Hallucinogen Overdose and Abuse Management

Hallucinogens
These are plant derived or synthetic drugs that alter sensory perceptions and sense of self and others. They are highly variable and unreliable producing different effects in different people at different times.

All hallucinogens contain nitrogen and they work at least partially by temporarily interfering with neurotransmitter action or by binding to their receptor sites. Abuse of hallucinogens is as a result of significant variations in amount and composition of active compounds, particularly those derived from plants and mushrooms.

Medical complications of hallucinogens

Complications when using hallucinogens is common because of the large number of psychoactive ingredients in any source of hallucinogens. They include:- 
Schizophrenia abusers of hallucinogens can exhibit delusions, hallucinations and a sensation of distance from ones environment.

Mood disturbances this complication usually occurs when on uses phencyclidine since PCP induced problems leads to significant elevations in anxiety symptoms.

Fetal abnormalities these usually occurs where pregnant women use mescaline and for long periods. The drugs interfere with the normal development of the unborn baby.

Hallucinogen persisting perception disorder (HPPD).These medical complication is also referred to as chronic flashbacks. Flashbacks may occur spontaneously and repeatedly although less intensely than their initial occurrence. HPPD has no established treatment and at times its mistaken for neurological disorders.

Persistence psychosis prolonged use of hallucinogens can lead to visual disturbances, disorganized thinking, paranoia, delirium, psychotic behavior and extreme agitation.

Addictionindividuals who abuse phencyclidine usually become addicted to the drug thus when they are intoxicated, they may become violent or suicidal and are dangerous to themselves and others.

Seizureshigh doses of phencyclidine can cause seizures and eventually death (death is usually as a result of accidental injury when someone is intoxicated and has seizures). The seizures are a result of loss of muscular coordination.

Insomnia this usually becomes a medical complication especially to abusers of LSD (d-Lysergic acid diethylamide). The abusers experience severe episodes of sleeplessness which they cannot reverse to normal.

The sedative effects of PCP can lead to coma when used in high doses. This is as aresult of the interactions of PCP with other Central Nervous System depressants.

Procedures for overdose management of hallucinogens

The management and treatment of users and abusers of hallucinogens usually takes time since hallucinogens usually affect the brain.  The procedures for management can include

Pre-hospital care

1. Focus pre-hospital care involves preventing patients from harming themselves or others and transporting them to an appropriate facility for further evaluation. Calm, reassurance and non threatening behavior can be useful in talking down patients to allow care and interventions to proceed.
2. Appropriate use of physical and chemical restraints may be required. Benzodiazepines are pobably the safest sedatives and effective for calming down patients.
3. Avoid use of antipsychotics particularly haloperidol or droperidol in patients who may have ingested PCP.
4. If use of physical restraints is necessary, then team approach using at least 5 persons should be effective in quickly subduing and restraining the patient and minimizing risks of addiction and injury to patients.

Emergency department care

1. Once patients have been evaluated for significant trauma, place them in quiet rooms with diminished lighting and other stimuli. Supportive reassurance that the hallucinations are not real or dangerous is adequate care.
2. Haloperidols (2-5 mg) may be necessary to control the toxic psychosis if patients do not respond to supportive care and benzodiazepines.
3. Patients with episodes of perceptual alterations or pseudo-hallucinations produced by sudden changes of lighting may be managed with benzodiazepines.
4. Intoxication usually lasts 8-12 hours, but psychotic behavior may be present for 4 days. Patients generally can be observed until the acute intoxication has cleared and mental status has returned to normal.
5. Patients without residual effects or psychosis can be discharged safely with suggested follow ups in a few days.
6. Admit any patient with prolonged toxic effects for observation until the toxic symptom resolve or the patient has had evaluation for persistent psychotic behavior

Psychopharmacology

Antidepressants drugs can be prescribed to help improve mood and treat psychoses

Mood stabilizers drugs can be used to treat mood disoders associated with hallucinogen intoxication and or withdrawal.

Hallucinogen addiction treatment

While there is no specific protocol for hallucinogens, there are medications that can calm the body and mind during withdrawal and then if necessary, they can handle any psychological shifts caused by the absence of the drug. Some of the specialized addiction therapies include experimental therapy, dialectical therapy, and creative arts therapies among others.

Psychotherapy

Involves sophisticated protocols with proven efficacy which provide a strong foundation upon which patients may cope with fear or confusion associated with visual disturbances.