Research Report Series (2015): Hallucinogens and Dissociative Drugs: Including LSD, Psilocybin, Peyote, DMT, Ayahuasca, PCP, Ketamine, Dextromethorphan, and Salvia

2015·1.9 MB·English

by  Volkow, Nora D. (NIDA Director)

Long-Term Effects of
Hallucinogens
See page 5.
Research Report Series
from the director:
Hallucinogens and dissociative drugs —
which have street names like acid,
angel dust, and vitamin K — distort the
way a user perceives time, motion,
colors, sounds, and self. These drugs
can disrupt a person’s ability to think
and communicate rationally, or even to
recognize reality, sometimes resulting
in bizarre or dangerous behavior.
Hallucinogens such as LSD, psilocybin, HALLUCINOGENS AND
peyote, DMT, and ayahuasca cause
emotions to swing wildly and real-world
DISSOCIATIVE DRUGS
sensations to appear unreal, sometimes
frightening. Dissociative drugs like PCP,
ketamine, dextromethorphan, and Salvia
Including LSD, Psilocybin, Peyote, DMT, Ayahuasca,
divinorum may make a user feel out of
PCP, Ketamine, Dextromethorphan, and Salvia
control and disconnected from their body
and environment.
What Are
In addition to their short-term effects
on perception and mood, hallucinogenic Hallucinogens and
drugs are associated with psychotic-
Dissociative Drugs?
like episodes that can occur long after
a person has taken the drug, and
dissociative drugs can cause respiratory Hallucinogens are a class of drugs that cause hallucinations—profound distortions
depression, heart rate abnormalities, and in a person’s perceptions of reality. Hallucinogens can be found in some plants and
a withdrawal syndrome. The good news is mushrooms (or their extracts) or can be man-made, and they are commonly divided
that use of hallucinogenic and dissociative into two broad categories: classic hallucinogens (such as LSD) and dissociative drugs (such
drugs among U.S. high school students, as PCP). When under the influence of either type of drug, people often report rapid, intense
in general, has remained relatively low in emotional swings and seeing images, hearing sounds, and feeling sensations that seem real
recent years. However, the introduction
but are not.
of new hallucinogenic and dissociative
While the exact mechanisms by which hallucinogens and dissociative drugs cause
drugs is of particular concern.
their effects are not yet clearly understood, research suggests that they work at least partially
by temporarily disrupting communication between neurotransmitter systems throughout
NIDA research is developing a clearer
the brain and spinal cord that regulate mood, sensory perception, sleep, hunger, body
picture of the dangers of hallucinogenic
and dissociative drugs. We have compiled temperature, sexual behavior, and muscle control.
the scientific information in this report to
inform readers and hopefully prevent the
use of these drugs.
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse Psilocybin mushrooms, LSD, and Salvia divinorum are commonly used
hallucinogenic and dissociative compounds.
U.S. Department of Health and Human Services | National Institutes of Health
Common
Hallucinogens and
Research Report Series
Dissociative Drugs
Classic Hallucinogens*
LSD (d-lysergic acid Peyote (Mescaline)— prevents the normal breakdown of
diethylamide)—also also known as buttons, DMT in the digestive tract. Ayahuasca
known as acid, blotter, cactus, and mesc— tea has traditionally been used for healing
doses, hits, microdots, is a small, spineless and religious purposes in indigenous
sugar cubes, trips, tabs, or window cactus with mescaline as its main South American cultures, mainly in the
panes—is one of the most potent mood- ingredient. It has been used by Amazon region.
and perception-altering hallucinogenic natives in northern Mexico and the
drugs. It is a clear or white, odorless, southwestern United States as a part
Dissociative Drugs
water-soluble material synthesized from of religious ceremonies. The top, or
lysergic acid, a compound derived from “crown,” of the peyote cactus has PCP (Phencyclidine)—also
a rye fungus. LSD is initially produced disc-shaped buttons that are cut out, known as ozone, rocket fuel,
in crystalline form, which can then dried, and usually chewed or soaked love boat, hog, embalming
be used to produce tablets known as in water to produce an intoxicating fluid, or superweed—was
“microdots” or thin squares of gelatin liquid. Because the extract is so bitter, originally developed in the 1950s as a
called “window panes.” It can also be some users prepare a tea by boiling general anesthetic for surgery. While it can
diluted with water or alcohol and sold the plant for several hours. Mescaline be found in a variety of forms, including
in liquid form. The most common form, can also be produced through tablets or capsules, it is usually sold as
however, is LSD-soaked paper punched chemical synthesis. a liquid or powder. PCP can be snorted,
into small individual squares, known smoked, injected, or swallowed. It is
DMT (Dimeth-
as “blotters.” sometimes smoked after being sprinkled
yltryptamine)—also
on marijuana, tobacco, or parsley.
