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chapter6 - CHAPTER 6 ALL AROUNDERS CHAPTER OVERVIEW Drugs...

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Unformatted text preview: CHAPTER 6 ALL AROUNDERS CHAPTER OVERVIEW Drugs such as marijuana, LSD, ketamine, PCP, MDMA (ecstasy), psilocybin mushrooms, and peyote (mescaline) are the most commonly used psychedelic (hallucinogenic) drugs. They cause intensified and mixed-up sensations, as well as illusions, delusions, and hallucinations. Many of them also cause stimu- lation and impaired judgment and reasoning. This chapter summarizes the history, pharmacology, epidemiology, and the physical/psychological effects of various psychedelic drugs. It also examines the history, epidemiology, botany, pharmacology, and compulsive qualities of the drug along with an examination of the medical marijuana controversy, which includes the 1999 special report to the President on the drug. I. HIST OR Y II. CLASSIFICA T ION III. GENERAL EFFECTS A. ASSESSING THE EFFECTS 1. Physical & Mental Effects 2. Illusions, Delusions, & Hallucinations IV. LSD, PSILOCYBIN 48 SHORT CHAPTER OUTLINE 4. Foxy (5-methoxy-N, N- A. KETAMINE diisopropyltryptamine [5-Me- B_ PCP DIPT]) & AMT (alphamemyltrypmne) C. SAL 'VIA DIVINORUM 5. Yage (salvrnonn A) K PEYOTE, MDMA, & OTHER D. AMANITA MUSHROOMS PHENYLALKYLAMINE 13- DEXTROMETHORPHAN PSYCHEDELICS (Robitussin DM®, Romilar®, A. PEYOTE (mescaline) & other cough syrups) 1. Effects F. NUTMEG & MACE MUSHROOMS, & OTHER INDOLE PS Y CHEDELI CS A. LSD (LYSERGIC ACID DIETHYLAMIDE) 1. History (also see Chapter I) 2. Epidemiology 3. Manufacture of LSD 4. Pharmacology 5. Physical Effects 6. Mental Effects 7. Bad Trips (acute anxiety reactions) 8. Mental Illness & LSD 9. Dependence B. “MAGIC MUSHROOMS” (psilocybin & psilocin) 1. Pharmacology 2. Effects C. OTHER INDOLE PSYCHEDELICS 1. Ibogaine 2. Morning Glory Seeds (ololiuqui) 3. DMT (dirnethyltryptamine) B. PSYCHO-STIMULANTS (MDA, MDMA, 2C-B, PMA, 2C-T-7, 2C-T-2, ET AL.) & CLUB DRUGS VIII. MARIJUANA & OTHER CANNABINOLS A. HISTORY OF USE l. MDMA (ecstasy, rave, 1“ EPIDEMIOLOGY “XTC,” “X,” “Adam,” “E,” et C. BOTANY a1.) 1. Species 2. Parties, Raves, & Music Clubs 2, Sinsemjlla & Other Forms of 3. Nexus (2C-B or 4-bromo-2,5- Marijuana dimethoxy phenylethylamine) 3, Growers 4. STP (DOM) (2.5-dimeth0xy- D. PHARMACOLOGY 4'methylamphetamme) 1. Marijuana Receptors & 5- PMA (4'MA 0r Neurotransmitters Parmethoxymphe‘amine) E. SHORT-TERM EFFECTS 6. 2C-T-7 & 2C-T-2 . 1. Phys1cal Effects VI. BELLADONNA & OTHER 2. Mental Effects ANTICHOLINERGIC F. LONG-TERM EFFECTS PS Y CHEDELI CS 1 . Respiratory Problems A. BELLADONNA, HENBANE, 2. Immune System MANDRAKE, & D ATURA 3. Learning & Emotional (jimsonweed, thornapple) Maturation VIL KETAMINE, PCP, & 4. Acute Mental Effects OTHER PS Y CHEDELI CS G. TOLERANCE, H. MARIJUANA (Cannabis) & OFFICE OF NATIONAL WITHDRAWAL, & THE LAW DRUG CONTROL POLICY ADDICTION 1. Marijuana, Driving, & Drug 1. Conclusions of the Report 1. Tolerance Testing 2. Recommendations of the 2. Withdrawal 2. Medical Use of Marijuana Report 3. Addiction 1. 1999 REPORT FROM THE 4. Is Marijuana a Gateway INSTITUTE OF Drug? MEDICINE TO THE EXTENDED CHAPTER OUTLINE I. HISTORY Psychedelic plants and fimgi have probably been used since the origin of man. More than 4,000 plants have psychedelic (hallucinogenic) proper- ties. The purpose of using hallucinogens is to alter one’s consciousness and perception of reality rather than to induce a rush. For this reason they are rarely injected. Today the majority of these drugs are grown and used in the Americas, Europe, and Africa, the major exception being marijuana which is grown in most countries. Hundreds of primitive tribes in the Americas, such as the Aztecs and Toltecs in the past and the Kiowas and Huich— ols in the present, have used peyote, psilocybin mushrooms, yage, marijuana, and morning glory seeds among other hallucinogens for religious, so- cial, ceremonial, and medical rites. Other than