Episode 30

  • What are dissociative hallucinogens?

  • What is Ketamine?

  • What are the effects of dissociative drugs?

Dissociative hallucinogens are specifically drugs like Ketamine, PCP, Salvia to name a few. They are known for making a person experience a form of dissociation. The level of dissociation is going to depend on dosage of course. We explore these drugs and their effects today on the podcast.    

Helpful Links

Substance Types and Effects: Hallucinogens

Ketamine for major depression: New tool, new questions – Harvard Health Blog – Harvard Health Publishing

Hallucinogens: what are they? – MyDr.com.au

Hallucinogens DrugFacts | National Institute on Drug Abuse (NIDA)

Hallucinogen-persisting perception disorder – Leo Hermle, Melanie Simon, Martin Ruchsow, Martin Geppert, 2012

Hallucinogen-persisting perception disorder

HPPD: Symptoms, causes, and treatment

A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD | SpringerLink

25 years of Hallucinogen Persisting Perception Disorder- A diagnostic challenge | British Journal of Medical Practitioners

Hallucinogens: Examples of Hallucinogenic Drugs

Hallucinogens | CAMH

Mescaline (hallucinogen) Uses, Effects & Hazards – Drugs.com

What Are Hallucinogens? | Drug Facts About Hallucinogens

PCP (Phencyclidine): 9 FAQs About Angel Dust

Substance use – phencyclidine (PCP): MedlinePlus Medical Encyclopedia

What is PCP?

PCP (Phencyclidine): Facts, effects and health risks

PCP (Angel Dust): Effects, Hazards & Extent of Use – Drugs.com

PCP: Risks, Warning Signs & What Parents Should Know – Partnership to End Addiction

The Association between Phencyclidine Use and Partner Violence: An Initial Examination

Phencyclidine Intoxication and Adverse Effects: A Clinical and Pharmacological Review of an Illicit Drug

Ketamine abuse potential and use disorder – ScienceDirect

Revisiting the Hallucinogenic Potential of Ketamine

Ketamine: Uses, effects, risks, and warnings

What Is Ketamine? | Dual Diagnosis

Patterns of Ketamine Use Among Young Injection Drug Users

How Long Does a Ketamine Treatment Last? – Principium Psychiatry

Ketamine | Effects of Ketamine | FRANK

Everything You Need to Know About Using Ketamine

Stories of Special K patients

Frontiers | Long-Term Heavy Ketamine Use is Associated with Spatial Memory Impairment and Altered Hippocampal Activation | Psychiatry

Long-Term Heavy Ketamine Use is Associated with Spatial Memory Impairment and Altered Hippocampal Activation

Ketamine abuse potential and use disorder – PubMed

Ketamine Abuse Signs, Symptoms, and Addiction Treatment

Dextromethorphan Abuse in Adolescence

Robotripping on DXM: What You Need to Know

Dextromethorphan (DXM) – Partnership to End Addiction

Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis

Dextromethorphan: a case study on addressing abuse of a safe and effective drug.

Cognitive deterioration from long-term abuse of dextromethorphan: a case report.

Dextromethorphan Withdrawal and Dependence Syndrome

What is Salvia? Drug Facts, Effects, & Use | NIDA for Teens

This Is My Brain on Salvia | WIRED

Salvia | Effects of Salvia | FRANK

Salvia Divinorum: Myths, Effects, Risks, and How to Get Help

Salvia: Extent of use, effects, and risks

What is Salvia? Drug Facts, Effects, & Use | NIDA for Teens

Free Treatment Tool https://betsybyler.com/treatment-tool/


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 30. Today we’re in part two of our mini series about hallucinogens. Hopefully you had a chance to listen to last week’s episode, where we talked about classic hallucinogens like LSD, shrooms, and DMT. This week, we’re going to be talking about a different class of hallucinogens called dissociative drugs.   As therapists we’re familiar with dissociation  because of our work with trauma. Dissociation is a normal response that the body takes when it feels like it’s in danger or needs to protect itself.

