40.1: Hallucinogens (Psychedelics)

• Hallucinogen — an inaccurate label generally applied to a certain group of drugs that produce visual illusions, sensory-perceptual distortions, synesthesias, depersonalization, and derealisation.

• This class of drugs is perhaps more appropriately termed illusionogenic, psychedelics, or mysticomimetic.

Lysergic Acid Diethylamide (LSD)

• LSD is the most potent and widely abused hallucinogen.

• It was first prepared by Stoll and Hofmann in 1938,  its discovery was an outgrowth of their search for the pharmacologically active derivative of ergot.

• Ergot — a biological product of the fungus Claviceps purpurea, a parasite of cereal grain.

  • It is synthesized from rye ergot. It is tasteless, odorless and the most potent hallucinogen in minute doses.

  • These can be supplied illicitly on sugar cubes, though it is available in the form of pills of varying colors, sizes, and shapes and also in ampoules.

Mescaline

• Mescaline is also derived from peyotol plants.

• It is in the form of a crystalline powder.

• It can be dissolved in water or taken in capsules.

• It is not as potent as LSD, acts same as peyote.

Peyote

• It is obtained from a variety of cactus (peyotol) plants.

• The toxic principle is present in its button shaped growth of the plant. They are just rolled into balls and kept in capsules. Rarely it may be placed in hot tea and served

• It is not as potent as LSD.

Action of Hallucinogens in General

All hallucinogens are potentially hazardous to human psychology, resulting in disorders of the mind such as:

• Anxiety

• Panic

• Depressive and paranoid reaction

• Mood changes and confusion

• Inability to distinguish between reality and fantasy

• Impairment of normal motivation of life such as to study, work, or otherwise contributions to society.

Signs and Symptoms

• Unusual bizarre behavior, hilarity, emotional swings and suspiciousness.

• The patient may complain of nausea and vomiting (especially with peyote).

• On examination, there may be dilated pupils and tremors.

• Bad trips — It is defined as the adverse effects experienced by a person on consuming LSD.

• Fatal Dose: As the dose required for desirous effects of any of the hallucinogens is minimum, lethal dose consumption is rare and death is exceptionally rare.

• He or she will see the color and hear noises.

• There will be a total disturbance of sense of time, space and distance.

• He or she will get into a dream like state with loss of awareness of body boundaries.

• He or she will be experiencing fantasies and hallucinations of varied nature and might present with a flight of ambivalent emotions such as depression and elation, happiness and sadness, etc. simultaneously.

Treatment

• Prolonged treatment is essential as ‘flash back’ effects lasts for long duration.

• Psychotherapy is helpful.

• Use of tranquilizers can be the choice of treatment helping to minimize the “flash back” effects.

Medicolegal Importance of Hallucinogens

• Hallucinogens are though habit forming, addiction is rare.

• They can pose hazards on psychosocial realm triggering psychotic or depressive reaction with “flash back” experience (especially with LSD) for long period.

• Suicide attempts to commit suicide or homicide after consuming hallucinogens have been reported with drug misadventure case.

• Taking hallucinogens may impair one’s capacity to drive a motor vehicle or operate machinery.

40.2: Stimulants

• Amphetamines (CNS stimulant, hallucinogen).

Signs and Symptoms

• Flushed face, sweating, excitement, restlessness, insomnia, tremors, ventricular tachycardia, hypertension, delirium, hallucinations, convulsions, and deep unconsciousness. Toxic psychosis in chronic poisoning.

• Fatal dose: 120 to 200 mg.

• Fatal period: Up to five days.

Treatment

• Gastric lavage, sedation with chlorpromazine, cardiorespiratory resuscitation, and general measures.

• Haloperidol 95-10 mg IV slowly to combat CNS effects.

40.3: Organic Solvent

• A wide variety of organic solvents, which are volatile substances such as:

  • Toluene

  • Gasoline

  • Xylene, benzene

  • Methylene

  • Ethylene chloride

  • Fluorocarbons

  • Carbon tetrachloride

  • Butane

  • Propane

• These are used for deliberate inhalation for their psychotropic and hallucinogenic effect.

