Psychedelics as medicines for substance abuse rehabilitation: evaluating treatments with LSD, Peyote, Ibogaine and Ayahuasca.

Substances known as psychedelics, hallucinogens and entheogens have been employed in ethnomedical traditions for thousands of years, but after promising uses in the 1950's and 1960's they were largely prohibited in medical treatment and human research starting in the 1970's as part of the fallout from the war on drugs. Nonetheless, there are a number of studies which suggest that these substances have potential applications in the treatment of addictions. While these substances are generally classified as Schedule I, alleging no established medical uses and a high drug abuse potential, there is nonetheless evidence indicating they might be safe and effective tools for short term interventions in addictions treatment. Evidence suggests that the psychedelics have a much greater safety profile than the major addictive drugs, having extremely low levels of mortality, and producing little if any physical dependence. This paper reviews studies evaluating the use of LSD, peyote, ibogaine and ayahuasca in the treatment of dependencies and the possible mechanisms underlying the indications of effectiveness. Evidence suggests that these substances help assist recovery from drug dependency through a variety of therapeutic mechanisms, including a notable "after-glow" effect that in part reflects their action on the serotonin neurotransmitter system. Serotonin has been long recognized as central to the psychedelics' well-known phenomenological, physical, emotional and cognitive dynamics. These serotonin-based dynamics are directly relevant to treatment of addiction because of depressed serotonin levels found in addict populations, as well as the role of serotonin as a neuromodulators affecting many other neurotransmitter systems.

GC-MS and GC-MS/MS in PCI mode determination of mescaline in peyote tea and in biological matrices.

Peyote, a cactus containing the hallucinogen mescaline, is used to induce altered states of consciousness in religious ceremonies or for recreational purpose. This study reports a case of an underage boy suspected of mescaline abuse. For this purpose, we analyzed a dark green liquid sample found in the bedroom of the boy whose urine and hair samples were collected shortly after the drink was found. A method by gas chromatography-mass spectrometry tandem mass spectrometry (GC-MS/MS) in positive chemical ionization mode was developed and validated in terms of linearity, specificity, accuracy, and sensitivity for mescaline determination at the low concentrations present in hair. GC-MS analysis of the liquid identified mescaline, while urine was negative; GC-MS/MS segmental hair analysis identified mescaline in the proximal segment (root to 2 cm), while the distal segments were negative. Although peyote was uncommonly encountered, its use was confirmed by segmental hair analysis that can provide long-term information about drugs use.

Drugs of abuse: the highs and lows of altered mental states in the emergency department.

The diagnosis and management of poisoned patients presenting with alterations in mental status can be challenging, as patients are often unable (or unwilling) to provide an adequate history. Several toxidromes exist. Recognition hinges upon vital signs and the physical examination. Understanding these "toxic syndromes" may guide early therapy and management, providing insight into the patient's underlying medical problem. Despite toxidrome recognition guiding antidotal therapy, the fundamental aspect of managing these patients involves meticulous supportive care. The authors begin with a discussion of various toxidromes and then delve into the drugs responsible for each syndrome. They conclude with a discussion on drug-facilitated sexual assault ("date rape"), which is both an underrecognized problem in the emergency department (ED) and representative of the drug-related problems faced in a modern ED.

Toxicología de las drogas de síntesis / Synthetic illicit drugs toxicology

Las drogas de síntesis o 'drogas de diseño' son sustancias psicoactivas de uso recreacional que se fabrican en laboratorios clandestinos. La producción, variedad y número de consumidores de estas drogas aumentan cada año en toda Europa, y con ellos los problemas sanitarios derivados de su uso. Estos problemas comprenden tanto sus efectos secundarios o la intoxicación aguda como sus aún no del todo conocidas repercusiones orgánicas a largo plazo, así como la toxicidad de las sustancias de corte, la de los productos residuales originados en la fabricación de la propia droga y su uso combinado con el de otras drogas. Dentro de la denominación de drogas de síntesis se diferencian principalmente cuatro grupos de sustancias muy diferentes: los derivados anfetamínicos, los opioides sintéticos, las arilhexilaminas y los derivados de la metacualona. Esta revisión aporta una descripción sistemática de dichos compuestos y de su efectos físicos y psíquicos. (AU)

Hallucinogens and redemption.