marijuana, psychedelics in the ’60s and ’7OS were and continue to be the most popular among young White users. (p. 227) II. CLASSIFICA TION Uppers stimulate the body and downers depress it. All arounders usually act as stimulants and occa- sionally as depressants but mostly psychedelics dramatically alter the user’s perception and create a world in which reason takes a back seat to inten- sified sensations by creating illusions, delusions, and hallucinations. The five main classes of psy- chedelics are indole psychedelics (LSD, psilocybin mushrooms), phenylalkylamines (peyote, MDMA [ecstasy]), anticholinergics (belladonna, datura), those in a class by themselves (ketamine, PCP, Salvia divinorum), and the cannabinols found in Cannabis (marijuana) plants. (p. 228) III. GENERAL EFFECTS A. Assessing the effects. The effects of many psy- chedelics are dependent on the amount in- gested, experience with the drug, the basic emotional makeup of the user, the mood and mental state at the time of use, any preexisting mental illnesses, and the surroundings in which the drug is taken. (p. 228) 1. Physical & mental effects. LSD and other hallucinogens stimulate the sympathetic nervous system causing a rise in pulse rate and blood pressure. Many psychedelics can trigger sweating, palpitations, or nausea. Generally psychedelics interfere with dopa- mine, norepinephrine, acetylcholine, anan- damide, alpha psychosin, and especially se- rotonin. The stimulation of the brainstem can overload the sensory pathways making the user acutely aware of all sensation. Dis— ruption of visual and auditory centers can confuse perception. The mixing of the senses is known as “synesthesia.” (p. 230) 2. Illusions, delusions, & hallucinations. An illusion is a mistaken perception of an exter- nal stimulus. A delusion is a mistaken idea that is not swayed by reason or other power- ful evidence. A hallucination is a sensory experience that doesn’t come from external stimuli. With LSD and most psychedelics, illusions and delusions are the primary expe- riences. With mescaline, psilocybin, and PCP, hallucinations are the primary experi— ences. (p. 230) IV. LSD, PSILOCYBIN MUSHROOMS, & OTHER INDOLE PS Y CHEDELI CS A. LSD (lysergic acid diethylamide) 1. History. LSD is a synthesized form of the ergot fungus toxin that infects rye and other grasses. It was responsible for many out- breaks of ergot poisoning (ergotism) and thousands of deaths over the centuries when people accidentally ate the infected grain, 49 50 particularly in parts of Europe and Russia. There are two types of ergotism: gangre- nous ergotism (also known as “St. An- thony’s Fire”) marked by fever, hallucina- tions, and rotting away of gangrenous ex— tremities of the body and convulsive ergot- ism marked by visual and auditory halluci- nations, vomiting, diarrhea, convulsions, etc. LSD was first extracted in 1938 by Dr. Al- bert Hoffman. In the 1950s, LSD was inves- tigated as a therapy for mental illness and alcoholism and as a key to exploring thought processes. In the 1960s LSD-25 was popu- larized by Harvard psychologists Drs. Timothy Leary and Richard Alpert and by Ken Kesey, author of One Flew Over the Cuckoo’s Nest. LSD was made illegal in 1966. (p. 230) . Epidemiology. Younger and younger Americans were using LSD in the early 1990s but those numbers dropped by the early 2000s possibly due to the increasing popularity of MDMA (ecstasy). In the 1960s “acidheads” were usually in their early 20s and many were searching for a quasi relig- ious experience. In the 2000s most younger teenagers say they just want to get high or augment the effects of ecstasy and other drugs. Standard drug testing usually does not test for LSD because doses are so small it is almost impossible to detect. (p. 231) . Manufacture of LSD takes place primarily in northern California, mostly in the Bay area, although there is some secondary manufacture in the Pacific Northwest and recently the Midwest. The production of LSD is tedious and involves volatile and