PHYSICAL AND PSYCHOLOGICAL PROBLEMS

PHYSICAL AND PSYCHOLOGICAL PROBLEMS

LSD, psilocybin, and mescaline do not generally cause dangerous phys­ical reactions; and blood pressure, body temperature, and other vital signs remain reasonably stable unless there are acute anxiety reactions. A user is in little danger of seizures or coma. Furthermore, there is lit­tle evidence that these drugs activate the pleasure centers, and addic­tion and physical dependence do not occur. In this sense, they are remarkably safe. However, the psychological consequences for some users can be extreme. The bad trip, in which the drug user feels acute anxiety and perhaps fears that he will not be able to return, is the most common. Fortunately, this reaction ends as the drug is eliminated from the body. Acute anxiety can usually be treated with a dose of a benzodiazepine (a Valium-like drug—see the "Sedatives" chapter). "Talking down" can be helpful, but it is not always practical. While antipsychotic medications like Thorazine (chlorpromazine) were once popular, they are not always effective on bad trips and, in fact, can make things worse. Now that we understand that many hallucinogens act on serotonin-2 receptors, it's possible that an antagonist (blocking) treatment will become available that would terminate the trip immedi­ately. Research studies show that a 5-HT2 antagonist called ketanserin effectively blocks most psychoactive effects of psilocybin. Such drugs exist but have not yet been investigated or approved for this purpose in the United States. Similarly, the narcotic antagonist naloxone should stop a Salvia trip, but this hasn't been tested yet.

What about the myth that taking LSD will make you crazy? Hallucino­gens can worsen the symptoms of people who are already psychotic, but we don't know if they can cause psychosis. They certainly don't very often. However, a number of studies have shown that hallucinogen users are dis­proportionately represented among psychiatric inpatients, and that one to five people out of one thousand who take hallucinogens experience an acute psychotic reaction.

There is a "chicken and egg" problem in understanding this statistic. Most people who are hospitalized for a psychotic reaction to hallucino­gens have never before been seen by a psychiatrist. So, it is impossible to know whether they were completely healthy before the drug experience We do know that a small number of people have very serious reactions to LSD and similar drugs, including prolonged psychotic states. Also, people with a family history of, or other predisposition toward, mental illness should be particularly careful. Sometimes a hallucinogenic experience can bring out symptoms in such individuals