Psychedelics (a class of hallucinogens) have received a lot of hype in the news and on social media in recent years. It's so important for parents and youth to be educated on the risks these powerful, mind altering drugs carry.
The headlines of early research and clinical trials on the treatment of certain mental health disorders have been eye-catching. We are facing a mental health crisis and Americans are desperate for a quick fix. Michael Pollan’s 2018 book, “How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence” tapped into that emerging crisis. It also added to the confusion. “Magic” Mushrooms? Microdosing? Ketamine? Journeys? It’s challenging for the general public - much less teens - to know what is what.
Use is on the Rise. Not surprisingly, according to the most recent Monitoring the Future surveys funded by the U.S. National Institutes of Health, use of non-LSD hallucinogens is rising. For 12th graders, past 30-day use and lifetime use showed an “unusual pattern of increasing prevalence” from 2021 to 2022. Most concerning is that for young adults (ages 19-30) use reached an all-time high in 2021 since the survey was launched in 1988. From 2018 to 2021, the rate almost doubled.
Decriminalization and Commercialization. Bay Area cities such as San Francisco, Oakland and Berkeley have decriminalized certain hallucinogens for adults 21 years and older. This SF Standard article shows the availability of psilocybin mushrooms and products in the form of chocolate bars, gummies and vapes. Although retail is technically illegal, these products are sold in what’s called a “gray” market, sometimes brazenly.
This does not mean that psychedelics are safe, especially when used recreationally by youth. Psychedelics carry substantial risks of “adverse events”. As use has increased, so have the number of emergency room visits and even deaths from adverse events related to their use. In California alone, emergency room visits from psychedelics have increased 84% from 2016-2021.
Psychedelics are powerful and unpredictable drugs. Emotional responses can range from euphoria to paranoia, terror and fight-or-flight panic. This can result in erratic behavior and psychological trauma that can be lasting. It can lead to suicidal ideation and suicide to accidental injuries, violent behavior and even death.
As Dr. David E. Smith, Founder of the Haight Ashbury Free Clinics, observed in a recent article opposing legalization of psychedelics in California without safeguards, unlike the 60s, “these drugs have become glorified in the press. Many have begun experimenting with them – for the sheer hallucinogenic experience, for spiritual enlightenment and for help with their mental health struggles. Yet their risks have not been publicized and been largely ignored”.
Young Marin Lives Lost. Tragically, Marin County teens and young adults have died in recent years from adverse events after taking psilocybin mushrooms. Their stories are shared in this Marin IJ article. Many parents are speaking out to help educate the community and advocate for guardrails and protections for youth in future legislation.
As public and legal acceptance continues and enticing products proliferate, perception of harm decreases. We know from experience with other substances that these factors, combined with easy availability, likely will increase use by all age groups. Of most concern is the explosion of new hallucinogenic products in the form of chocolate bars, gummies and vapes that are enticing to youth.
For these reasons, it’s so important for parents and youth to be educated on the risks these powerful, mind altering drugs carry. Adolescents and teens are the most vulnerable of all.
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TYPES OF PSYCHEDELICS - PSILOCYBIN MUSHROOMS AND MORE
Psychedelics are a class of hallucinogens and come in many forms. Here we will discuss:
Some occur naturally (in fungi, cacti, trees, vines, seeds, and leaves) while others are made in laboratories.
PSILOCYBIN MUSHROOMS
Between the popularized “magic” mushroom name and the proliferation of products in the form of chocolate bars, gummies and vapes with packaging enticing to youth, these hallucinogens are of particular concern. Our community in Marin County has suffered tragic deaths of teens and young adults - all due “adverse events” after use of psilocybin mushrooms.
Psilocybin mushrooms are fungi that contain psilocybin, a naturally occurring substance which turns into an alkaloid, psilocin, when ingested. Magic mushrooms look like ordinary mushrooms and are eaten fresh, cooked or brewed into a tea. The dried version is sometimes smoked, mixed with cannabis or tobacco. Not all mushrooms are "magic mushrooms" and some can be poisonous. Others are safe to eat but have no psychoactive effect.
Dosing. Recreational dosing may include auditory and visual hallucinations and delusions, and intense sensory experiences. Doses range from .5 grams to over 5 grams. Lower doses are sometimes referred to as a “museum” or “Van Gogh” dose, for its heightened sensory experience. A medium dose for a psychedelic “journey” produces more intense hallucinogenic symptoms. A high dose is even more mind-altering with breaks from reality. The highest dosage level (over 5 grams) can involve a complete loss of a sense of self. That said, any dosage can be unpredictable - particularly for youth.