Psilocybin known as Dimitri—is a
(4-phosphoryloxy- powerful hallucinogenic
Ketamine—also known
N, N-dimethyl- chemical found naturally occurring in
as K, Special K, or cat
tryptamine)—also some Amazonian plant species (see
Valium—is a dissociative
known as magic mushrooms, shrooms, “Ayahuasca”) and also synthesized in
currently used as an
boomers, or little smoke—is extracted the laboratory. Synthetic DMT usually
anesthetic for humans as well as animals.
from certain types of mushrooms found takes the form of a white crystalline
Much of the ketamine sold on the street
in tropical and subtropical regions of powder and is typically vaporized or
has been diverted from veterinary
South America, Mexico, and the United smoked in a pipe.
offices. Although it is manufactured
States. In the past, psilocybin was
Ayahuasca—also as an injectable liquid, ketamine is
ingested during religious ceremonies by
known as hoasca, generally evaporated to form a powder
indigenous cultures from Mexico and
aya, and yagé—is a that is snorted or compressed into pills for
Central America. Psilocybin can either
hallucinogenic brew illicit use. Because ketamine is odorless
be dried or fresh and eaten raw, mixed
made from one of several Amazonian and tasteless and has amnesia-inducing
with food, or brewed into a tea, and
plants containing DMT (the primary properties, it is sometimes added to drinks
produces similar effects to LSD.
psychoactive ingredient) along with a to facilitate sexual assault.
vine containing a natural alkaloid that
*In this report, the term “hallucinogen” will refer to the classic hallucinogenic drugs LSD and Psilocybin.
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Past-Year Use of Hallucinogenic and Dissociative
DXM (Dextromethorphan)—
also known as robo—is Drugs Among 12th-Grade Students
a cough suppressant and 8.0
expectorant ingredient in Salvia
some over-the-counter (OTC) cold and %) 6.0 LSD
cough medications that are often abused h ( PCP
nt
by adolescents and young adults. The o
M
most common sources of abused DXM st
a 4.0
P
are “extra-strength” cough syrup, which e
h
typically contains around 15 milligrams n t
e i
of DXM per teaspoon, and pills and s 2.0
U
gel capsules, which typically contain
15 milligrams of DXM per pill. OTC
0.0
medications that contain DXM often also
2007 2008 2009 2010 2011 2012 2013 2014
contain antihistamines and decongestants.
Source: Monitoring the Future National Survey Results on Drug Use, 2014 Overview
Salvia divinorum—also
known as diviner’s sage, While regular use of hallucinogenic
Why Do
Maria Pastora, Sally-D, and dissociative drugs in general has
People Take
or magic mint—is a remained relatively low in recent years,
psychoactive plant common to southern one study reported that the United States Hallucinogenic
Mexico and Central and South America. ranks first among 36 nations in the or Dissociative
Salvia is typically ingested by chewing proportion of high school students ever
Drugs?
fresh leaves or by drinking their extracted using LSD or other hallucinogens in
juices. The dried leaves of salvia can also their lifetime (6 percent versus 2 percent Hallucinogenic and dissociative drugs
be smoked or vaporized and inhaled. in Europe) (Hibell, 2012). have been used for a variety of reasons
Additionally, tourism to the Amazon (Bogenschutz, 2012; Bonson, 2001).
for the purpose of using ayahuasca has Historically, hallucinogenic plants have
How Widespread
become increasingly popular among been used for religious rituals to induce
Is the Abuse of Americans and Europeans in recent states of detachment from reality and
Hallucinogens and years, and ayahuasca use has also been precipitate “visions” thought to provide
reported in major cities in Brazil and mystical insight or enable contact
Dissociative Drugs?
abroad (Barbosa, 2012; McKenna, with a spirit world or “higher power.”
