Lecture 11 - Hallucinogens (and ecstasy) 1

Question 1

What are hallucinogens?

Answer 1

• Induce an altered state of consciousness, characterized by distortions of perception, hallucinations or visions, ecstasy, dissolution of self-boundaries and the experience of union with the world
• Alternatively referred to as ‘psychedelics’ (mind revealing/opening) and – less often – ‘psychotomimetic’ (mimicking psychosis) or ‘entheogen’ (generating the divine/spiritual within)

Question 2

What are classical hallucinogens?

Answer 2

• Include plant-derived substances, such as psilocybin (from Psycocybe ‘magic’ mushrooms) and mescaline (from peyote cactus), and synthetic drugs, such as LSD
• Agonists at serotonin (5-HT), especially 5-HT2A, receptors
• Altered state of consciousness is primary effect

Question 3

What are dissociative anaesthetics?

Answer 3

• Synthetic drugs, such as phencyclidine (PCP) and ketamine
• Produce anaesthesia (loss of all sensation) at higher doses and altered states of consciousness at lower doses, including ‘disconnection/dissociation’ from environment (loss of time sense, feeling of floating/hovering weightlessly) and body (altered perception of body consistency and out of body experience)
• Non-competitive NMDA receptor antagonists

Question 4

What does a comparison of classical hallucinogen (psilocybin) and dissociative anaesthetic (ketamine) show?

Answer 4

• Five-dimensional altered states of consciousness (5DASC) rating scale
• 5 primary dimensions with subdimensions
• ‘Oceanic boundlessness’ = referring to positively experienced loss of ego boundaries
• ‘Anxious ego-disintegration’ (purple boxes) = including thought disorder and loss of self-control
• ‘Visionary restructuralization’ (blue boxes) = referring to perceptual alterations (such as visual illusions and hallucinations), and altered meaning of percepts
• ‘Acoustic alterations’ = including hypersensitivity to sound and auditory hallucinations, and ‘altered vigilance’ are not shown
• Vollenweider and Kometer (2010)

Question 5

What is the importance of ‘set’ (expectations) and ‘setting’ in determining subjective experience induced by hallucinogenic drugs?

Answer 5

• Psychopharmacological actions of hallucinogenic drugs may be less predictable than those of other drugs (due to expectations/environment)
• Hallucinogen effects are heavily dependent on the user’s expectations (“set”) and the environment (“setting”). For example, expectations and environments that would foster religious or spiritual experiences increase the probability of the drug producing such an effect
• Stanislov Grof (1975), who supervised many clinical LSD sessions, wrote, “I consider LSD to be a powerful unspecific amplifier or catalyst of biochemical and physiological processes in the brain”. Barr et al. (1972) stated, “…the phenomena induced by LSD (and probably by any similar drug) cannot be predicted or understood in purely pharmacological terms; the personality of the drug taker plays an enormous and critical role in determining how much effect there will be and of what particular type.”
• The above also suggests that an individual’s response to repeated administration of the same drug and dose may vary

Question 6

Describe the historical background of hallucinogens

Answer 6

• Natural hallucinogens have been used for millennia (possibly longer than any other psychoactive drug because they are in edible mushrooms), often as part of rituals (under control of suitably experienced people)
• Plant-derived hallucinogens and LSD entered Northern American and European mainstream culture in first half of 20th century
• PCP developed as anaesthetic in mid-1950; ketamine synthesized as safer alternative in 1962 – still used as anaesthetic in humans (when limited anaesthesia infrastructure and support and in children, which show less pronounced psychological effects) and in animals e.g. horse tranquiliser
• In Europe and North America, there was substantial interest by researchers in understanding hallucinogenic drug actions and to exploit them clinically (either by using them for research to reveal mechanisms of altered states of consciousness in neuropsychiatric disorders or by using them for therapy)
• On the other hand, especially the classical hallucinogens became associated with 1960s counterculture and were made illegal
• Ketamine approved as depression treatment in US in 2019

Question 7

What is ecstasy (MDMA)?

Answer 7

• MDMA (3,4-methylene-dioxymethamphetamine) is an amphetamine with strong effects on serotonin transmission
• Has stimulant properties, increasing alertness and energy, and hallucinogenic-like properties, increasing sociability and talkativeness and inducing an ‘altered state of consciousness with emotional and sensual overtones . . . can be compared in its effects to marijuana, to psilocybin devoid of the hallucinatory component’ (Schulgin & Nichols)
• The unique pattern . . . of high . . . oceanic boundlessness, low visionary restructuralization and low dread of ego-dissolution produced by MDMA discriminates it from hallucinogens and stimulants (Vollenweider et al., 1998)
• Overall, the ‘alteration of consciousness’ may be much weaker, though, than the one produced by LSD (Holze et al., 2020)
• Has been suggested for use in psychotherapy (with recent focus on PTSD), but has also become notorious for use in the rave scene and ecstasy-related deaths
• Nutt (2012) = drugs - without the hot air

Question 8

What did the global drug survey 2017 show?

Answer 8

• 120,000 online participants – not a probability sample
• Hallucinogens/ecstasy high

Question 9

What did the crime survey for England and Wales 2017/18 show?

Answer 9

• Proportion of 16-59 year olds using:
• LSD = 0.4%
• Magic mushrooms = 0.4%
• Ketamine = 0.8%
• Ecstasy more common

Question 10

Is ecstasy less dangerous than horse riding?

Answer 10

• David Nutt, then the Chair of the governments Advisory Council for the Misuse of Drugs (ACMD), made the provocative claim that ecstasy use may be less dangerous than horse riding in order to promote debate about drug harms and legality of drugs

Question 11

What is the harmfulness of hallucinogenic drugs and MDMA?

Answer 11

• Apart from potential distress caused by the subjective experiences induced by classical hallucinogenic drugs (depending on ‘set’/’setting’ and a particular risk in people with mental health problems), these drugs cause otherwise virtually no physical harm and no dependence (not addictive)
• Ecstasy and dissociative anaesthetics (PCP, ketamine) can cause dependence and cause neurodegeneration, although it is debated if typical recreational usage and doses cause neurodegeneration
• Ecstasy-related deaths: about 130 in England, Wales and Scotland in 2017; may be related to overheating and dehydration
• Expert assessment of harms to user and to others
• Nielsen et al. (2017) = association between alcohol, cannabis and other illicit substances of abuse and risk of developing schizophrenia

Question 12

What are the legal restrictions on hallucinogens and MDMA

Answer 12

Severe
- Hallucinogens/ecstasy heavily regulated in UK
- Three Classes (A, B and C) to determine the penalties for offences such as supply, production and possession of a controlled drug
- Five schedules regulate the clinical use of controlled substances and their storage and labelling requirements (1 = strictest)