CNS Stimulants And Hallucinogens
S.J. Mulé, Henry Brill in Chemical and Biological Aspects of Drug Dependence, 2019
These agents have had many labels, including hallucinogenic, psychotomimetic, psychodysleptic, and psychosomimetic, but most of these are somewhat misleading. For instance, “hallucinogenic” suggests that the drug gives rise to formed hallucinations in the sense that the user will see things that “aren’t there.” The term “psychedelic” is tinged with disrepute since it connotes the fascinating effects of these drugs and thus suggests a tacit approval of their use. Actually, although hallucinogens generally elicit perceptual distortions, they rarely produce true hallucinations. “Psychotomimetic” is a poor term, since drugs that give rise to toxic mental effects, agents as diverse as atropine, gasoline and alcohol, also produce psychosis. Yet the toxic delirium of gasoline intoxication is surely very different from the transcendental state elicited by LSD.
Historical Notes
Albert A. Kurland, S. Joseph Mulé in Psychiatric Aspects of Opiate Dependence, 2019
With the synthesis of cyclazocine, an N-substituted benzomorphine derivative, there became available an antagonist with two important advantages: The compound could be administered orally and was long-acting; moreover, if the dosage was gradually increased, cyclazocine blocked the effect of an opiate over a period of 24 hr or longer.121 The next step was taken by Martin and Gorodetzky122 and Jaffe and Brill123 as they carried out studies to determine cyclazocine’s usefulness in the management of the abstinent narcotic abuser. The rationale for this approach was that the administration of the narcotic antagonist on a maintenance schedule would attenuate or neutralize the euphorigenic characteristics, as well as minimizing the risk of physical dependence resulting from administration of an opiate. However, a number of disadvantages were associated with the use of cyclazocine: Rapid escalation of the drug’s dosage would result in the occurrence of relatively mild psychotomimetic effects of a transitory nature.The continued administration of cyclazocine was capable of inducing a dependency reaction so that the abrupt cessation of the drug’s use could result in the appearance of withdrawal symptomatology, although this was not particularly distressing.Restricting widespread clinical use of cyclazocine and carefully regulating the dosage was necessary to avoid producing its psychotomimetic effects.
Principles and examples of quality in medical communications
Stephen W. Gutkin in Writing High-Quality Medical Publications, 2018
We share a manuscript with an editor to fact check it and ensure “external fidelity” (see below), or accuracy compared to study data and published references. In addition to fact checking, what about “theory checking?” Take, for instance, a study of a medication being investigated to reduce behavioral disturbances in patients with schizophrenia that reveals very infrequent, potential psychotomimetic adverse effects (e.g., hallucinations). Although the incidence of the adverse event might be small, a caveat about this potentially distressing pharmacodynamic effect may need to be included as a limitation in the Discussion section of a study report.
Successful conversion from butorphanol nasal spray to buprenorphine/naloxone using a low-dose regimen to assist with opioid tapering in the setting of chronic pain and migraine management in an older adult patient: A case report
Published in Canadian Journal of Pain, 2022
Joshua MacAusland-Berg, Amy Wiebe, Radhika Marwah, Katelyn Halpape
Butorphanol is a mixed agonist–antagonist opioid that was approved by the U.S. Food and Drug Administration in 1991 in a nasal spray formulation for short-term treatment of severe pain.6 However, it was later marketed for migraine treatment despite a paucity of evidence for this indication.6 Butorphanol was initially proposed to have less psychotomimetic effects and reduced abuse potential compared to other opioids; however, postmarketing surveillance data identified drastic increases in addiction-related adverse effects up to 24%.6,7 In 2013, the Canadian Headache Society strongly recommended against the use of butorphanol for migraines due to the risk of adverse effects, dependence, and medication overuse headaches; lack of evidence of benefit compared to other agents; and potential for withdrawal upon discontinuation.7,8 Unfortunately, this recommendation came after many patients had been started on butorphanol and possibly developed dependence, creating a need for strategies to safely transition patients off butorphanol.
Can the revival of serotonergic psychedelic drugs as treatments for mental disorders help to characterize their risks and benefits?
Published in Expert Opinion on Drug Safety, 2022
M. Ishrat Husain, Madeha Umer, Benoit H. Mulsant
Current clinical trials have been conducted under highly controlled conditions. When using moderate to high psychedelic doses, acute psychotomimetic effects would be anticipated in close to 100% of individuals [20–23]. These effects include changes in five broad domains: cognition, perception, emotion, mystical experience, and social connectedness. All domains may have negative or positive effects with a dose-response that vary greatly between individuals. Cognitive changes associated with psychedelics may include increased flexibility and creativity, or disorganized and distractible thought patterns. Perceptual disturbances may be hallucinatory (primarily visual and auditory) or dissociative (derealization, depersonalization, time distortion). Negative emotions can include anxiety, irritability, mood lability, agitation, or frank paranoia; these negative emotions may be markedly distressing and drive patients to want to ‘escape,’ requiring close monitoring during treatment sessions.
Treatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2020
Alexandra H. Bettis, Richard T. Liu, Barent W. Walsh, E. David Klonsky
One promising possibility that has received increasing interest is ketamine and its derivative esketamine, which can be administered intravenously or as a nasal spray. In contrast to traditional treatment options, ketamine produces a therapeutic effect within hours rather than weeks (Berman et al., 2000). Reflective of the potential of ketamine, esketamine has been recently approved by the FDA for treatment-resistant depression (U.S. Food & Drug Administration, 2019), and several studies have been suggestive of its potential for producing a rapid reduction of suicidal ideation (Bartoli et al., 2017; Wilkinson et al., 2018). Although in its early stages, research has also identified potential neural correlates of both depression and suicidal ideation reduction and ketamine (Ballard et al., 2014; Ionescu et al., 2018). Although there are understandable concerns regarding the potential psychotomimetic effects and addictive properties of ketamine, there is evidence that this potential for adverse events is relatively low (Acevedo-Diaz et al., 2020; Daly et al., 2018). However, to date, no studies to our knowledge have directly examined the impact of ketamine on adolescent brain development, nor the potential addictive properties in adolescent samples. Thus, rigorous research in this area is needed. Nonetheless, the need for strict monitoring of ketamine administration, particularly with youth, cannot be overstated, and additional research is required to evaluate its potential as a short-term, fast-acting intervention for suicidality.
Related Knowledge Centers
- Butorphanol
- Delirium
- Delusion
- Hallucination
- Pentazocine
- Psychosis
- Cannabinoid
- Opioid
- Κ-Opioid Receptor
- Μ-Opioid Receptor