According to the 2013 National Survey on 2004). Although DMT is a schedule More recently, people report using
Drug Use and Health, 229,000 Americans I drug, plants containing DMT are hallucinogenic drugs for more social or
ages 12 and older reported current (past- not scheduled, and there is ambiguity recreational purposes, including to have
month) use of LSD and 33,000 reported over ayahuasca’s legal status in the fun, help them deal with stress, or enable
current use of PCP (Substance Abuse and United States (McKenna, 2004). Two them to enter into what they perceive
Mental Health Services Administration, U.S. Brazilian churches have obtained as a more enlightened sense of thinking
2013). Among high school seniors, salvia permission to import and use these or being. Hallucinogens have also been
was significantly more popular than plants in their ceremonies. investigated as therapeutic agents to
treat diseases associated with perceptual
LSD or PCP when it was added to the
distortions, such as schizophrenia,
Monitoring the Future survey in 2009.
obsessive-compulsive disorder, bipolar
Past-year use was reported to be 5.9
disorder, and dementia. Anecdotal reports
percent for salvia, 2.7 percent for LSD,
and small studies have suggested that
and 1.3 percent for PCP. Fortunately, rates
ayahuasca may be a potential treatment
have dropped significantly for saliva—to
for substance use disorders and other
1.8 percent in 2014—with LSD and PCP
mental health issues, but no large-
use dropping slightly (Johnston, 2014).
scale research has verified its efficacy
(Barbosa, 2012).
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are often unpredictable and may vary
How Do
with the amount ingested and the
Hallucinogens
user’s personality, mood, expectations,
(LSD, Psilocybin, and surroundings. The effects of
hallucinogens like LSD can be described
Peyote, DMT, and
as drug-induced psychosis—distortion
Ayahuasca) Affect
or disorganization of a person’s capacity
the Brain and Body? to recognize reality, think rationally,
or communicate with others. Users
How Do Hallucinogens
refer to LSD and other hallucinogenic
Work?
experiences as “trips” and to acute
adverse or unpleasant experiences as
Classic hallucinogens are thought to Short-Term
“bad trips.” On some trips, users
produce their perception-altering effects General Effects
experience sensations that are
by acting on neural circuits in the brain of Hallucinogens
enjoyable and mentally stimulating
that use the neurotransmitter serotonin
and that produce a sense of heightened Sensory Effects
(Passie, 2008; Nichols, 2004; Schindler,
understanding. Bad trips, however, • Hallucinations, including
2012; Lee, 2012). Specifically, some of
seeing, hearing, touching, or
include terrifying thoughts and
their most prominent effects occur in smelling things in a distorted
the prefrontal cortex—an area involved nightmarish feelings of anxiety and way or perceiving things that
despair that include fears do not exist
in mood, cognition, and perception—as
of losing control, insanity, or death. • Intensified feelings and
well as other regions important in
sensory experiences (brighter
Like LSD and psilocybin, DMT
regulating arousal and physiological
colors, sharper sounds)
produces its effects through action at
responses to stress and panic.
• Mixed senses (“seeing”
serotonin (5-HT) receptors in the brain
What Are the Short- sounds or “hearing” colors)
(Strassman, 1996). Some research has
Term Effects of • Changes in sense or
suggested that DMT occurs naturally perception of time (time
Hallucinogens?
in the human brain in small quantities, goes by slowly)
Ingesting hallucinogenic drugs can cause leading to the hypothesis that release of Physical Effects
users to see images, hear sounds, and endogenous DMT may be involved in • Increased energy and
feel sensations that seem real but do not reports of alien abductions, spontaneous heart rate
exist. Their effects typically begin within mystical experiences, and near- • Nausea
20 to 90 minutes of ingestion and can death experiences, but this remains
last as long as 12 hours. Experiences controversial (Barker, 2012).

Specific short-term effects of LSD, psilocybin, peyote, DMT, and ayahuasca include:
LSD Psilocybin DMT
• Increased blood pressure, heart • Feelings of relaxation (similar to • Increased heart rate
rate, and body temperature effects of low doses of marijuana) • Agitation
• Dizziness and sleeplessness • Nervousness, paranoia, and • Hallucinations frequently involving
• Loss of appetite, dry mouth, panic reactions radically altered environments as
and sweating • Introspective/spiritual experiences well as body and spatial distortions
• Numbness, weakness, and tremors • Misidentification of poisonousmushrooms
Ayahuasca
• Impulsiveness and rapid emotional resembling psilocybin could lead to
• Increased blood pressure
shifts that can range from fear to unintentional, potentially fatal poisoning
• Severe vomiting (induced by the tea)
euphoria, with transitions so rapid
Peyote • Profoundly altered state of awareness
that the user may seem to experience
• Increased body temperature and and perceptions of otherworldly imagery
several emotions simultaneously
heart rate
• Uncoordinated movements (ataxia)
• Profound sweating
• Flushing
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What Are the Long- especially among those using the brew
Term Effects of for religious activities.
