Hallucinogens are a diverse group of drugs that alter a person’s awareness of their surroundings as well as their own thoughts and feelings. They are commonly split into two categories: classic hallucinogens (such as LSD) and dissociative drugs (such as PCP). Both types of hallucinogens can cause hallucinations, or sensations and images that seem real though they are not. Additionally, dissociative drugs can cause users to feel out of control or disconnected from their body and environment. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]
Dissociative drugs such as phencyclidine (PCP) or ketamine produces an anesthetic effect characterized by a feeling of being detached from the physical self. They 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. Dissociative drugs like PCP, ketamine, dextromethorphan, and Salvia divinorum may make a user feel out of control and disconnected from their body and environment.
In addition to their short-term effects on perception and mood, dissociative drugs can cause respiratory depression, heart rate abnormalities, and a withdrawal syndrome. These drugs are not that widely used worldwide. In the U.S., the use of dissociative drugs among U.S. high school students, in general, has remained relatively low in recent years. However, the introduction of new versions of the drugs is of particular concern.
The use of dissociative drugs among U.S. high school students, in general, has remained relatively low in recent years. However, the introduction of new dissociative drugs is of particular concern.An estimated 0.9 percent of 12th graders reported using ketamine in the past 12 months. An estimated 0.5 percent of 8th graders, 0.4 percent of 10th graders, and 0.6 percent of 12th graders reported using salvia in the past 12 months. [Source: 2021 Monitoring the Future Survey]
Effects of Dissociative Drugs
Short-Term Effects of dissociative drug effects can appear within a few minutes and can last several hours in some cases; some users report experiencing drug effects for days. Effects depend on how much is used. In low and moderate doses, dissociative drugs can cause: 1) numbness disorientation and loss of coordination; 2) hallucinations; 3) increase in blood pressure, heart rate, and body temperature.
Dissociative drugs can produce visual and auditory distortions and a sense of floating and dissociation (feeling detached from reality) in users. In high doses, dissociative drugs can cause: 1) memory loss; 2) panic and anxiety; 3) seizures; 4) psychotic symptoms; 5) amnesia; 6) inability to move; 7) mood swings; 8) impaired motor function, including body tremors; and 9) trouble breathing. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]
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 an addiction that includes a withdrawal syndrome (including craving for the drug, headaches, and sweating) when drug use is stopped.Other long-term effects may continue for a year or more after use stops, including: 1) speech problems; 2) memory loss; 3) weight loss; 4) anxiety; 5) depression and suicidal thoughts; and 6) and social withdrawal that may persist for a year or more after chronic use stops.
How Do Dissociative Drugs Work?
While the exact mechanisms by which hallucinogens and dissociative drugs cause their effects are not yet clearly understood, research suggests that they work at least partially by temporarily disrupting communication between neurotransmitter systems throughout the brain and spinal cord that regulate mood, sensory perception, sleep, hunger, body temperature, sexual behavior, and muscle control. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, February 2015]
Dissociative drugs interfere with the action of the brain chemical glutamate, which regulates: pain perception, responses to the environment, emotion, learning and memory Laboratory studies suggest that dissociative drugs, including PCP, ketamine, and DXM, cause their effects by disrupting the actions of the brain chemical glutamate at certain types of receptors — called N-methyl-D-aspartate (NMDA) receptors — on nerve cells throughout the brain. Glutamate plays a major role in cognition (including learning and memory), emotion, and the perception of pain (the latter via activation of pain-regulating cells outside of the brain). PCP also alters the actions of dopamine, a neurotransmitter responsible for the euphoria and “rush” associated with many abused drugs.
Salvia divinorum works differently. While classified as a dissociative drug, salvia causes its effects by activating the kappa opioid receptor on nerve cells.These receptors differ from those activated by the more commonly known opioids such as heroin and morphine.
