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Introduction   

Surveys show that the use of hallucinogen use among teens and young adults is rising. This course is not meant to create panic or anxiety, but to raise awareness and equip healthcare providers with knowledge on commonly used hallucinogens, how to recognize signs that someone is using them, possible dangers, and treatment options. .

Statistics on Hallucinogen Use 

The statistics on hallucinogen use among teens and young adults are important in understanding the prevalence. Hallucinogen use had been relatively stable for the past few decades until 2020, when it started to dramatically increase. In 2020, a study found that 8% of young adults reported using hallucinogen within the following year, which is the highest level found in the two decades since its use was first assessed in 1988 (7). Essentially, these studies have found that nearly one in 10 young people reported using hallucinogens within the past year. A larger poll and analysis in 2021 found that of people aged 12 or older, 2.6% (or about 7.4 million people) reported using hallucinogens in the past 12 months (4). According to the National Institute on Drug Abuse (NIDA) hallucinogens are most frequently abused by those between the ages of 18 and 25. The term “young adults” is fairly broad, so we will break it down. 

Among young people in 2022: (4) 

• An estimated 1.2% of 8th graders, 2.1% of 10th graders, and 4.4% of 12th graders reported using some form of hallucinogen in the past 12 months. 

• An estimated 0.6% of 8th graders, 1.3% of 10th graders, and 2.5% of 12th graders reported using the drug LSD in the past 12 months. 

• An estimated 1% of 8th graders, 1.6% of 10th graders, and 3.4% of 12th graders reported using non-LSD in the past 12 months. 

• An estimated 0.6% of 8th graders, 0.7% of 10th graders, and 1.4% of 12th graders reported using the drug MDMA. 

Types of hallucinogens reported during studies included LSD, MDMA (ecstasy), mescaline, peyote, psilocybin (mushrooms or “shrooms”), and PCP (7). The most commonly abused hallucinogens among junior and senior high school students were hallucinogenic mushrooms, LSD, and MDMA (2). The most commonly used non-LSD hallucinogen was psilocybin (1). Studies have noted that use of non-LSD were higher among males, whites, and individuals from households with higher parental education (1). 

Social media platforms have a significant influence on teens and young adults. Research has found that the platform is having a negative impact and further encouraging use. Common online videos describing positive experiences with hallucinogens and incorporating humor appear to normalize the use of these substances and may persuade viewers to try hallucinogens (3). Once a behavior seems normal and accepted, the probability of young adults participating increases. In the research study, common hashtags were: #Acid (LSD), #Shrooms (psilocybin), #Peyote (peyote), #DMT (DMT), and #Ayahuasca (ayahuasca) (3). Parameters and optional restrictions are needed for teens and young adults on social media platforms. 

Hallucinogens 

Hallucinogens are known for uniquely causing altered thoughts, perception, and mood. They are commonly called psychedelics (“mind-revealing”) or psychomimetic (“psychosis mimicking”) (7). Hallucinogens are referred to by many other slang terms including: (7) 

• LSD: acid, yellow sunshine, tab, blotter, yellow submarine, tripping 

• Mushrooms/psilocybin: little smoke, magic mushrooms 

• PEYOTE: cactus, buttons 

• PCP: angel dust, peace pill, dippers, greens 

Hallucinogens are found in a variety of forms. Hallucinogens are typically taken orally or can be smoked. Those who use hallucinogens report feeling strong emotions ranging from bliss to fear and significant altering of their reality perception (4).  

Types of Hallucinogens 

Hallucinogens are both naturally occurring and synthetic (made in the lab). Many psychedelic drugs are derived from plants and fungi and have been used for thousands of years for medicinal purposes or religious rituals. The term “hallucinogens” refers to psychedelic and dissociative drugs. There is debate on how different hallucinogens should be classified, but at this time they are grouped according to how the substance affects the brain [Table 1 below] (4). 

Table 1: Classification of Hallucinogens 

Psychedelic Drugs 

Studies suggest psychedelic drugs, such as psilocybin, LSD, and DMT, primarily affect 5-HT2A receptors in the brain, which are typically activated by the neurotransmitter serotonin (4). The effect from these substances also arises from the temporary disruption of communication between different brain regions, including the default mode network (DMN). The DMN is most active during brain activity that is related to self-awareness—such as reflecting on past events or planning future actions (4). This may be why psychedelic drugs can make an individual’s thought less self-centered and specific, but broader to the world around them. At certain doses, psychedelics may bring on vivid visions or sensations and promote feelings of insightfulness (4). 