I think the dissociation is actually pretty brilliant. Our body figured out a way to take care of itself when it wasn’t able to get away from a scary situation. I think many of us have experienced dissociative moments when we’ve gone through something difficult or witnessed something difficult. I am thankful for the body’s ability to protect a person from having to absorb all of the intensity of a situation. 

In my work as a trauma therapist I see the association all the time.   I’ve heard people talk about dissociative episodes and currently there’s a lot of discussion on the social media app Tik Tok about depersonalization. I’ve had a number of my younger clients bring it up casually  as though it’s something that’s common and generally accepted. I do EMDR work with clients and we always have to be monitoring people’s dissociative level and whether or not it’s safe for us to continue processing or to begin processing.

The interesting thing about these drugs is that they have a dissociative effect, but they still are hallucinogenic and there are those properties. Each one of the drugs in this class are really interesting and pretty different. They’re in the same class because they generally do the same thing, but it’s not the same as saying Tylenol and Advil are in the same class and the same thing. These are really different experiences.

Dissociative drugs are like classic hallucinogens in that they distort a person’s perception of space and time. They can cause hallucinations just like classic hallucinogens, but the reason that they’re separated is that there’s a distance that’s created by these drugs. It’s a specific feeling of detachment. 

Now, when you take acid or shrooms or any of those other things, there is a detachment there as well, because you’re clearly not experiencing the world the way other people are experiencing the world, but this is a little more significant. Many of these drugs were actually used to be anesthetics that could be used during surgery, but have found other uses. 

Scientists believe that dissociative drugs work primarily by disrupting the action of glutamate, which is a neuro-transmitter, throughout the brain affecting the user’s perception of pain responses to environmental stimuli and memory. Many of the dissociatives in this category can produce depressant-like effects so that it slows things down and there can be a risk of things like sedation and respiratory depression.

When these drugs are used at a sub anesthetic level (so not enough to knock someone out or really put them in a state where they are totally disconnected) that’s when they have more hallucinogenic effects. Depersonalization and derealization are some of the main effects of using these substances.  So depersonalization, which is the feeling of being disconnected from oneself or unable to control one’s actions. Derealization is the feeling that the outside world is unreal or that one is dreaming.

The first one we’ll talk about today is the most dangerous of the hallucinogenic drugs. In general, a lot of the hallucinogens don’t have  a ton of serious risk to them, but this one does. Phencyclidine or PCP or commonly called Angel Dust is a dissociative anesthetic.

Taking PCP leads to the distortion of sights, colors, sounds, self and one’s environment. It was originally developed in the 1950s as an IV anesthetic,  but because of serious neurotoxic side effects, its development for human medical use was discontinued.  This led to the use of ketamine instead being used for surgery and painful procedures because it is structurally similar to PCP, but doesn’t have the same neurotoxic side effects.

In its purest form, PCP is a white crystalline powder and it dissolves readily in water or alcohol. There’s a distinctive bitter chemical taste. On the black market though, PCP contains a number of contaminants which causes the color to change and it’ll be from light to darker brown and  go from powdery to a more gummy type consistency. It’s sold in a variety of forms like tablets, capsules, colored powders.  PCP can be snorted, smoked, injected, or swallowed.  It’s most commonly sold as a powder or liquid and as applied to leafy material such as herbs, tobacco, or marijuana. 

The neurotoxic effects that are listed when it comes to PCP are agitation, mania, hallucinations, of course, and irrational thinking in patients  following its use for anesthesia. Agitation and the risk for violence is something that PCP is well known for. It’s been linked to violent and aggressive actions, psychosis, and risk of accidental death and overdose also can be life-threatening.

PCP appeared on the market in the 1950s as an anesthetic and tranquilizer known as Sernyl. It was discontinued in 1967 and limited to veterinary use only. Which is a little alarming to me because how would we know if animals are having hallucinations. In 1979, legal manufacturing of PCP in the United States was suspended. It’s now a Schedule 2 controlled substance because it carries a high potential for abuse and may have severe psychological or physical dependence upon it. It’s thought to be primarily made in the US and mostly in Southern California, but of course it’s made elsewhere as well.