Dangers of Dissociative Drugs
Dissociative drugs can also cause extreme dizziness, nausea, vomiting, produce changes in sensory perceptions (such as sight, sound, shapes, time, and body image) and increase in blood pressure, heart rate, respiration, and body temperature Physical distress may include dangerous changes in blood pressure, heart rate, respiration, and body temperature. Marked psychological distress may include feelings of extreme panic, fear, anxiety, paranoia, invulnerability, exaggerated strength, and aggression. Use with high doses of alcohol or other central nervous system depressants can lead to respiratory distress or arrest, resulting in death.
In addition to these general effects, different dissociative drugs can produce a variety of distinct and dangerous effects. For example, at moderate to high doses, PCP can cause a user to have seizures or severe muscle contractions, become aggressive or violent, or even experience psychotic symptoms similar to schizophrenia. At moderate to high doses, ketamine can cause sedation, immobility, and amnesia. At high doses, ketamine users also report experiencing terrifying feelings of almost complete sensory detachment likened to a near-death experience (called a “K-hole,” similar to a bad LSD trip). Salvia users report intense but short-lived effects — up to 30 minutes — including emotional mood swings ranging from sadness to uncontrolled laughter. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, February 2015]
Overdose is more likely with some dissociative drugs. High doses of PCP can cause seizures, coma, and death. Additionally, taking PCP with depressants such as alcohol or benzodiazepines can also lead to coma. Benzodiazepines, such as alprazolam (Xanax), are prescribed to relieve anxiety or promote sleep.[Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]
Dissociative drug users also risk serious harm because of the profound alteration of perception and mood these drugs can cause. Users might do things they would never do in real life, like jump out of a window or off a roof, for instance, or they may experience profound suicidal feelings and act on them. With all drugs there is also a risk of accidental poisoning from contaminants or other substances mixed with the drug.
PCP (Phencyclidine) was developed in the 1950s as a general anesthetic for surgery, but is no longer used for this purpose due to serious side effects. PCP can be found in a variety of forms, including tablets or capsules; however, liquid and white crystal powder are the most common. PCP is 1) swallowed as tablets or pills; 2) snorted; 3) injected; 4) inhaled, vaporized or smoked; It is sometimes smoked after being sprinkled on marijuana, tobacco, or parsley. In some places this used to be called killer weed. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, February 2015]
PCP and ketamine work in similar ways: instead of numbing the body as an opiate would, they disconnect the subject from their body and environment. At moderate to high doses, PCP can cause a user to have seizures or severe muscle contractions, become aggressive or violent, or even experience psychotic symptoms similar to schizophrenia. High doses of PCP can cause seizures, coma, and death. Additionally, taking PCP with depressants such as alcohol or benzodiazepines can also lead to coma. Benzodiazepines, such as alprazolam (Xanax), are prescribed to relieve anxiety or promote sleep
PCP was invented in the U.S.. Dylan Levi King wrote in Palladium:. In the late 1950s, the venerable drug maker Parke, Davis & Co. tasked the Departments of Pharmacology and Anesthesiology at the University of Michigan Medical Center with developing inexpensive and reliable alternatives to narcotics derived from the opium poppy. The first product of those efforts had been phencyclidine, which was marketed under the trade names Sernyl and Sernylan but more commonly known as PCP. [Source: Dylan Levi King, Palladium, June 23, 2021]
DXM (Dextromethorphan) is a cough suppressant and expectorant ingredient in some over-the-counter (OTC) cold and cough medications (syrups, tablets, and gel capsules). that are often abused by adolescents and young adults. The most common sources of abused DXM are “extra-strength” cough syrup, which typically contains around 15 milligrams of DXM per teaspoon, and pills and gel capsules, which typically contain 15 milligrams of DXM per pill. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, February 2015]
DXM is 1) swallowed as tablets or pills; 2) swallowed as liquid. OTC medications that contain DXM often also contain antihistamines and decongestants.
DXM, which is safe and effective as a cough suppressant and expectorant when used at recommended doses, can lead to serious side effects when abused. For example, use of DXM at doses from 200 to 1,500 milligrams can produce dissociative effects similar to PCP and ketamine and increase the risk of serious central nervous system and cardiovascular effects such as respiratory distress, seizures, and increased heart rate from the antihistamines found in cough medicines.