Of particular concern is the difficulty in getting an exact dose for chocolate bars and gummies. It’s risky to rely on product labeling or dosing guidance from retail establishments and websites pushing these products. “Just a few bites will send you on a powerful psychedelic trip” and “with 10-15 pieces, the walls might melt” are examples of the marketing and hype.
Effects. The effects of mushrooms are both physical and psychological and can appear within 20 minutes of ingestion and last up to 6 hours. Higher doses increase the risk of unpredictable results and last between 8 - 72 hours.
Mushrooms can cause hallucinations and an inability to discern reality from fantasy. Real or imagined objects appearing to be moving with eyes opened or closed. Depending on how much the user takes, and how their brain responds, a trip may be "good" or "bad." A good trip may be stimulating and pleasurable. A bad trip can be very unpleasant or involve a disturbing and frightening hallucination which can lead to panic and risky behavior, like running across a road or attempting self harm such as suicide and other adverse events. This can depend on what’s known as “set and setting” - mood and environment.
In a Phase 2 clinical trial investigating psilocybin therapy for treatment-resistant depression by Compass Pathways (the largest randomized, controlled, double-blind study), Compass reported that 14-17% of patients, depending on the dose, experienced serious adverse events requiring emergency treatment, including suicidal behavior, intentional self injury and suicidal ideation. These were patients given psychological support from specially trained therapists in carefully controlled clinical settings, which shows there is even risk involved under these conditions.
A recent systematic literature review and meta-analysis, the highest level of scientific evidence, shows that to date, there is low certainty of evidence to support psilocybin’s use for behavioral or developmental disorders.
Coming down. After taking magic mushrooms, delayed headaches can happen. These usually don’t last longer than a day. Coming down can also involve feelings of exhaustion, depression and anxiety. Taking mushrooms regularly doesn’t appear to cause addiction or physical dependence.
Flashbacks. Some people who regularly use psilocybin mushrooms may experience flashbacks from a previous experience. They are usually visual distortions that involve changes in your emotions or perception. Flashbacks can happen weeks, months or even years after the drug was last taken. This can be disturbing, especially if a frightening experience or hallucination is recalled. Flashbacks can be brought on by using other drugs, stress, tiredness or exercise and usually last a minute or two.
Also called: shrooms, mushies, blue meanies, golden tops, liberty caps.
Sources: https://adf.org.au/drug-facts/psilocybin/ and Stanford REACH Lab Curriculum.
LSD
Lysergic acid diethylamide or LSD is a synthetic chemical made from a substance found in ergot, which is a fungus that infects rye. In its pure state, LSD is a white odorless crystalline substance. However, LSD is so potent that an effective dose of the pure drug is so small as to be virtually invisible. As a result, it’s usually diluted with other materials.
The most common form is liquid drops of LSD solution dried onto gelatin sheets or pieces of blotter paper or sugar cubes, placed on the tongue and then swallowed, which releases the drug. LSD is also sometimes in a tablet or capsule. It can also be sniffed, injected or smoked.
The danger of LSD is that its effects are unpredictable. Like mushrooms, users do not know if they will have a good trip or a bad trip, and the effects of LSD can last up to 12 hours.
Coming down in the following days after using LSD, users may experience insomnia, fatigue, body and muscle aches, and feeling depressed.
Like magic mushrooms, some people who regularly use LSD may eventually experience flashbacks in the same manner as described above.
Other names: Acid, Trips, Tabs, Microdots, Dots, Lucy
Sources: https://adf.org.au/drug-facts/lsd/, Stanford REACH Lab Curriculum.
DMT
Dimethyltryptamine (DMT) is the active chemical found in a number of plants, including ayahuasca (pronounced “eye-ah-WAH-ska”) plant. It is a very strong psychedelic brew originally used by indigenous cultures in South America for spiritual ceremonies and psychosomatic healing. Its use has expanded to North America and Europe for spiritual and recreational drug tourism. DMT is structurally similar to psilocybin mushrooms. It can also be synthesized in a lab. DMT can also be smoked, and vapes have been found on the illegal market.
DMT is known to produce short-acting but intense visual hallucinations. DMT use can also cause unpredictable negative reactions, such as uncontrollable anxiety and delusions and psychosis, particularly among people predisposed to mental health issues.
In a 2022 study by Bouso et al, data from the online Global Ayahuasca Survey collected between 2017-2019 showed acute physical adverse effects (primarily vomiting) reported by 70% of users. Adverse mental health effects in the following days (weeks and months) were reported by 56% of the respondents, the most common being feeling socially disconnected, “energetically attacked”, anxious, and low mood. Most considered these effects part of the positive process of growth or integration. However 12% sought psychological support.