Hallucinogens? Overall, two long-term effects—
persistent psychosis and HPPD—have
LSD users quickly develop a high degree
been associated with use of classic
of tolerance to the drug’s effects, such
hallucinogens (see sidebar). Although
that repeated use requires increasingly
occurrence of either is rare, it is also
larger doses to produce similar effects.
unpredictable and may happen more
Use of hallucinogenic drugs also
often than previously thought, and
produces tolerance to other drugs in this
sometimes both conditions occur
class, including psilocybin and peyote.
together. While the exact causes are not
Use of classic hallucinogens does not,
known, both conditions are more often
however, produce tolerance to drugs that Long-Term Effects
seen in individuals with a history of
do not act directly on the same brain of Hallucinogens
psychological problems but can happen
cell receptors. In other words, there is
to anyone, even after a single exposure. Persistent psychosis
no cross-tolerance to drugs that act on
There is no established treatment for • Visual disturbances
other neurotransmitter systems, such
HPPD, in which flashbacks may occur • Disorganized thinking
as marijuana, amphetamines, or PCP,
spontaneously and repeatedly although • Paranoia
among others. Furthermore, tolerance for
less intensely than their initial occurrence.
• Mood disturbances
hallucinogenic drugs is short-lived—it is
Some antidepressant and antipsychotic
lost if the user stops taking the drugs for Hallucinogen Persisting
drugs can be prescribed to help improve
several days—and physical withdrawal Perception Disorder (HPPD)
mood and treat psychoses, however.
symptoms are not typically experienced • Hallucinations
Psychotherapy may also help patients
when chronic use is stopped. • Other visual disturbances
cope with fear or confusion associated
The long-term residual (such as seeing halos or trails
with visual disturbances or other
psychological and cognitive effects attached to moving objects)
consequences of long-term LSD use.
of peyote remain poorly understood. • Symptoms sometimes
More research on the causes, incidence,
mistaken for neurological
Although one study found no evidence
and long-term effects of both disorders is disorders (such as stroke
of psychological or cognitive deficits
being conducted. or brain tumor)
among Native Americans who use peyote
regularly in a religious setting, those
What Are the
findings may not generalize to those who
Effects of Common
repeatedly abuse the drug for recreational
Dissociative role in cognition (including learning and
purposes (Halpern, 2005). Peyote users
may also experience hallucinogen Drugs on the memory), emotion, and the perception
of pain (the latter via activation of pain-
persisting perception disorder (HPPD)— Brain and Body?
regulating cells outside of the brain).
also often referred to as flashbacks. The
PCP also alters the actions of dopamine,
active ingredient mescaline has also been How Do Dissociative
a neurotransmitter responsible for the
associated, in at least one report, to Drugs Work?
euphoria and “rush” associated with
fetal abnormalities (Gilmore, 2001).
Laboratory studies suggest that many abused drugs.
Long-term effects of DMT use
dissociative drugs, including PCP, Salvia divinorum works differently.
and abuse and addiction liability are
ketamine, and DXM, cause their effects While classified as a dissociative drug,
currently unknown. Unlike most other
by disrupting the actions of the brain salvia causes its effects by activating
hallucinogens, DMT does not appear to
chemical glutamate at certain types of the kappa opioid receptor on nerve
induce tolerance (Winstock, 2013).
receptors—called N-methyl-D-aspartate cells (Cunningham, 2011; MacLean,
As with some other hallucinogens,
(NMDA) receptors—on nerve cells 2013). These receptors differ from those
there is little information to suggest
throughout the brain (Morgan, 2012; activated by the more commonly known
that ayahuasca use creates lasting
Morris, 2005). Glutamate plays a major opioids such as heroin and morphine.
physiological or neurological deficits,
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What Are the Short-Term Effects of Dissociative Drugs?