So when somebody takes PCP, it affects multiple neurotransmitter systems in the brain. It inhibits the reuptake of dopamine, norepinephrine and serotonin. It also inhibits the action of glutamate by blocking the NMDA receptors, which are responsible for pain sensation, emotions, learning, and memory functions.

Interrupting these receptors allows the brain to disconnect from normal sensory experiences or reality. In higher doses however, it may also excite these receptors.  A typical dose is 5 to 10 milligrams and at the 10 milligram level it’s been reported to cause someone to go into a stupor.

How long it takes to kick in depends on the route of administration, which is the case for pretty much everything. Taking something orally is going to mean that it  takes longer to kick in because  it’s not being put directly into the bloodstream. Smoking it is faster than oral, snorting it would be next and then of course injecting it is the fastest.

So with an oral usage it takes like 30 to 60 minutes to kick in, which is pretty common for hallucinogens. With the other routes of administration we’re talking a few minutes to pretty much instantly. The immediate effects last like four to six hours, but returning to a normal state can take up to 24 hours later.

In addition to having hallucinations and feelings of detachment there can also be numbness, loss of coordination, disorientation of course, confusion, dizziness, nausea, increased heart rate and elevated blood pressure. At a lower dose, PCP makes you feel euphoric, floaty, disconnected from your body. As you increase the dose, the effects get more intense leading to hallucinations and sometimes erratic behavior. Just like most hallucinogens there’s a balance here with good experiences on one side and bad experiences on the other and it’s kinda like a seesaw. You’re not really sure what you’re going to get and things can change quickly depending on what happened, depending on a number of factors during your experience. 

You could go into it feeling euphoric, feeling weightless,  feeling relaxed or drowsy, or you could end up having anxiety, panic, agitation, paranoia, delusions, suicidal thoughts, those kinds of things. Physically speaking there are a lot of effects that could happen, but it’s not necessarily guaranteed that every one of these is going to go on. Remembering that there’s a lot of contaminants in PCP and  it’s not pure when you’re getting it off the black market. The physical effects we’re talking about are blurred vision, dizziness, difficulty speaking, impaired motor skills, decreased sensitivity to pain, which could be problematic if somebody is doing something that’s causing their body pain, but they can’t necessarily feel it. They could definitely get injured. 

I remember watching someone who was on a hallucinogen picking at their foot with a razor blade because they were convinced there was something in their foot. There wasn’t actually anything in their foot, but  they thought that there was something there and so they were using a razor blade to try to cut it out. You can see how this could be dangerous pretty quickly. There’s also muscle rigidity, irregular heartbeat, slow shallow breathing, changes in blood pressure, increase in body temperature, numbness, drooling has been reported, shivering and chills, nausea and vomiting, rapid involuntary eye movements, convulsions, loss of consciousness and coma. .

PCP generally lasts six to 24 hours, but it could linger up to even 48 hours in some people. PCP is said to be fat soluble and stored by fat cells. So lipid stores and fatty tissues hang on to it longer. PCPs half-life  is around 21 hours, but it can be detected for a few days or months, depending on  the type of drug test, body mass, metabolism, hydration level, dosage, frequency of use, those kinds of things. In general, the detection window is about 1 to 10 days in urine,  24 hours in the blood, 1 to 10 days in saliva and hair up to 90 days.

The overdose potential increases exponentially when you mix Angel Dust with substances that depress the central nervous system. The combination can cause your breathing to become dangerously slow and lead to a respiratory arrest or a coma. Which means that it can interact with things like alcohol, marijuana, heroin, narcotics, those kinds of things. It’s not to say that taking a stimulant is a great idea on PCP either, just that with depressants there’s a particular risk.

