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.
Williams LC, Keyes C. Psychoactive drugs. Ford MD, Delaney KA, Ling LJ, Erickson T, eds. Clinical Toxicology. Philadelphia, Pa: WB Saunders; 2001. 640-9.

Media Gallery

Hallucinogens. Claviceps purpurea.
Hallucinogens. Morning glory (Ipomoea violacea).
Hallucinogens. Bufo marinus.
Hallucinogens. Psilocybe coprophilia.
Hallucinogens. Amanita muscaria.

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Author

Jeffrey S Forrest, MD, FAPA Staff Psychiatrist, Adult and Older Adult Mental Health Recovery Services, Orange County Health Care Agency

Jeffrey S Forrest, MD, FAPA is a member of the following medical societies: American Association of Community Psychiatrists, American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Alexander B Shortridge, BA East Tennessee State University

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Glen L Xiong, MD Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California, Davis, School of Medicine; Medical Director, Sacramento County Mental Health Treatment Center

Glen L Xiong, MD is a member of the following medical societies: AMDA - The Society for Post-Acute and Long-Term Care Medicine, American College of Physicians, American Psychiatric Association, Central California Psychiatric Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: SafelyYou, Blue Cross Blue Shield<br/>book co-editor for: Wolter Kluwer, American Psychiatric Publishing Inc.

Additional Contributors

Scott Cameron, MD Consulting Staff, Department of Emergency Medicine, Regions Hospital

Scott Cameron, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Michael E Richards, MD, MPA Associate Professor and Chair, Department of Emergency Medicine, University of New Mexico School of Medicine

Michael E Richards, MD, MPA is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Brooke S Parish, MD Associate Professor, Department of Psychiatry, University of New Mexico School of Medicine

Brooke S Parish, MD is a member of the following medical societies: American College of Physicians, American Psychiatric Association

Disclosure: Nothing to disclose.

Acknowledgements

Ronald C Albucher, MD Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center

Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Hallucinogen Use Medication

Medication Summary

Benzodiazepines

Class Summary

Lorazepam (Ativan)

Lorazepam (Ativan)

Diazepam (Valium)

Diazepam (Valium)

Neuroleptics

Class Summary

Haloperidol (Haldol)

Haloperidol (Haldol)

Antidotes

Class Summary

Dextrose (D-glucose)

Dextrose (D-glucose)

Thiamine (Thiamilate)

Thiamine (Thiamilate)

Naloxone (Narcan)

Naloxone (Narcan)

Hallucinogen Use Medication

Medication Summary

Benzodiazepines

Class Summary

Lorazepam (Ativan)

Lorazepam (Ativan)

Diazepam (Valium)

Diazepam (Valium)

Neuroleptics

Class Summary

Haloperidol (Haldol)

Haloperidol (Haldol)

Antidotes

Class Summary

Dextrose (D-glucose)

Dextrose (D-glucose)

Thiamine (Thiamilate)

Thiamine (Thiamilate)

Naloxone (Narcan)

Naloxone (Narcan)

References

Tables

Contributor Information and Disclosures

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