Salvia (Salvia divinorum) is a plant common to southern Mexico and Central and South America. It is brewed into tea and inhaled, vaporized or smoked and is typically ingested by chewing fresh leaves or by drinking their extracted juices. The dried leaves of salvia can also be smoked or vaporized and inhaled.
Salvia users report intense but short-lived effects — up to 30 minutes — including emotional mood swings ranging from sadness to uncontrolled laughter. According to a 2021 survey in the U.S., an estimated 0.5 percent of 8th graders, 0.4 percent of 10th graders, and 0.6 percent of 12th graders reported using salvia in the past 12 months.
Salvia divinorum works differently that other dissociative drugs. While classified as a dissociative drug, salvia causes its effects by activating the kappa opioid receptor on nerve cells.These receptors differ from those activated by the more commonly known opioids such as heroin and morphine.
Ketamine is used as a surgery anesthetic for humans and animals. Ketamine is swallowed as tablets or pills; swallowed as liquid; and snorted. Much of the ketamine sold illegally come from veterinary offices. It mostly sells as a powder or as pills, but it also available as an injectable liquid. Ketamine is snorted or sometimes added to drinks as a date-rape drug. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]
At moderate to high doses, ketamine can cause sedation, immobility, and amnesia. Although it is manufactured as an injectable liquid, ketamine is generally evaporated to form a powder that is snorted or compressed into pills for illicit use. Ketamine is used in sexual assaults because it is odorless and tasteless and has amnesia-inducing properties. According to the 2021 Monitoring the Future Survey An estimated 0.9 percent of 12th graders reported using ketamine in the past 12 months.
Ketamine is widely-used for pain relief and putting people to sleep during surgical operations. The World Health Organization has labeled it an "essential medicine" since 1985. At high doses, ketamine users also report experiencing terrifying feelings of almost complete sensory detachment likened to a near-death experience (called a “K-hole,” similar to a bad LSD trip).
Like PCP, Ketamine was invented in the U.S. as a analogue of PCP. Dylan Levi King wrote in Palladium:.Ketamine was intended to deliver analgesic effects without turning people violent, as PCP sometimes did in human tests. The drug was patented by Parke, Davis & Co. in 1966 and approved by the FDA under the trade name Ketalar in 1970. [Source: Dylan Levi King, Palladium, June 23, 2021]
“It spread quickly through the Global South, since it was valuable emergency medicine in settings with undeveloped medical infrastructure. It was also an ideal battlefield anesthetic. It was easy to train people to administer an intramuscular injection of ketamine. Unlike with opioids, it was hard to accidentally kill a patient by suppressing their breathing. It provided the type of superficial anesthesia that worked when you needed to keep someone moving.PCP and ketamine work in similar ways: instead of numbing the body as an opiate would, they disconnect the subject from their body and environment.
“The fact that ketamine did not slip from the medkit to the streets is a testament to the control the party-state had over its charges — and also perhaps the limited appeal of ketamine to anyone that had access to morphine. The idea of abusing ketamine was introduced from the outside world.
“Shortly after ketamine got FDA approval, recreational drug users in San Francisco and Los Angeles immediately got their hands on it and sold it as a powder variously called K, 1980 Acid, and Special LA Coke. While working-class kids used PCP to replace barbiturates and heroin, ketamine attracted the same young, white middle-class Americans that were taking LSD.
“In the late 1970s, leaders in the psychedelic movement trumpeted ketamine as its future. When Western dropouts hit Goa, they discovered that Indian pharmaceutical plants were turning the stuff out in bulk. It became a staple on the Hippie Trail, eventually carried as far as Hong Kong.
Ketamine as a Medicine
Ketamine was approved many years ago as an anesthetic for painful medical procedures. In March 2019, the medicine esketamine (called “Spravato” by the manufacturer) was approved by the Food and Drug Administration as a treatment for severe depression in patients that do not respond to other treatments. Esketamine is closely related to the drug ketamine which is used illicitly and so there are concerns about the potential for misuse of this newly approved medication. In response, esketamine will be limited to administration in medical facilities [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services].