Some of the long-term risks for PCP are lasting learning and memory deficiencies that can cause problems in day-to-day functioning. There can be flashbacks and some of this is going to be like HPPD that we talked about (the hallucinogen persisting perception disorder where they have visual effects that are lingering) but there’s also that feeling of detachment that can come back. There can also be problems with speech like stuttering, trouble articulating and the inability to speak.

Feelings of depression and anxiety are common effects even with low doses of PCP. Higher doses or more frequent use of PCP can cause some severe depression and anxiety along with suicidal thoughts and behavior. PCP can cause some pretty intense psychosis, which there’ve been reports of that leading to risky behavior that can be the cause of death.

Overdose death  from PCP is possible, but a lot of the information talks about the danger being from being from the person’s behaviors while on PCP. Either suicidal thought or action, or other kinds of behaviors stemming from the feelings that PCP can give you of omnipotence, superhuman strength, and social and sexual prowess. You can imagine that being on a drug that detaches you from reality,  fills you with feelings of euphoria, superhuman strength, omnipotence, and agitation. Probably not a great combination.

There have been studies done to determine the link between PCP usage and intimate partner violence. They did find a correlation, although not quite as high as they were expecting, but what they found is  that intimate partner violence wasn’t the only type of violence that was happening as the person was also being aggressive outside of their relationships. They couldn’t conclude that PCP was directly the cause of the violence, but that violence was more likely to occur when PCP was present in a substance use profile.

Interesting things about PCP is that  there’s almost always a cannabis abuse situation as well because PCP is very often put on something to smoke. This is one of the issues that I talked about in the last episode about things getting laced with PCP. Because when that happens and you don’t know what it is (and I know from experience) it can be really, really scary when you’re not expecting it.

We’ll move on next to talk about ketamine. Ketamine is a PCP derivative.  Ketamine was partially created as an alternative to using PCP for anesthetic purposes. Ketamine is a Schedule 3 drug and is approved for use in hospitals and in other medical settings. 

Ketamine is similar in structure to PCP and it causes a trance-like state and a sense of disconnection from the environment. It’s been most commonly used as an anesthetic in veterinary medicine and is used for some surgical procedures in humans. Veterinary offices that also do surgery know that they have to be on guard for theft because of this particular drug. Certainly there may be other things on site that somebody would want, but Ketamine or Special K is the thing that a lot of people are after when they break into a veterinary office.

Like PCP, ketamine is also addictive. The most common form of ketamine is a white powder, which people typically snort or swallow  though some will dissolve it for use intravenously. The tablet form of ketamine has actually lost popularity since its club days, but many will still crush and dilute the tablets to mix them with other substances. The pharmaceutical version of ketamine that’s used for medical and vet purposes is in liquid form.

Snorting ketamine is thought to be the most ineffective method of ingestion merely because the high doesn’t last very long in comparison to other methods. Other methods though, have more risks since they require larger doses. Most people who swallow ketamine will mix it with something in order to make it go down easier. Putting it with alcohol, as you can imagine, is particularly risky since both have depressant effects.

So I think it’s clear that ketamine is a dissociative drug and that it can be used for an anesthetic. Creating a dream-like and detached state makes you feel chilled out relaxed or happy, but the hallucinogen side of it also causes it also has its own effect. It alters your perception of time and space and can make you hallucinate, visual or auditory. The fact that it stops you from feeling pain can increase risk for hurting yourself accidentally. 

If you take too much ketamine, you can lose the ability to move and go into a K-hole as it’s called. And this feels like your mind and your body has been separated and you can’t do anything about it. Probably similar to sleep paralysis. How long ketamine lasts depends on how much you take.

When snorting it ketamine takes about 15 minutes to take effect. When taken orally it’s longer, about 20 minutes to an hour. The high from ketamine or the buzz lasts like 30 minutes to about two hours. The come down from it can last anywhere to a full day to recover and to feel normal again. I should note that ketamine is sometimes used as a date rape drug rendering, the person immobile and unable to connect but still, in most cases, awake. 

