Hallucinogens (psychedelics) have been used and abused since time immemorial. Many of these compounds, including mescaline (peyote cactus) and psilocybin (mushrooms), are used in religious ceremonies by Native Americans. These drugs were used actively during the 1960s and early 1970s. In the 1980s they were displaced by cocaine, but there has been a resurgence in their use, especially among teenagers.

The most commonly abused hallucinogen in the United States is lysergic acid diethylamide (LSD). LSD is made from lysergic acid found in the fungus, ergot, which can grow on grains. Many of the hallucinogens are structurally similar to serotonin, which suggests that this class of drugs exerts its effects by altering this neurotransmitter. LSD also alters adrenergic mechanisms in the periphery and acts as a partial dopaminergic agonist. It is the most powerful hallucinogen and produces symptoms at doses varying from 25 to 50 pg. LSD is sold in a variety of forms, including small sticky pieces of paper that contain as much as 300 pg of the drug. LSD is readily absorbable after oral administration. Its effects peak after 2 to 4 hours and may last for several hours.

Symptoms consist of euphoria, intensive arousal, panic, or even depression. Perceptual distortions are very common, as are hallucinations. Neurological abnormalities include papillary dilatation, lacrimation, and hyperreflexia. Patients report visual changes consisting of increased intensity of colors and alterations in shapes. No toxic fatalities have been reported with LSD use. A number of LSD users have recurring episodic visual disturbances, which include flashes of color, geometric pseudohallucinations, and fleeting perceptions in the peripheral visual fields. Formerly known as "flashbacks," these have been renamed the hallucinogen persisting perception disorder (HPPD). Some chronic heavy users of LSD have been reported to suffer from impaired memory, poor attention span, and confusion.

Users of LSD may require treatment because they experience severe anxiety, intense depression, or suicidal ideation. Therapy consists of "talking the patient down," which is a highly effective approach. If medication is required, diazepam given orally is the drug of choice.

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