Psilocybin, the psychedelic component of “magic mushrooms” is a compound of several mushroom-forming fungi species (8). Psilocybin is a pro-drug, which is an inactive compound that can be metabolized in the body and acts as a drug to chemical changes in the body (8). Psilocybin and psilocin were first identified in a laboratory setting in 1958 and studied for years, then given Schedule I classification in 1970 (8). Psilocybin can be ingested in the raw mushroom form or steeped in water to create a tea. 

Dissociative drugs 

Dissociative drugs, such as ketamine and PCP, also affect the balance of specific chemicals in the brain by disrupting the actions of the chemical glutamate at a type of receptor called the N-methyl-D-aspartate (NMDA) receptor (4). Glutamate is important in memory, emotion, and the perception of pain. While dissociative drugs can alter perception, they are known for causing an individual to feel disconnected from their body and environment (4).  

Other Hallucinogens 

Other drugs such as MDMA, ibogaine, and salvia work on a variety of brain functions to cause psychedelic or dissociative effects (4). MDMA stimulates the brain to release serotonin, mildly activates serotonin receptors, and increases activity of other neurotransmitters, such as dopamine and norepinephrine, which are involved in mood and attention (4). 

Hallucinogen Appearance and Packaging 

MDMA or ecstasy tablets are sold in many colors with a variety of logos to attract youth. LSD is sold in the form of saturated paper (blotter paper), typically imprinted with colorful graphic designs.  

Image 1: Examples of hallucinogens (MDMA and LSD blotter sheet) (2) 

Classifications 

As we mentioned, although researchers and medical professionals debate how specific hallucinogens should be classified, they are generally grouped according to knowledge on how they work in the brain (4). Many hallucinogens are Schedule I under the Controlled Substances Act (2). Schedule I substances are categorized like this due to high potential for abuse, the fact that they are not used for medical treatments in the United States, and a lack of accepted safety for use under medical supervision (2). 

Short- and Long- Term Effects 

As we educate on the impact of hallucinogen use, it is important to evaluate long term and short-term effects. A common misconception is that there is no harm in using these substances. However, studies show a tremendous impact on the wellbeing of users.  

Short-Term Effects 

• Acute Toxicity (8) 

• Anticholinergic toxicity can occur within 1 to 4 hours after ingestion.  

• Psychiatric manifestations may include confusion, agitation, delirium, and hallucinations.  

• Other clinical findings: Seizures, hyperthermia, hyperventilation, urinary retention, and arrhythmias  

• Psychosis 

• Altered perception 

• Impaired motor skills 

• Suicidal ideation 

• Poor decision-making abilities 

• Dysrhythmias (irregular heartbeats) 

• High risk behavior  

Long-Term Effects 

• Cognitive damage 

• Poor occupational performance 

• Job loss 

• Homelessness 

• Arrest 

• Ruined interpersonal relationships 

• Depression 

• Family conflict 

• Financial instability 

• Incarceration 

• Death 

Dangers of Hallucinogen Misuse 

There are many dangers to uncontrolled use of hallucinogens. In addition to physical injury due to compromised mental acuity, acute complications of hallucinogen use may include cardiovascular and central nervous system complications, metabolic disturbances, and hyperthermia (8). Reports reveal accidental traumas including drowning, motor vehicle accidents, homicide, and falls or jumps from great heights (8). The different types of hallucinogens have varied levels of risk. LSD is considered one of the most dangerous hallucinogens with the greatest potential to cause serious long-term damage. 

Many fatalities have resulted from cardiovascular complications associated with hallucinogen use (8). Some of the hallucinogens have anticholinergic effects. The release of endogenous catecholamines leads to increased blood pressure, heart rate, and myocardial oxygen demand (8). The use of hallucinogens is especially dangerous for patients with underlying cardiovascular diseases like heart failure and arrhythmias.  

There have been cases of acute cardiac failure including Takotsubo cardiomyopathy, cardiac ischemia, and myocardial infarction in patients with preexisting cardiac conditions following the ingestion of psilocybin, 5- MeO-DIPT, MDMA, and ibogaine (8). Ibogaine has also been implicated in fatal cases of cardiomyopathy, QT prolongation, arrhythmias, and cardiac hypertrophy, mostly in patients with preexisting cardiac issues (8). Long-term danger related to cardiac function has also been reported. Chronic cardiac toxicity associated with hallucinogen use may include cardiomyopathy.  

Hyponatremia has been reported as a result of hallucinogen ingestion (8). The mechanism is thought to occur due to increased release of antidiuretic hormone from the hypothalamus produced by serotonergic substances (8). Excessive water intake following hallucinogen use, especially with MDMA, may further worsen hyponatremia (8). Untreated hyponatremia could progress to cerebral edema, which may have serious effects including seizures, coma, and death. Hyperthermia may be induced as a result of extreme agitation, psychomotor activity, impaired sweating from anticholinergic effect, and inadequate fluid replacement (8). 