When it comes to ketamine, there are short-term and long-term effects. It’s an interesting drug  because most of us have heard about ketamine being used in depression. We’re going to talk about this in the next episode  and other hallucinogens that are being used in mental health treatment.

There certainly are uses for ketamine  in treating depression, although we’re still in the early stages of understanding that. What we’re talking about today is about high dosage being mixed with other chemicals, potentially impure products to begin with and using it as a drug of abuse. This is really different  from ketamine and esketamine that are being administered in a clinic with medical procedures.  There is a withdrawal syndrome, just like you would expect from a substance that you can get addicted to. 

The physical dependency on ketamine doesn’t seem to be as strong  as a dependency that comes with things like alcohol or heroin, but there definitely is a withdrawal syndrome. Withdrawal symptoms are nausea, diarrhea, depression, anxiety. It’s pretty common for people who really like this drug to say it’s not addictive, but the treatment admissions for ketamine would suggest otherwise.

The main thing in the withdrawal for ketamine is going to be some mental cloudiness and trouble with memory and that kind of thing, sort of feeling foggy. Short-term problems with ketamine can be problems with attention and learning also memory, raise blood pressure, dangerously slowed breathing, unconsciousness and as to be expected slurred speech and diminished reflexes.

Ketamine affects a number of different systems in the body. There are lots of articles and I’ll link some of them that have to do with multi-system failures in the body due to chronic ketamine abuse. It affects the cardiovascular system, the central nervous system, the gastrointestinal system, the renal system, and the respiratory system, not to mention the psychological effects.

There’s a lot of different long-term effects that can happen because of all the systems that are being involved. But the most common ones are ulcers, bladder issues, kidney problems, and memory issues.

Some of the damage that can be caused by ketamine to the bladder and to the urinary tract system could be reversed if the person quits using, but a lot of it can be permanent. There are reports of people having to have surgery on their bladder or have their bladder removed because of the amount of ketamine that they had been using. There’s also quite a bit of evidence for liver damage related to ketamine use as well. Long-term users of ketamine do report things like depression and psychosis. This has implications for how we use ketamine to treat mental health. 

Ketamine is an interesting drug. It seems like  in drug abuse situations that at higher doses and the longer you use it, the more at risk you are for these adverse effects. It also seems like that depressive symptoms aren’t going to get better in those situations. Ketamine being used to treat depression needs to be well monitored so that the dosage is appropriate.

I have had several occasions in my career to work with people who have treatment resistant depression and it is awful. I have sat with people and felt so incredibly helpless, knowing that we have tried everything and that by all accounts that this person really shouldn’t be alive because they’ve been so suicidal and they’ve been hanging on for so long. As a therapist, I’m not sure that there are many worse feelings than feeling completely and utterly helpless for someone who’s in your office.

Treatment resistant depression I don’t believe is super common, but I have seen it a few times and it just leaves me feeling totally lost. Even though I’m an addict in recovery, even though I’m a drug and alcohol counselor, I still believe that if ketamine can help with people who have treatment resistant depression, I want us to be able to give it a try.

I absolutely believe that it is less damaging than what happens with ECT. I’m not an expert on ECT. It’s just my opinion in people I’ve worked with and seeing the aftermath of ECT. There are some people who have used ECT and they swear by it and it has been a lifesaver. And for that, I am also grateful. For the patients I have had I haven’t thought that ECT was the route to go, but in some cases it was literally the only thing and I knew it was just a matter of time before my client ended up killing themselves. So when we talk about ketamine as a treatment, which we’ll do next week, I am saying that in these instances, I believe we need to seek out all alternatives.

We’re going to cover two more drugs today. One is dextromethorphan, which is abbreviated DXM. For those of you who are working through the treatment planning tool I created, this is going to be in a little bit of a different class of drugs. Most people when you ask them aren’t going to think of dextromethorphan as a hallucinogen.

It’s going to be under the over the counter drugs. So when you’re working on finding out what substances of abuse that they’ve used, this is under the over the counter category. They may be able to tell you how many times they’ve used it. But if not, then we know that it’s been quite a bit.

