Hallucinogen Poisoning

Hallucinogen Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Predominantly alters perception, cognition, and mood
  • All hallucinogens potentiate neurotransmitter release or bind directly to receptors:
    • Serotonin (5-hydroxytryptamine; 5-HT): Many hallucinogens are agonists or antagonists at 5-HT receptor subtypes
    • Norepinephrine, N-methyl-D-aspartate (NMDA), dopamine

Etiology

  • Most exposures are intentional
  • Common hallucinogens:
    • Indolamine:
      • Lysergic acid diethylamide (LSD) (duration 6–12 hr)
      • Morning glory (Ipomoea spp.)
    • Tryptamines:
      • Psilocybin (Psilocybe mushrooms); frequently adulterated with LSD
      • N,N-dimethyltryptamine (DMT); 5-MeO-DMT (“foxy-methoxy”), and other tryptamine congeners
    • Phenylethylamines (hallucinogenic amphetamines):
      • Methylenedioxyamphetamine (MDA)
      • Methylenedioxymethamphetamine (MDEA)
      • Methylenedioxymethamphetamine (MDMA; “ecstasy”; duration 8–12 hr)
      • Paramethoxyamphetamine
      • Dimethoxyamphetamine
      • Mescaline (peyote cactus); frequently adulterated with LSD (duration 6–12 hr)
    • Arylcycloalkylamines:
      • Phencyclidine (PCP), (duration is variable 11–96 hr in 1 report)
      • Ketamine, (duration depends on route of administration 30–120 min)
    • Anticholinergic:
      • Deadly nightshade (Atropa belladonna)
      • Jimsonweed (Datura stramonium)
    • Other:
      • Piperazines: Benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP)
      • Dextromethorphan (DXM), (duration 3–6 hr)
      • Marijuana
      • Kratom, (duration 4–6 hr)

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Basics

Description

  • Predominantly alters perception, cognition, and mood
  • All hallucinogens potentiate neurotransmitter release or bind directly to receptors:
    • Serotonin (5-hydroxytryptamine; 5-HT): Many hallucinogens are agonists or antagonists at 5-HT receptor subtypes
    • Norepinephrine, N-methyl-D-aspartate (NMDA), dopamine

Etiology

  • Most exposures are intentional
  • Common hallucinogens:
    • Indolamine:
      • Lysergic acid diethylamide (LSD) (duration 6–12 hr)
      • Morning glory (Ipomoea spp.)
    • Tryptamines:
      • Psilocybin (Psilocybe mushrooms); frequently adulterated with LSD
      • N,N-dimethyltryptamine (DMT); 5-MeO-DMT (“foxy-methoxy”), and other tryptamine congeners
    • Phenylethylamines (hallucinogenic amphetamines):
      • Methylenedioxyamphetamine (MDA)
      • Methylenedioxymethamphetamine (MDEA)
      • Methylenedioxymethamphetamine (MDMA; “ecstasy”; duration 8–12 hr)
      • Paramethoxyamphetamine
      • Dimethoxyamphetamine
      • Mescaline (peyote cactus); frequently adulterated with LSD (duration 6–12 hr)
    • Arylcycloalkylamines:
      • Phencyclidine (PCP), (duration is variable 11–96 hr in 1 report)
      • Ketamine, (duration depends on route of administration 30–120 min)
    • Anticholinergic:
      • Deadly nightshade (Atropa belladonna)
      • Jimsonweed (Datura stramonium)
    • Other:
      • Piperazines: Benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP)
      • Dextromethorphan (DXM), (duration 3–6 hr)
      • Marijuana
      • Kratom, (duration 4–6 hr)

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