This article examines drug substitution with regard to hallucinogens (ayahuasca, ibogaine, peyote and LSD) set within the concept of redemption. The model examines both religious and secular approaches to the contemporary use of hallucinogens in drug substitution, both by scientists and in religious settings worldwide. The redemptive model posits that the proper use of one psychoactive substance within a spiritual or clinical context helps to free an individual from the adverse effects of their addiction to another substance and thus restores them as functioning members of their community or group. Data is drawn from the U.S., Brazil, Peru, and West Africa. Two principle mechanisms for this are proposed: the psychological mechanism of suggestibility is examined in terms of the individual reaching abstinence goals from addictive substances such as alcohol and opiates. Neurophysiological and neurochemical mechanisms to understand the efficacy of such substitution are highlighted from ongoing research on hallucinogens. Research by two of the authors with the Uñaio do Vegetal (UDV) Church in Brazil is examined in terms of the model.

Peyote use during pregnancy.

Peyote is a substance with varied potential. Used properly it may be a spiritual aid but used in excess, it can be a hallucinogenic agent with teratogenic potential. There is a growing community of devout people who use it as part of their religious observance. The active ingredient, mescaline, has been linked to a specific group of fetal abnormalities when the substance is used inappropriately.

Blood flow and cerebral laterality in the mescaline model of psychosis.

The psychological, neuropsychological, and neurometabolic effects of the hallucinogenic agent mescaline were investigated in 12 normal male volunteers. Between 3 1/2 and 4 hours after drug intake, mescaline produced an acute psychotomimetic state, as measured by the BPRS and PDS-P. The APZ questionnaire revealed the specific effects of mescaline in the visual system. Neuropsychological effects were studied with a face/non-face decision task with known right hemisphere advantage, in which mescaline induced a decrease in functioning of the right hemisphere. In functional brain imaging using SPECT, mescaline produced a "hyperfrontal" pattern with an emphasis on the right hemisphere, which was correlated with mescaline-induced psychotomimetic psychopathology. Our findings question the validity of the concept of hypofrontality as an explanation for acute psychotic symptomatology.

Second thoughts on psychedelic drugs.

Psychedelic drugs are making a comeback. Proponents of psychedelics point to the widespread medical experimentation with mescaline and lysergic acid diethylamide-125 (LSD) in the 1950s as proof of their safety and efficacy. However, a review of the private and published writings of Sidney Cohen, MD, who conducted the first study of the safety of psychedelics, reveals that serious medical concerns about psychedelics arose before the public backlash against the drugs in the 1960s. The story of psychedelic research is a reminder of the inevitable complications involved in testing drugs on human subjects.

Visual hallucinations during hallucinogenic experience and schizophrenia.

The visual hallucinations experienced by a 26-year-old woman under the influence of hallucinogens and during schizophrenia are described. Three types of hallucinations are delineated: (1) superimposed hallucinations, (2) spatial and depth distortions, and (3) animations. These three types of hallucinations appear to represent consecutive gradations on a continuum of the ego function of reality testing, with superimposed hallucinations revealing the least and animations the greatest degree of disorientation. The findings of the present study indicate the need for a research design that compares the hallucinations of schizophrenics to the toxic hallucinations of nonschizophrenics.

Psychoses precipitated by psychotomimetic drugs. A follow-up study.

Fifteen patients who developed prolonged psychotic reactions following psychotomimetic drug use (probably primarily LSD) were followed up 1.9 to 5.8 years later. Two patients had committed suicide. Approximately half of the patients had a relatively good outcome and half did poorly. Aspects of the initial clinical picture that correlated with outcome measures are discussed. The possibility is considered that vulnerability to a prolonged psychotic reaction following psychotomimetic drug use may be related to a genetic vulnerability to illnesses in the manic-depressive/schizo-affective spectrum. In some instances this vulnerability may implicate central serotonergic neuronal systems.

Ego functioning and acute adverse reactions to psychoactive drugs.

The relationship between ego functioning and acute adverse reactions to psychoactive drugs was examined using retrospective data. The data were consistent with a causal model in which characteristic use of regression (and to a lesser extent repression) was associated with acute adverse reactions to marijuana and to LSD. Regression also had an indirect effect through increased usage of LSD. Subjects characterized by the use of intellectualization and denial were less likely to report developing acute adverse reactions. A higher score on a general measure of coping was related to avoiding acute adverse reactions to LSD, but not to marijuana. Projection, regression in the service of the ego, and tolerance of ambiguity has no effect on acute adverse reactions.