  • The usual way in which these are used is, by placing some of the solvent in a plastic bag and holding the open end over the nose and mouth.

• Death in these abusers may be due to vagal inhibition by the gases, which may be sprayed directly into the mouth or due to the sensitization of the myocardium, by noradrenaline, leading to ventricular fibrillation and arrest.

• Asphyxia and direct toxic effect of the substance on brain/heart tissue are alternative mechanisms.

Signs and Symptoms

• When inhaled, can result in irritation of eyes and throat, headache, nausea, vomiting, mental confusion, loss of consciousness, arrhythmia, slow respirations, convulsions, etc. When ingested, can cause dizziness, headache, nausea, vomiting, colic, tremors, convulsions, coma.

• Fatal dose: 2 to 4 ml (adults), 1 ml (children).

• Fatal period: 1 to 2 days.

40.4: Drug Dependence

• Drug dependence — a psychic and physical state of the person characterized by behavioral and other responses resulting in a compulsion to take a drug, on a continuous or periodic basis in order to experience its psychic effect and at times to avoid the discomfort of its absence.

• Drug addiction — a state of periodic or chronic intoxication harmful to the individual and to society resulting from repeated consumption of a drug such as opium and its derivatives, pethidine, cannabis, heroin, alcohol, barbiturates, cocaine, LSD, amphetamine, chloral hydrates, etc.

• Drug habituation — a condition resulting from repeated consumption of a drug, which produces a psychological or emotional dependency on the drug such as caffeine, nicotine, etc.

• Drug Abuse — improper use of a therapeutic or nontherapeutic drug, which may or may not be harmful, even in absence of addiction constitutes drug abuse.

Etiology of Drug Dependence

• Common in adolescents and adults.

• More common among persons with a tendency of:

  • Taking risks

  • Rebelliousness

  • Truancy

  • Sexual promiscuity

• The drug may be taken for the following effect:

  • Euphoria

  • Improvements in capacity to understand and creativity

  • Better relaxation

  • Improvements in capacity to overcome stress and strains of life

  • Enhanced sexual capacities

  • Experience of sexual pleasure without having actual sexual relation

  • Improve power of meditation (religious).

• Common among people with psychological disorders such as:

  • Psychoneurosis

  • Psychopathic state

  • Frank psychoses

Consequences of Drug Dependence

• Daily intake of drugs requires money to buy the same from any source making:

  • Males indulge in thefts, forgery, etc. for money.

  • Female may take up prostitution as easiest way to get money.

• Food, personal hygiene, clothing are often neglected and an addict may appear—deshelled, unkept, unshaven, dirty, etc.

Signs and Symptoms of Drug Addiction

• Irresistible desire to continue to take the drug

• Development of tolerance

• A tendency to increase the dose

• Physical dependence on drug

• Desire to obtain drug by any means (even using criminal ways)

• Withdrawal symptoms when the drug is stopped.

Withdrawal Symptoms (Abstinence Syndrome)

They develop in 6 to 48 hours of withdrawal of drugs to which an individual has become an addict, and are characterized by:

• Restlessness

• A feeling of anxiety

• Vague pain in abdomen and limbs

• Diarrhea

• Increased libido.

Treatment of Addiction

• Institutional treatment is recommended

• Secret watch for preventing further supply of drugs

• Gradual withdrawal of drug in stages by progressive tapering of dose

• Administration of small doses of sedatives, e.g. barbiturates

• Keeping the victim engaged with physical and mental activities

• Psychotherapy in the form of encouragement

• Improving general health by consuming good and rich food

• Symptomatic measures.

Signs and Symptoms of Drug Habituation

Person habituated to drug is called a drug habituate, and presents with following:

1. A desire, but not irresistible to continue to take the drugs.

2. Little or no tolerance

3. Hence, little or no tendency to increase the dose.

4. Some degree of psychic, but no physical dependence.

5. A detrimental effect only on the person if any, but not on society.

6. Absence of withdrawal symptoms.