Unlike a prescription that can be taken home and might be diverted into recreational use, esketamine will be administered in a medical office as a nasal spray. Patients must wait at least 2 hours under medical supervision to ensure proper management of potential side effects. It is a rapid acting medication, so improvements may be seen immediately or within the first few weeks of treatment (unlike most other antidepressants which can take weeks to begin to show an effect). Traditional antidepressants target the neurotransmitters serotonin, norepinephrine or dopamine. Esketamine affects the receptor for a different brain chemical called glutamate and so it represents a new approach to treating depression.
There is also some evidence that psilocybin may be effective in treating depression and anxiety.1 The FDA has granted “Breakthrough Therapy” designation for two formulations of psilocybin being studied for safety and efficacy as a medical treatment for depression. It’s important to note that during such studies, psilocybin is always taken under medical supervision.
'Encouraging' Studyon Using Ketamine to Help People Quit Alcohol
A study published in 2022 said an infusion of ketamine could represent "new hope" in the treatment of millions of people with alcohol problems. “People with severe alcohol problems who were given ketamine infusions alongside psychological therapy quit drinking for longer than those who received a standard treatment for alcoholism, according to the findings of a study published in the American Journal of Psychiatry. [Source: Dr. Catherine Schuster-Bruce, Business Insider, January 12, 2022]
Dr. Catherine Schuster-Bruce wrote in Business Insider:“The risk of relapse in the group that received ketamine-plus-therapy at six months was 2.7 times less than in those who received a placebo plus alcohol cessation education, researchers from University of Exeter and Awakn Life Sciences, a US biotech, said. “Celia Morgan, lead of the Ketamine for reduction of Alcohol Relapse (KARE) trials, said of the findings: "We've had no new treatments for alcoholism in the last fifty years. We found that controlled, low doses of ketamine combined with therapy can offer a new hope for alcoholics and save lives."
Ketamine was chosen for treatment of rigid behaviour, such as addiction, because it can cause hallucinations, dissociation and changes in perception, “Morgan, a professor of psychopharmacology at the University of Exeter, told Insider that the approach was "a radical shift from normal addiction treatment services, particularly using a drug as a catalyst for psychological therapy."
“Morgan, also head of ketamine-assisted therapy for addiction at Awakn Life Sciences, said that participants got three infusion over three weeks with a final therapy or education session on the fourth week. "It's really promising that effects were seen six months after a fairly short duration of treatment", she said. "We hope here in the UK that it should be something that's more widely available within three to five years," she said, adding that the team was preparing for it to be released as a treatment in countries like the US too.
“Morgan cautioned the treatment wouldn't work for everyone and others may need "top up" sessions. "While effects are long lasting in some, it's not likely to be a 'once and done' treatment for everyone," she said. "We will need to explore further in future how booster sessions may be given."
“Experts cautioned that a larger study will need to be undertaken to better understand the potential benefits of using ketamine to treat alcoholism. Allan Young, director of the centre for affective disorders at King's College London who was not involved in the study, told Insider that there was a "great need" for new treatments for alcohol use disorder — an area that had been underinvested in.
“The findings provide evidence that this approach might be beneficial, which "merits further study", he said. "You've got to have really large numbers in a study to show a drug is safe," and we need to find out if its effects last beyond six months, he added.
“"There's no justification for you taking ketamine as a treatment for your alcohol at the moment. But it's possible that this may give rise to a form of medical treatment in the future," he said.
Image Source: Wikimedia Commons, DEA (Drug Enforcement Administration)
Text Sources: 1) “Buzzed, the Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy” by Cynthia Kuhn, Ph.D., Scott Swartzwelder Ph.D., Wilkie Wilson Ph.D., Duke University Medical Center (W.W. Norton, New York, 2003); 2) National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services; 3) United Nations Office on Drugs and Crime (UNODC) and 4) National Geographic, New York Times, Washington Post, Los Angeles Times, Wikipedia, The Independent, Times of London, The New Yorker, Time, Newsweek, Reuters, Associated Press, AFP, , Lonely Planet Guides, and various books and other publications.
Last updated April 2022