Like magic mushrooms and LSD, DMT flashbacks may be experienced.
KETAMINE
Ketamine is used by medical practitioners and veterinarians as an anesthetic. It’s also sometimes used illegally by people to get high and has been popular as a “club drug” among teens and young adults for its ability to produce dissociative sensations and hallucinations. Ketamine is a dissociative drug, which means it acts on different chemicals in the brain to produce visual and auditory distortion, and a detachment from reality.
The ketamine market is already up and running in the US and elsewhere, as ketamine was FDA approved as an anesthetic and is now used as an off-label treatment for mental health conditions, without much oversight. Indeed, during the pandemic, the DEA allowed ketamine to be ordered online and delivered to your door.
Adverse events on ketamine. There is some evidence to suggest ketamine can become psychologically addictive, and many anecdotal accounts of this. The problem has been particularly studied in China, where ketamine addiction has been a societal problem. Ketamine has been associated with kidney damage, is toxic when mixed with alcohol, and can cause dissociative effects leading to a “K hole,” where communication and interaction with surroundings are difficult. Ketamine use is associated with attention and memory problems, anxiety/unease/paranoia, muscle control problems (including stiffness), nausea/vomiting, slurred speech, slowed breathing, elevated heart issues (blood pressure, heart rate, chest pain).
It should not be used unless under the strict supervision of a medical professional.
Also called: Special K, K, Ket, Kitkat, Super K or Horse Trank
Sources: https://adf.org.au/drug-facts/ketamine/, Stanford REACH Lab Curriculum.
See also: https://tripsitter.clinic/blog/is-ketamine-psychedelic https://www.dea.gov/sites/default/files/2020-06/Ketamine-2020.pdf
MESCALINE AND PEYOTE
Mescaline is derived from Peyote, a potent psychedelic cactus used by Native Americans. It has similar effects to LSD. It grows as ‘buttons’ low to the ground. Peyote buttons may be ground into a powder and smoked or inhaled, sometimes with cannabis or tobacco. The buttons can also be chewed or soaked in water to produce a liquid and swallowed.
IBOGAINE
Ibogaine is extracted from an African shrub and has dissociative properties with psychoactive effects on the brain that are poorly understood because of its complex pharmacology. It is associated with intense visions and there have been alarming reports of adverse reactions. With a propensity to induce cardiac arrhythmias, there have been sudden deaths and other life threatening complications. In 1993, the FDA stopped a clinical trial after the sudden death of a patient.
MDMA (Methylenedioxymethamphetamine)
MDMA ( A.K.A. Ecstasy or “Molly”) is a synthesized drug made in a lab. It is a popular club drug - at nightclubs, raves and festivals. It causes the release of dopamine and serotonin in the brain. Serotonin controls mood, appetite and sleep. The MDMA molecule has the same base structure as methamphetamine (or meth), which is a stimulant. A person may experience the effects of MDMA within 45 minutes after taking a single dose. Those effects may include a sense of well-being, increased extroversion, emotional warmth, empathy toward others, and a willingness to discuss emotionally-charged memories. In addition, people report enhanced sensory perception, which may last 4-6 hours.
MDMA can also cause adverse health effects, with symptoms including high blood pressure (hypertension), faintness, panic attacks, and in severe cases, sweating and hyperthermia (overheating) which can lead to a loss of consciousness and seizures.
MDMA also causes extremely high levels of neurotransmitters (like dopamine) in the brain, which causes euphoria. As MDMA leaves the system, the body is dealing with the damage the overproduction of neurotransmitters caused. Depression and sadness during an MDMA comedown can be quite severe and can last for hours or days. After continued use, there can be long-term reductions in serotonin and other neurotransmitters, which make users feel much worse over time.
Sources: https://adf.org.au/drug-facts/empathogens/, Stanford Reach Lab
Significantly, a Phase 3 clinical trial of MDMA for treating PTSD conducted by the company MAPS, 7% of participants reported increased feelings of suicidality.
PSYCHEDELICS AND THEIR EFFECTS
Psychedelics are a category of hallucinogens
Psychedelics affect all the senses, altering a person’s thinking, sense of time and emotions. They can produce hallucinations - seeing or hearing things that do not exist or are distorted, delusions and detachment from reality. Hallucinogens affect everyone differently, based on:
size, weight and health
whether the person is used to taking it
whether other drugs are taken around the same time
the amount taken
the strength of the drug (varies from batch to batch)
mood (set)
environment (setting)
How do psychedelics affect the brain?