dangerous chemicals. The end product of the initial synthesis, crystalline LSD, is dis- solved in alcohol and drops of the solution are put on blotter paper and chewed or swallowed. (p. 232) . Pharmacology. LSD is remarkable for its potency. Doses as low as 25 micrograms or 25 millionths of a gram can cause mental changes. Effects appear 15 minutes to 1 hour after ingestion and last 6—8 hours. The usual dose is 150—300 micrograms. Tolerance de- velops rapidly to the psychedelic effects but is lost rapidly after cessation of use, usually within a few days. Withdrawal after LSD use is usually more mental and emotional than physical—a psychedelic hangover. (p. 232) . Physical Effects. LSD can cause a rise in heart rate and blood pressure, a higher body temperature, dizziness, dilated pupils, and some sweating, much like amphetamines. Users see light trails (an aftereffect known as a “trailing phenomena”). (p. 233) . Mental effects. LSD overloads the brain- stem causing sensory distortions (seeing sounds, feeling smells, or hearing colors [synesthesia]), dreaminess, depersonaliza- tion, altered mood, and impaired concentra- tion and motivation. One of the greatest dangers of LSD is the loss of judgment and impaired reasoning. (p. 233) . Bad trips (acute anxiety reactions). Be- cause LSD affects the emotional center of the brain and distorts reality, some users, particularly first—time users who take it without supportive experienced users around them, are subject to the extremes of euphoria and panic. (p. 233) . Mental illness and LSD. Proponents of psychotherapeutic use of LSD claim that drug-stimulated insights afford some users a shortcut to the extended process of psycho- therapy in which uncovering traumas and conflicts from the subconscious helps to heal the patient. Opponents say the dangerous side effects of LSD more than outweigh any benefits. The popular picture of someone using LSD just one time and becoming per- manently psychotic is incorrect. It is a very unusual occurrence. However in people with a preexisting mental illness or instability, LSD can aggravate those conditions into more severe mental disturbances, e. g., hallu- cinogen persisting perceptual disorder (HPPD) that consists of mental flashbacks of sensations or of a bad trip a user had while under the influence of LSD. These can hap- pen several months or even years after ces- sation of use. Although flashbacks appear to be similar to a posttraumatic stress disorder (PTSD), medications like sertraline, Cloni- dine®, and naltrexone may be useful in treating this problem. (p. 233) . Dependence. Since LSD generally does not produce compulsive use, it is not considered addictive. Larger numbers of trips by users are probably due to a psychological rather than a physical dependence. (p. 234) B. “Magic mushrooms” (psilocybin and psilo- cin). Psilocybin and psilocin are the active in— gredients in a number of mushrooms found in Mexico, the United States, South America, Southeast Asia, and Europe. They were espe- cially important to Indian cultures in Mexico and some other areas in the pre-Colombian Americas and were used in ceremonies dating as far back as 1000 BC During these ceremo- nies the mushrooms induce visions that report- edly helped treat illnesses, solve problems, or get in contact with the spirit world. (p. 234) l. Pharmacology. Psilocybin and psilocin are found in about 75 different species of mush- rooms. Both wild and cultivated mushrooms vary greatly in strength, so a single potent mushroom might have as much psilocybin as 10 weak ones. The chemical structure of psilocybin is similar to that of LSD. (p. 235) 2. Effects. Most mushrooms containing psilo- cybin cause nausea and other physical symptoms. Psychedelic effects follow in- cluding visceral sensations, changes in sight, hearing, taste, and touch, and altered states of consciousness. The major danger in “’shroom” harvesting is mistaking poison— ous mushrooms for those containing psilo- cybin. (p. 235) C. Other indole