Dissociative drugs can produce visual and auditory distortions and a sense of floating and dissociation (feeling
detached from reality) in users. Use of dissociative drugs can also cause anxiety, memory loss, and impaired motor
function, including body tremors and numbness. These effects, which depend on the amount of the drug taken, are
also unpredictable—typically beginning within minutes of ingestion and lasting for several hours, although some
users report feeling the drug’s effects for days. See text box for general effects of dissociative drugs.
General Common Effects of Dissociative Drugs
Low to Moderate Doses High Doses
Numbness Hallucinations
Disorientation, confusion, and loss of coordination Memory loss
Dizziness, nausea, vomiting Physical distress, including dangerous changes in blood
pressure, heart rate, respiration, and body temperature
Changes in sensory perceptions (such as
sight, sound, shapes, time, and body image) Marked psychological distress, including feelings of extreme
panic, fear, anxiety, paranoia, invulnerability, exaggerated
Hallucinations strength, and aggression
Feelings of detachment from self and environment Use with high doses of alcohol or other central nervous
system depressants can lead to respiratory distress or
Increase in blood pressure, heart rate, respiration,
arrest, resulting in death
and body temperature
In addition to these general experiencing terrifying feelings of 15 to 30 milligrams), can lead to
effects, different dissociative drugs almost complete sensory detachment serious side effects when abused.
can produce a variety of distinct and likened to a near-death experience For example, use of DXM at doses
dangerous effects. For example, at (called a “K-hole,” similar to a bad from 200 to 1,500 milligrams can
moderate to high doses, PCP can LSD trip). Salvia users report intense produce dissociative effects similar
cause a user to have seizures or but short-lived effects—up to 30 to PCP and ketamine and increase
severe muscle contractions, become minutes—including emotional mood the risk of serious central nervous
aggressive or violent, or even swings ranging from sadness to system and cardiovascular effects
experience psychotic symptoms uncontrolled laughter. such as respiratory distress,
similar to schizophrenia. At moderate DXM, which is safe and seizures, and increased heart rate
to high doses, ketamine can cause effective as a cough suppressant from the antihistamines found in
sedation, immobility, and amnesia. At and expectorant when used at cough medicines.
high doses, ketamine users also report recommended doses (typically
What Are the Long-Term Effects of
Dissociative Drugs?
While the long-term use of most dissociative drugs has not been
investigated systematically, research shows that repeated use of PCP can
lead to tolerance and the development of a substance use disorder that
includes a withdrawal syndrome (including craving for the drug, headaches,
and sweating) when drug use is stopped. Other effects of long-term PCP
use include persistent speech difficulties, memory loss, depression, suicidal
thoughts, anxiety, and social withdrawal that may persist for a year or more
after chronic use stops.
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NIDA Research Report Series
Where can I get further information about hallucinogens?
To learn more about hallucinogens NIDA’s website includes: For Physician Information
and other drugs of abuse,
• Information on drugs of abuse
visit the NIDA website at
and related health consequences
www.drugabuse.gov or www.drugabuse.gov/nidamed
contact the DrugPubs Research • NIDA publications, news,
Dissemination Center at and events Other Websites
877-NIDA-NIH (877-643-2644; • Resources for health care Information on hallucingens
TTY/TDD: 240-645-0228). professionals, educators, and dissociative drugs is
also available through:
and patients and families
• Funding information (including • Substance Abuse and Mental
program announcements and Health Services Administration:
deadlines) www.samhsa.gov

• International activities
• Drug Enforcement Administration:
• Links to related websites www.deadiversion.usdoj.gov
(access to websites of many
• Monitoring the Future:
other organizations in the field)
www.monitoringthefuture.org/
• Information in Spanish (en español)
• The Partnership at Drug Free.org:
NIDA Websites and Webpages
www.drugfree.org/drug-guide
www.drugabuse.gov
www.teens.drugabuse.gov
www.easyread.drugabuse.gov
www.drugabuse.gov/drugs-abuse/
hallucinogens
www.drugabuse.gov/publications/
term/160/DrugFacts
www.hiv.drugabuse.gov/
www.researchstudies.drugabuse.gov/
www.irp.drugabuse.gov/
NIH Publication Number 15-4209 • Revised February 2015
This publication is in the public domain and may be used or reproduced in its entirety
without permission from NIDA. Citation of the source is appreciated.
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NIDA Research Report Series