Remember, those who are under the influence of a hallucinogen are not using their typical decision-making skills. Risks and seemingly foolish activities may occur, for example, walking into a busy road while following perceived rainbow lights. 

Signs of Hallucinogen Use in Teens and Young Adults 

The symptoms of hallucinogen use, which are subjective and can be perceived only by the individual who uses the hallucinogen, are numerous and range from hallucinations to euphoria. However, it is vital to raise public awareness on the signs, which are the objective findings that can be seen by others or measured by a medical provider. Diagnosis of hallucinogen use is typically made with clinical judgement because drug levels are not usually measured. Other than PCP, most hallucinogens are not included in routine urine drug screens (5).  

Signs can include hearing the individual report intense psychological effects, which may alternate with periods of lucidity (5). LSD can have several physical effects, including mydriasis (dilation of the pupils), sweating, palpitations, and impaired coordination. Many other hallucinogens cause vomiting (8). With LSD, delusions, vivid hallucinations, anxiety attacks, extreme apprehensiveness, and panic states can occur. Psilocybin and mescaline are more likely to cause hallucinations.  

Figure 1: Signs of Hallucinogen Use in Teens and Young Adults 

This design was created on Canva.com on September 10, 2023. It is copyrighted by Abbie Schmitt, RN, MSN and may not be reproduced without permission from Nursing CE Central. 

Treatment Options 

Treatment for hallucinogen can vary depending on the type ingested, current symptoms, and length of abuse. It is important to recognize where the substance is active in the brain, which can help to understand and treat disorders resulting from use. Research shows the most significant activity of hallucinogens is in the brain’s prefrontal cortex, an area involved in mood, cognition, and perception (4). Treatment should focus on managing signs and symptoms. For acute intoxication from hallucinogens, providing a quiet, calming environment may help to reassure the patient with bizarre thoughts, visions, and sounds. Sedatives such as benzodiazepines (e.g., lorazepam, diazepam) may help reduce severe anxiety, but should be used with caution. Some patients may require chemical and physical restraints until the safety of others and themselves is assured. If the effects of hallucinogens become prolonged and persistent, it may precipitate psychotic states or other mental disorders and would require appropriate psychiatric care (5).  

Hallucinogen Disorder 

In recent years, there has been growing research interest in the potential of hallucinogens to treat medical conditions, including mental health disorders (4). In addition to those taking the substance within a medical setting, there is an increasing number of people who report taking it for recreation or to improve well-being and outlook outside of the healthcare setting. Sometimes, those who have used hallucinogens can experience the same signs and symptoms from the original drug used when they have not taken the drug (comparable to when you get off of a merry-go-round or roller coaster and continue feeling dizzy). This condition is referred to as hallucinogen persistent perception disorder (HPPD). This disorder is more common in long-term or repeat users (particularly of LSD). The recurrent episodes are commonly visual illusions and hallucinations (8).  

Research shows HPPD episodes or flashbacks commonly have triggers such as stress, fatigue, or use of marijuana, alcohol, or barbiturates. However, flashbacks can occur without apparent reason at times. The majority of those with HPPD report the episodes subsiding within 6 to 12 months, but some report that it lasts for years (8). Knowledge of this disorder is important for nurses and mental health professionals as bizarre behavior that aligns with hallucinogen intake may be the result of current or previous use of hallucinogens. Treatment for HPPD should be managed by a mental health provider and may include psychotherapy and use of sedatives (5).  

Support and Resources 

Support is a key factor in helping those impacted by hallucinogen use. It is important to convey the message that teens or young adults that are using hallucinogens, and their significant others, are not alone in the struggle.  

The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the U.S. Department of Health and Human Services (HHS) that has a mission to improve the lives of individuals living with mental and substance use disorders. This agency provides education on specific drug abuse, and resources on treatments recovery. SAMHSA’s National Helpline is available 24/7 for free and confidential information and treatment referrals are available in English and Spanish. SAMHSA’s Treatment Services Locator can be found at: https://findtreatment.gov/. 

Conclusion

Most nurses have a unique skill of predicting a “perfect storm,” in which a dangerous situation is possible when a number of negative and unpredictable factors are present. The euphoric effect of hallucinogens combined with the common attributes of teens and young adults (adrenaline-craving and feelings of invincibility) combined with social media making it seem “cool”, serves as a dangerous “perfect storm.”  It is important for nurses to be aware of hallucinogen types, statistics, dangers, signs of use, and resources for advocacy.   

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