psychedelics l. Ibogaine is a long-acting psychedelic in high doses and a stimulant in low doses. Its use is generally limited to native cultures in western and central Africa. There has been research into the use of ibogaine to treat heroin or cocaine addiction. (p. 235) 2. Morning glory seeds (ololiuqui) contain an LSD-like substance (lysergic acid amide) which is about one-tenth as potent as LSD. Morning glory seeds are sold commercially but to prevent misuse they are dipped in a toxic, vomit-inducing substance. (p. 235) 3. DMT (dimethyltryptamine) is a psyche- delic substance similar to psilocin. South American tribes have used it for at least 400 years preparing it from several different plants as a snuff. They blow it into each other’s noses through a hollow reed and then dance, hallucinate, and sing. A synthetic form can be made in basement laboratories. DMT causes intense visual rather than auditory hallucinations, intoxication, and often a loss of awareness of surroundings lasting 30—60 minutes. The short duration of action gave rise to the nickname “business- man’s special” since one can get high and sober up during lunch. (p. 236) 4. Foxy (5-methoxy-N, N- diisopropyltryptamine [5—Me-DIPT]) & AMT (alphamethyltryptamine). These two psychedelic tryptamines appeared in the early 2000s while they were still not listed as scheduled drugs. However, they have been prosecuted under the federal drug- analogue statute. The effects include hallu- cinations, euphoria, empathy, visual and auditory disturbances (illusions), and emo- tional distress. Effects also include nausea, vomiting, and diarrhea. (p. 236) 5. Yage is made from an Amazonian vine and causes intense vomiting, diarrhea, and then a dreamlike condition that usually lasts up to 10 hours. (p. 236) V. PE YOTE, MDMA, & OTHER PHENYLALKYLAMINE PS Y CHEDELI CS This class is chemically related to adrenaline and amphetamine although many of the effects are quite different. The phenylalkylamines take several hours longer to reach their peak than ampheta- mines or indole psychedelics like LSD. (p. 236) A. Peyote (mescaline). Mescaline is the active component of the peyote cactus and the San Pedro cactus. It is used by Native American people in religious ceremonies though its his- tory goes back to pre-Columbian times. The Spanish tried to stamp it out. In 1990 the US. Supreme Court ruled that the use of peyote during religious ceremonies is not protected by the Constitution and that states can ban it. For this reason many ceremonies by the Native American Church of North America which use peyote are held in secret. (p. 237) 1. Effects. Peyote is derived from the tops (“buttons”) of the peyote cactus cut at ground level. They can be used fresh or dried. The effects last approximately 12 hours and are very similar to LSD with em- phasis on colorful visions. (p. 237) 51 B. 52 Psycho-stimulants (MDA, MDMA, 2C-B, PMA, 2C-T-7, 2C-T-2, et al.) & club drugs are laboratory variations of the amphetamine molecule. Often called designer psychedelics or psycho-stimulants, they are chemically defined as phenylethylamine derivatives similar to mes- caline. The drugs can cause feelings of well- being and euphoria, some psychedelic effects, stimulatory effects, side effects, and toxicity similar to amphetamines. MDA was the first of these compounds to be widely used and abused in the ’6OS, ’70s, and early ’803 on college campuses. (p. 238) 1. MDMA (ecstasy, rave, “XTC,” “X,” “Adam,” “E,” et al.). MDMA (ecstasy) is shorter acting than MDA (4—6 hrs. vs. 10—12 hrs.). It can be swallowed, snorted, or in- jected, much like methamphetamine, though it is usually sold as a capsule, tablet, or powder. MDMA is often taken at raves be- cause users claim it creates a strong desire to move about, dance, and interact with other people. (p. 238) History. Although MDMA was first discov— ered in 1914, it wasn’t until 1969 that the first human study was published. The authors recommended it to a number of therapists to help their patients