Lecture on Recreational Drugs: Hallucinogens and Cannabis

Introduction

• Hallucinogens and cannabis are the last group of recreational drugs covered.
• Unlike stimulants and depressants, hallucinogens do not follow traditional sympathetic vs. parasympathetic rules.
• Effects are not clear-cut and require memorization.

Main Classes of Recreational Drugs

1. Cannabis (Marijuana, THC)
2. Serotonergic Psychedelics
   • LSD
   • Peyote
   • Psilocybin (Mushrooms)
3. Dissociative Psychedelics
   • PCP
   • Ketamine

Cannabis (Marijuana, THC)

• Usage: Widely used with historical records dating back to 3,000 BC.
• Psychological Effects:
  • Relaxation and euphoria.
  • Downsides include paranoia, impaired memory, lack of motivation.
• Physiological Effects:
  • Increased appetite (munchies), red eyes.
• Mnemonic: PIER (Paranoia, Euphoria, Eating, Red eyes).
• Withdrawal Symptoms: Anxiety, irritability, sleep issues, nausea, appetite decrease.
• Mechanism: Binds to cannabinoid receptors, similar to opioid receptors.
• Controversy:
  • No significant morbidity/mortality.
  • Potential treatment for PTSD, chronic pain.
  • Concerns about exacerbating psychosis in vulnerable individuals.
• Synthetic Cannabis (Spice/K2): Stronger side effects, not illegal.

Serotonergic Psychedelics

• Drugs Include: LSD, Psilocybin, Mescaline.
• Effects:
  • Sensory perception distortions (not hallucinations).
  • Visual disturbances, feelings of openness.
• LSD:
  • Famous from 60s counterculture.
  • Effects last 6-12 hours (the trip).
• Mescaline: Used in Native American rituals.
• Psilocybin (Mushrooms): Similar to LSD effects.
• Clinical Perspective:
  • Less harmful physiologically and psychologically than other drugs.
  • Possible hallucinogen persisting perception disorder.

Dissociative Psychedelics

• Characterized by: Dissociation from the body.
• Mechanism: Antagonize glutamate receptor (NMDA subtype).

PCP

• Effects:
  • Hallucinatory, induces belligerence, impulsiveness, psychosis.
  • Associated with eye movements (nystagmus).
• Clinical Presentation: Agitation requiring restraint.
• Withdrawal: Poorly characterized.

Ketamine

• Uses: Emergency anesthesia, recreational.
• Effects: Depersonalization, detachment, euphoria.
• Withdrawal: Poorly understood.

Recognizing Toxidromes

• Pupil Changes:
  • Dilated pupils: Stimulant intoxication or depressant withdrawal.
  • Constricted pupils: Opiate overdose or stimulant withdrawal.
• Nystagmus: Likely PCP.
• Conjunctival Injection: Likely marijuana.

Conclusion

• Tests often include eye-related symptoms to determine drug states.
• Further discussion on treatment modalities for psychiatric disorders.