Other Hallucinogen (LSD, MDMA) Intoxication

• The prevalence of other hallucinogen intoxication (not phencyclidine or PCP-like substances) can be roughly estimated by the prevalence of use.
• In the United States, about 1.8% of individuals age 12 years or older report using hallucinogens in the past year.
  • About 7.1% of adults age 18 to 25 using hallucinogens in the past year.^[2]

• The perceptual disturbances and impaired judgment from hallucinogen intoxication can result in injuries or fatalities.
  • This includes car crashes, fights, or unintentional self injury (e.g. - attempting to “fly” from high places)
  • Environmental factors, the “set and setting”, personality structure, expectations of the individual using the hallucinogen modulate the nature of and severity of hallucinogen intoxication.^[3]
• Other hallucinogen intoxication may lead to increased the risk for suicidality, although suicide is rare among users of hallucinogens.^[4]

Recent use of a hallucinogen (other than phencyclidine).

Clinically significant problematic behavioural or psychological changes (e.g. - marked anxiety or depression, ideas of reference, fear of “losing one’s mind,” paranoid ideation, impaired judgment) that developed during, or shortly after, hallucinogen use.

Perceptual changes occurring in a state of full wakefulness and alertness (e.g. - subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use.

At least 2 of the following signs developing during, or shortly after, hallucinogen use:

1. Pupillary dilation
2. Tachycardia
3. Sweating
4. Palpitations
5. Blurring of vision
6. Tremors
7. Incoordination

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

• LSD intoxication: Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, flashbacks (usually non-disturbing).
• MDMA intoxication: hallucinogenic stimulant: euphoria, hallucinations, disinhibition, hyperactivity, increased thirst, bruxism, distorted sensory and time perception.
  • Life-threatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome.
    • Fatal hyperthermia can be a consequence from MDMA use in rare cases.^[5]
  • MDMA withdrawal: depression, fatigue, change in appetite, difficulty concentrating, anxiety.

• Other substance intoxication
  • Intoxication with amphetamines, cocaine (or other stimulants), anticholinergics, inhalants, and phencyclidine may present similarly. Toxicological tests are useful to make the distinction.
• Other mental disorders
  • Other disorders and conditions to be considered include schizophrenia, depression, withdrawal from other drugs (e.g. - sedatives, alcohol),
• Other medical conditions
  • Certain metabolic disorders such as hypoglycemia, seizure disorders, tumors of the central nervous system, and vascular insults may present similarly.
• Hallucinogen persisting perception disorder (HPPD)
  • Other hallucinogen intoxication is different from HPPD because the symptoms in the HPPD continue episodically or continuously for weeks (or even longer) after the most recent intoxication.
• Other hallucinogen-induced disorders
  • Other hallucinogen intoxication is distinguished from the other hallucinogen-induced disorders (e.g., - hallucinogen-induced anxiety disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and warrant additional, independent clinical attention.