see into their emotions and repressed memories. MDMA was banned in 1998. (p. 238) Use & cost. In 2002 about 7.4% of high school seniors had used MDMA but only 2.4% used on a monthly basis. A capsule, tablet, or equivalent powder packet (75—125 mg) costs $10 to $35. A DEA report found that 30—50% of the tablets sold as MDMA at rave parties actually contain no MDMA but do contain other illicit drugs like PCP, methamphetamine, PMA, or MDA. (p. 239) Physical effects. MDMA has many stimu- lant effects similar to amphetamines. The onset of action usually consists of tightness in muscles with generalized muscle spasms, trismus (jaw muscle spasm), and bruxism (clenching of teeth) just before most of the psychic effects begin to appear. Tolerance to its mental effects develops rapidly. Included in the many serious side effects are malig- nant hypertherrnia (high body temperature), high blood pressure, and seizures. (p. 239) Mental/emotional effects. About 20 min- utes to 1 hour after ingestion and continuing for 3—4 more hours, MDMA induces feel- ings of happiness, clarity, peace, pleasure, and altered sensory perceptions without causing any depersonalization or detachment from the realities of the environment. Users also report increased nonsexual empathy for others. For the first few hours ecstasy forces nerve cells to discharge their reservoirs of serotonin into the synaptic gap. This de- pletes the vesicles after about 3 hours. It can take up to a week or more to produce a suf- ficient amount of serotonin to reexperience similar feelings. Due to this excessive stimulation, serotonin receptors also retreat into the cell membrane (down regulation) to avoid damage, causing severe depression and suicidal ideation. High-dose usage has resulted in an acute anxiety reaction (“bum trip”). (p. 240) MDMA polydrug combinations. Some of the combinations include ecstasy combined with either LSD, hydrocodone, OxyContin®, heroin, GHB, nitrous oxide, Prozac®, or even Viagra® (called “sextacy”). (p. 240) . Parties, raves, and music clubs are social or dance gatherings filled with loud com— puter—generated techno music, light shows and laser light effects, and at many, club drugs and drug paraphernalia. The drugs that have been popular at these gatherings are primarily ecstasy, nitrous oxide (laughing gas), GHB or GBL, and occasionally dex- tromethorphan, ketamine, PCP, and nexus (2C-B). The problems that occur at these gatherings include bad reactions to drugs, overheating of the body, falling injuries, passing out, and bad trips. (p. 241) . Nexus (2C-B or 4—bromo-2,5—dimethoxy phenylethylamine). The effects of 2C-B are very dependant on the amount taken—mild stimulation at low doses and intense psyche- delic experiences at high doses. (p. 241) . STP (DOM) (2,5-dimethoxy-4— methylamphetamine). STP, also called “serenity,” “tranquility,” or “peace” pill, is similar to MDA and causes a 12-hour in- toxication that is reportedly a thicker duller trip than those induced by LSD or mesca- line. (p. 241) 5. PMA (4-MA or paramethoxyampheta- mine). Recently PMA has been found in pills purporting to be ecstasy that were smuggled from Europe. After 1 hour this drug causes a sudden rise in blood pressure, distinct afterimages, and a pins-and-needles tingly feeling like a chill or hair standing on end. It can cause seizures, hypertherrnia, co- agulation of blood, and muscle damage. It has caused deaths from overdose. (p. 241) 6. 2C-T-7 & 2C-T-2 induce delirium, heighten sensitivity, and increase awareness in the user. They can also cause dangerous cardio- vascular effects and death when taken in high doses. (p. 242) VI. BELLADONNA & OTHER A. AN T I CH OLINER GI C PS YCHEDELI CS Belladonna, henbane, mandrake, & datura (jimsonweed, thornapple). From ancient times through the Middle Ages and the Renais- sance, these plants, which contain scopolamine, hyoscyamine, and atropine, have been used in magic ceremonies, sorcery, witchcraft (...
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