There are different forms of it and so you’ll have to ask them which form they’ve been using, whether it’s been a liquid cough medicine or pills, and how many pills at a time, that kind of thing.  

If you haven’t had a chance to download the treatment planning tool yet just go tobetsybyler.com/treatment tool and you’ll be able to put your email address in and get the download link. The goal of the treatment planning tool is to  help you determine when to intervene in your client’s substance use. It’s totally free and there for you to use. 

Dextromethorphan is a common ingredient in a lot of cold medications. You may have heard of it when people are taking things like cough medicine in excess in order to get a trip, Dextromethorphan or DXM is used as a cough suppressant for the most part and it’s usually in things marked “extra strength”. When taken as directed, it’s safe and effective. DXM is a popular drug with a lot of adolescents  because it’s easy to get and found in a lot of people’s homes.

Low dosages of it produce a mild stimulant effect and possibly some distorted visual perceptions.  When you take a high enough dose of DXM the drug causes effects similar to PCP and ketamine.  There’s a complete detachment from the body like other dissociative drugs.  Some of this is done in liquid form in a cough syrup,  but dextromethorphan is also increasingly in a lot of cold medications that are in pill or tablet form. 

DXM effects really depend on dosage; any of us who’ve taken anything with DXM in it know that we’re not going to get high from it. It’s just going to be a  cough suppressant. So the effects of it change as you increase dose. There are said to be different stages of intoxication often called plateaus.

So the first plateau is at a hundred to two milligram dose produces effects similar to ecstasy, causes mild simulation and has an uplifting effect. People describe feeling more energetic, social and talkative. This is not to say that it’s the same as ecstasy.  It’s reminiscent of ecstasy, but nowhere near as powerful. For perspective here, we’re talking about 25 milligrams when you take it as a cold medication and 100 to 200 milligrams when we’re talking the first and lowest level of intoxication.

The second stage happens with like 200 to 400 milligrams of DXM. It’s compared with alcohol intoxication, except with more noticeable decline in motor skills and cognitive functioning. Euphoria and hallucinations are also likely with this dose. I’ve heard it said when taking this in cough syrup form also called robotripping for the Robitussin brand name that you either trip or you puke red.

The third plateau can get pretty intense. This is where the effects are similar to those of ketamine. This happens around 400 to 600 milligrams of dextromethorphan. Remember 25 milligrams is the normal dose for having a cold. Now we’re at 400 to 600 milligrams, and that is enough to leave you almost incapacitated. You’re strongly dissociated from your body and other things around you. There will be intense hallucinations and a loss of motor coordination. 

The fourth plateau is an extremely high dose of DXM anywhere from 500 to 1500 milligrams.  At this stage the effects are similar to taking PCP. The effects of this are kind of hard to shake off and lasts longer than the effects at other stages. Some people have experienced effects for two weeks after stopping DXM. It can cause a trance-like state  and sensation similar to an out-of-body experience. 

The physical side-effects are intense and dangerous. It could be things like increased body temperature, hot flashes, sweating, nausea, dizziness, slurred speech, lethargy, hyperactivity, high blood pressure, slow breathing, irregular heartbeat, itching, rash, involuntary eye movements, unconsciousness, seizures and a rare side effect would be respiratory depression. Dextromethorphan has been thought to cause Olney’s Lesions when administered IV.  Long-term use can cause some really serious problems  like liver injury and cardiovascular effects. 

I’ve known about robo tripping since high school. I personally haven’t done it, but I have known people that have. It wasn’t something that a lot of people did on a regular basis, but sort of a stop gap can’t-find-what-I-want, want-to-alter-my-state-of-consciousness. I have worked with people in treatment who were using it as their drug of choice. I worked with a young man once who was using triple C’s that’s Coricidin Cough & Cold. He was using 36 pills a day and the doctors believed that it had caused heart damage. 