Scientists are still researching how psychedelics affect brain functioning. Much study has focused on an area in the brain called the claustrum, tucked deep inside each brain hemisphere. The claustrum is connected to almost every other region of the brain. This area has been compared to a switchboard that tells other brain regions to turn on and off in response to changing stimuli.
Studies suggest psilocybin can suppress the claustrum, and the resulting effect is as if the brain’s switchboard operator has walked away.
With the switchboard operator out to lunch, as one John Hopkins University neuroscientist explains, the different regions of the brain can interact in radically different ways. “Networks that normally don’t turn on at the same time may turn on and stay on, and they begin to fight for control. And other brain networks that would normally be involved in emotions or memories are firing on and off in an unpredictable fashion.”
Potential treatment of serious mental health disorders by medical professionals
When psychedelics suppress the claustrum, scientists have observed other “default areas'' of the brain may become quieter as well. These include a brain area that is active when we think about ourselves - an “ego” linked region. This ego region contributes to “default mode” thoughts in the brain, our regular inner chatter. Decreasing the input of these default areas in the brain through psychedelic use may contribute to the feeling of egolessness that many psychedelics users report.
For those with serious mental illness some default thoughts become so deeply ingrained they produce a profound psychological chasm that is resistant to talk therapy or medicines.
Psychedelics-assisted therapy for mental health conditions such as these is currently the subject of neuroscientific research and clinical study. Reportedly, over 180 clinical trials are currently underway. Hallucinogens such as psilocybin, LSD, DMT, Mescaline, and MDMA are being used in clinical settings to treat certain mental health disorders, including treatment resistant depression, anxiety, post traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and substance use disorders.
The goal of this experimental therapy is to create more plasticity in the brain, leading to thoughts “outside of the box”. However, increasing brain plasticity won’t automatically lead to a positive outcome. Medical doctors warn that trained therapists guiding and supporting patients in a controlled environment through the therapeutic process is not only more effective but also protective for a safe experience. Researchers still don’t fully understand how these drugs work, or what the long term effects are on the brain, so physicians don’t recommend using them unless in tightly controlled clinical studies.
Contraindications for use of Hallucinogens
Certain individuals are at greater risk for developing sustained psychosis or other bad outcomes from psychedelic use. Accordingly, there are many serious contraindications for use, which mean that pre-existing conditions may disqualify an individual from receiving a specific treatment due to potential risks involved. These include:
being on antidepressants
a family history of bi-polar disorder, schizophrenia or psychosis
Significant trauma histories or suicide ideation
heart conditions
seizure disorders
pregnancy
a previous adverse event from use of psychedelics
For this reason, clinical trials screen out persons with these conditions and histories.
Source:
Emerging Research on Harms
Research that directly focuses on the risks and adverse psychological experiences is beginning. One study by Jules Evans, et al (2023) found long term adverse effects from psychedelics use, including anxiety, social disconnection and continued visual distortions that persisted for weeks, months and even years (one-third reported difficulties lasting longer than a year, and one sixth longer than three years). Of the 608 survey respondents, 8% reported these difficulties even from use in therapeutic or clinical settings.
Another study by Otto Simonsson et al (2023) found 6% of respondents who used classic psychedelics considered harming themselves or others, with the most common adverse mental health effect being anxiety.
Reports of alarming incidents are also becoming more well known. Just a few months ago, psilocybin mushrooms were implicated in a midair emergency on a commercial airline. An off-duty Alaska Airlines pilot riding in the cockpit tried to shut off the plane’s engines after taking psilocybin mushrooms for depression 48 hours before.
Mixing psychedelics with other drugs
The effects of mixing psychedelics with other drugs, including alcohol, cannabis, prescription medications and over-the-counter medicines, are unpredictable.
Mixing psychedelics with stimulant drugs increases the stimulant effect and can further increase heart rate and place the body under extreme stress. Stimulants can also increase anxiety which can lead to a negative experience. Mixing psychedelics with benzodiazepines (Xanax, Klonopin, Ativan, Valium) can increase anxiety, sadness and rapid heart rate.
Most concerning is that it is not unusual for youth to mix psychedelics with alcohol and cannabis.
Distinguishing Microdosing from Recreational Use for Hallucinogenic Effects
Finally, it’s important to distinguish microdosing. Microdosing, called a “sub-perceptible dose”, is the amount too little to trigger hallucinations. Typically it is between 1/20 to 1/10 of a recreational dose. Microdosing affects the brain synapses and neurotransmitters (chemical messengers relaying signals in the brain) like a larger dose, but to a lesser degree. However, even microdosing can lead to tolerance, resulting in a desire for more frequent or needing a higher dose to get the same effect.
For this reason, even microdosing is not recommended on a daily basis.