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Hallucinogens: Psychodelics, Dissociatives and Deliriants – Drugs of Abuse

by Pravin Shukle, MD
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    00:01 The next category of drugs are hallucinogens. They include the psychedelics, the dissociatives drug and the deliriants.

    00:10 Now, psychedelics are classical hallucinogens.

    00:13 So, when we talk about classical hallucinogens, what we're talking about are psychodelic drugs.

    00:18 These cause a change in thought, in mood, in perception, and they often cause intellectual and memory impairment as well.

    00:28 However, the amount of intellectual and memory impairment is actually quite minimal compared to other drugs.

    00:34 You often will have a stupor or a narcosis, but once again, this is not a predominant effect of the hallucinogens, particularly the psychodelics. What you really see is altered perception.

    00:48 Now they act through the 5-HT2 serotonin receptor. LSD or mescaline or some of the most commonly known ones, but we also have drugs like PCP, often called "angel dust".

    01:02 We have serotonin releasing agents. So, they are the substituted MD drugs.

    01:10 So, it can be MDMA or ecstasy or MDA. There's a whole class of them that we can cover, and I did cover in previous lectures.

    01:18 And then of course, there are the cannabinoids. The most common of course is marijuanna, but then we also have the new synthetic cannabinoids that have recently entered onto the market.

    01:27 The dissociative drugs act predominantly through the NMDA receptor. They produce an analgesia, amnesia and derealization.

    01:38 They cause dissociative perception. And they cause clinically horizontal and vertical nystagmus and marked hypertension and seizures. So, when you have a patient show up and they are delirious and you can't really communicate with them on one on one basis, and they are imagining things.

    01:55 Look at their eyes, and if they're having horizontal and vertical nystagmus, they are not on a classic hallucinogen or psychodelic drug, they are on one of the dissociatives.

    02:07 Ketamine, or "special K" on the street, is probably the most commonly used and most well known dissociative drug.

    02:14 We use it in anesthesia all the time. Other drugs include dextromethorphan which is often put in cough syrup and cough tablets. Nitrous oxide is often used in dental anesthesia.

    02:26 And PCP or "angel dust" also act at the serotonin receptor, and this cause dissociative symptoms as well.

    02:35 The next category of drugs are deliriants. So, these induce a delirium with extreme confusion and they are absolutely unable to control their actions. They are anticholinergic agents, so they cause a lot of toxic effects with respect to the anticholinergic axis.

    02:53 Dehydration, mydriasis or dilated pupils are very very common. So, look at the pupils, once again, if they have a lot of nystagmus, they're on one of the dissociative drugs, if they have very dilated pupils, that's an anticholinergic effect, and you should be thinking about drugs like ketamine.

    03:10 Now, the interesting thing about these drugs is they actually don't necessarily cause sedation.

    03:16 And in fact, they were first used by warriors in Sparta before they went into battle so that they would have no fear.

    03:24 And here's some of the plant based origins. Belladonna comes from a plant called nightshade, and I've got it illustrated up in the top here. And Jimson weed is another example, and these are things that are sometimes picked by patients or abusers, and they ingest the drug directly from the plant source.

    03:47 Angel's trumpet is a plant that can cause a lot of delirium. Mandrake, made famous by the Harry Potter movies, is also another drug that is derived from a plant. Uncured tobacco can act as a deliriant.

    04:05 And benadryl and dramamine, which are common antinauseant medications, are sometimes used as deliriants as well.

    04:15 Let's talk specially about PCPs. So, I talked to you about "angel dust" before, and I mentioned it briefly in the other lectures, it is classified as the most dangerous drug by the FDA. It causes psychotic reactions.

    04:29 And often people who've committed murder were on PCP or under the influence of PCP.

    04:34 I had mentioned to you before that it causes vertical and horizontal nystagmus, high temperatures, tachycardia, hypertension, dry skin and seizures.

    04:45 The problem with PCP in diagnosing a PCP overdose is that your blood chemistry is essentially normal.

    04:51 So this is a very hard clinical situation to figure out because people come in, they are absolutely off the wall, and they have a normal blood chemistry.

    05:04 I also want to talk about something called "soap". It is MDPV but we will know what is "soap" on the street.

    05:11 And this is something that really showed up a few years ago in Florida, and has just taken the country by storm.

    05:17 It is either smoked or injected or snorted or ingested. It causes a non-rewarding dose of alcohol to become very rewarding. So, a small drink, maybe one shot, all of a sudden gives them the effect of drinking eight or nine shots or nine ounces of alcohol.

    05:36 It cannot be detected by dogs, and cannot be detected in standard urinalysis. You have to have special urinalysis.

    05:43 So, it's a horrible drug. It's just starting to take off. I don't know what will happen over the next 5 or 10 years, but hopefully this drug never becomes as mainstream as the others.

    05:56 One of the mainstream drugs that's out there today are cannabinoids or marijuanna.

    06:00 The active agent is THC, but we also have cannabidiol and other agents that are active that do cause the effect.

    06:09 Now, some of the derivations of cannabinoids is "hash". So, hashish or hash, is a purified paste that's made from marijuanna. And hash oil is a purification of the hash paste.

    06:22 Initially, it causes presynaptic release of dopamine and serotonin.

    06:27 So, it generally gives a feeling of wellbeing, and you know, not to care in the world.

    06:31 After a while, it causes tachycardia. A low dose can cause depression in young adults.

    06:38 One of the problems with cannabinoids use in young people is that it's little as a half joint, once a week, leads to three times increase in depression in people under the age of 25.

    06:51 So, although people tend to think of it as a nontoxic agent, or a nontoxic drug, it actually is quite toxic, and it does have long term effects, particularly on young people.

    07:04 Now, some of the drugs that we've derived from the cannabinoid receptor based plants, are now being used in cancer patients.

    07:12 So, you can actually purchase pills like these two that I've mentioned here, one to treat obesity, and one to treat nausea in cancer patients.

    07:21 The nice thing about these drugs and the nice thing about the medical marijuanna strategy is that it can cause a reduction in nausea in patients who are receiving cancer therapy without causing them to become anorexic. So, they actually maintain their diet and they maintain their hunger.

    07:41 And in terms of treating obesity, it seems counterintuitive that these people would benefit, but it actually has some clinical benefit. Now, they do not get high from these particular drugs because they're not given in concentration high enough to cause that effect.


    About the Lecture

    The lecture Hallucinogens: Psychodelics, Dissociatives and Deliriants – Drugs of Abuse by Pravin Shukle, MD is from the course Toxicology. It contains the following chapters:

    • Psychedelics
    • Dissociatives
    • Deliriants
    • Special Discussion: PCP
    • Special Discussion: Cannabinoids

    Included Quiz Questions

    1. Serotonin
    2. Norepinephrine
    3. Dopamine
    4. Adenosine
    5. GABA
    1. Nystagmus
    2. hypothermia
    3. Dysarthria
    4. Hypernatremia
    5. Metabolic acidosis with respiratory alkalosis
    1. Anti-nausea medication
    2. Proton-pump inhibitor medication
    3. Chemotherapy
    4. Psychedelic
    5. Dissociative
    1. Increases risk of depression
    2. Increases aggression
    3. Decreases appetite
    4. Helps students study
    5. Increase risk of hypertension later in life

    Author of lecture Hallucinogens: Psychodelics, Dissociatives and Deliriants – Drugs of Abuse

     Pravin Shukle, MD

    Pravin Shukle, MD


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