There are case studies of adults becoming addicted  to using dextromethorphan. One of them was a man in his forties who was using 1800 milligrams a day. There is a tolerance effect and a withdrawal effect. The withdrawal effect is, as you would expect, agitation, cravings, nausea, jitteriness, those kinds of things. So it is something that we need to pay attention to. Typically the words I hear are robo tripping or triple C’s, and sometimes people will say DXM, but  often I just ask about their use of over-the-counter medications and if they’ve ever abused them. 

A lot of times my adult clients will say “yeah, when I was in high school I did that” and I’ll ask them if they remember how often they did it, just because I’m curious to know what their use was like then. It helps me understand better their stages of use and how they got to where they are now. 

This is not a scheduled drug.  It’s been brought up at different times in different contexts for suggestion than it should be  a scheduled drug, but it hasn’t been yet. There are a number of states who have banned the sale of things with dextromethorphan in it to minors. But for the most part it’s not heavily regulated. You’ll note that a number of years ago we stopped being able to buy things like Sudafed that had pseudoephedrine in it because of its use in making meth.

Now you have to buy things with pseudoephedrine from the pharmacy counter, even if they are over-the-counter. They’ll often limit the number of packages that you can buy at a time. That’s in direct response to people abusing that substance. If dextromethorphan became scheduled that is what would happen to it as well and we’d have to buy it at the pharmacy counter.

We have seen a decrease  in DXM use nationally in the United States since about 2010. There was a large push during that time to make people aware of this medication being abused.  The reports say that the use dropped as much as 35%. Sounds like a really big number and I’m not totally sure about that, but I do think that there are more people aware that you can abuse cough medicine. Teenagers, of course, generally know this, but a lot of parents haven’t and hopefully are becoming more informed.

The last drug we’re going to cover today is salvia. Salvia divinorum is a plant species with a transient psychoactive property when the leaves are consumed by chewing, smoking or in a tea. The leaves contain opioid-like compounds that induce hallucinations.

The plant hasn’t been studied super well. There have been studies recently looking into this, suggesting that salvia is kind of an atypical hallucinogen.  It is naturally occurring, which is rare for a lot of hallucinogens and we don’t have a lot of information about its toxicology,  adverse effects or safety.

It’s in the mint family, has large leaves and occasionally white flowers. Native plants reproduce it vegetatively, but rarely produce viable seeds. Again, our old friend, Albert Hoffman who helped find LSD  and synthesize the psilocin  for mushrooms was also the person to work on salvia. 

The plant originates in Mexico. It’s still used by the Mazatec  primarily to facilitate shamanic visions. It was first recorded in print by a man in 1939 who was  studying Mazatec  shamanism. He later documented its usage and effects through personal testimonies. It wasn’t until the 90s that the psychoactive mechanism was identified.

The active ingredient is salvinorin, a Kappa-opioid receptor agonist. The agonist attaches to and activates specific central nervous system receptors that are mainly in the brain. This receptor seems to play a key role in regulating human perception. Salvia may also have an effect on dopamine. 

Traditionally the leaves are rolled into a cigar and they chew and suck on the end of that without swallowing and it goes into  the lining of the mouth, or  it can be brewed in a tea. Recreationally it’s typically smoked using a hookah or being rolled in some kind of paper, or chewing on the leaves and holding the juice inside the cheek. The most intense effects usually appear within two minutes after smoking. The effect will last for less than 20 minutes.

A lot of times people will say it’s about five to 10 minutes. The reason people like salvia to abuse, (and this is not about using it for traditional purposes, this is about abuse) the reason people talk about it is that it’s really intense and really fast. It hits fast and it’s over fast rather than having some really long trip.

Some people have talked about using salvia as being something like turning on a light switch. It happens near instantly once you use it. Things are normal and then all of a sudden turn into an altered sense of reality. It’s supposed to change your interoception or the experience of what’s going on in your body as well as create feelings of disorientation and uncertainty about what’s real. How much salvia is needed to produce this effect it depends on the person as well as the quality of the plant. 

It can produce visual distortions and hallucinations, dissociation  and disconnection from reality disorientation or dizziness,  synthesia (which is hearing colors or smelling sounds), cartoon-like imagery, improved mood and uncontrollable laughter. Of course like most hallucinogens this is if it’s a good experience. There are a number of people who don’t like salvia because they found it to be intense and scary.

Around 2010 there were a lot of videos on YouTube, which I’m sure you could still find of people using salvia and their experience being recorded. Of course you can’t see what’s going on in their heads, but if you watch those it looks kind of like they’re having a psychotic break along with a panic attack. It doesn’t look terribly pleasant.

The aftereffect  is a little bit like coming off of a panic attack, sort of thinking “what the fuck was that”?  And then trying to get your brain to sort out and feel normal again. It’s not clear if it has an addiction potential or withdrawal or a tolerance. I personally haven’t known anybody who’s used it so often that that would happen. Again it’s sort of self-limiting, it’s really intense  and seems like it sort of crams an eight hour trip into five or 10 minutes. And that honestly sounds terrifying to me.

In a lot of places salvia has been totally legal. They sell it in head shops. And head shops, by the way, are places where you can buy stuff to smoke weed, hookahs, pipes, bongs, that kind of thing. Although they’re not marketed as being able to be used for weed, but that’s what they’re there for.

A lot of them now are attached to vaping and tobacco shops, not all of them,  but it’s definitely something that’s being combined. Depending on the law they just have to have it in a separate room and make sure that no one under  18 is going in there. But you could buy salvia in head shops. You could buy it online. There are some places that have decided that it’s a Schedule 1 drug and can’t be used for any reason, but the laws vary around the United States.

There has been research that’s been happening at John Hopkins University into salvia and its effects. They’ve been doing some scans  while people have used the drug to look at the brain activity and where it happens. In general there’s not a whole lot more known about salvia. I bring it up because it is part of the dissociative drug category because of the detachment feeling. I’m not certain that I think it belongs there because it feels a little more like a classic hallucinogen to me, but I’m not the one who made the classification.

Those are the drugs that we’re going to cover in this episode. There is a drug that you’ve probably noticed is absent from the last episode and this episode and that’s ecstasy, or MDMA. Ecstasy is sort of a different kind of drug. It definitely is a psychedelic, but it also has stimulant properties. It’s really a lot more complex in a lot of ways. Ecstasy is the one I think we hear the most about when it comes to mental health treatment or at least it has been. Next up, ketamine and after that psilocybin, which my husband pointed out might be pronounced psilocybin. And so I apologize if I’m annoying the hell out of anybody with my pronunciation, but I call it psilocybin and probably won’t remember to change it. 

So ecstasy is something that bears more attention because I do think that there are some uses that are probably going to become more standardized. It feels really weird as a therapist to be thinking about the idea of saying, “let’s let somebody take some ecstasy”. 

Instead of tripping a lot of times people will say that they were rolling on ecstasy. The words change kind of a lot, and I haven’t kept up with it. But ecstasy in recent years started to be called Molly. So if you hear that, that’s the same thing. In some places, there are people who say that Molly and ecstasy are different, but MDMA is the drug.  There are different variations of it because people are making this as it’s not naturally occurring. And of course we don’t know exactly what’s in it, depending on who made it, because we can’t tell. 

So that’s why I haven’t covered ecstasy in these two episodes. I’m going to talk about it next time and its implications for treatment. I will share with you the issues with recreational use.  But I didn’t think it belonged in either one of these categories. Next week, we’re going to be addressing the hallucinogens that are being used or suggested for use in mental health treatment.

Again, I am not an expert in this area. I think it’s something that as therapists, we need to be aware of to make sure that we know what the science is saying and also what treatments are available for our clients.

If you have questions about any of this and you think maybe I missed something, or you want to know about something specific, I encourage you to reach out and ask me. I love hearing from listeners, and I’m always happy to try to answer what I can.

I hope to see you next week when we talk about psychedelics and mental health treatment. .

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

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