Today we have the fourth and final installment in the series with the above article. In this post, we’ll start with the hallucinogens and then continue on with organic solvents and performance enhancing drugs. So, we’re going to cover a lot of different drugs in a short span here.
First, are the hallucinogens.
Phencyclidine aka angel dust was originally used as an anesthesia. It can be taken by mouth, nasally or inhalation, but most commonly by smoking it. Folks abuse it because it gives one “heightened sensory perception with eventual hallucinogenic effects.” Besides the hallucinations, it also decreases the ability to feel pain, flushes the skin, causes sweating, raised blood pressure and rapid heartbeat. At higher doses, you’ll also get confusion, incoordination, slurred speech and “prominent nystagmus” or bouncing eyes. Because of the inability to feel pain and the hallucinations, these folks tend to self-mutilate, which is why angel dust fell out of favor. “Strokes were reported in some patients.”
LSD “alters perception, mood and thought.” LSD is more typically known for the bizarre behavior it creates which land it in newspapers for accidents and suicide. The same is also true for mushrooms. Only a few reports of stroke are associated with LSD, and of the ones that are reported, the stroke could be due to them person taking multiple drugs, which couldn’t be ruled out.
Ketamine is a veterinary anesthesia. It causes hallucinations and large doses can cause coma in humans.
“There is no convincing association with stroke in marijuana users.” Which was a surprise to me. Very large amounts can produce “toxic psychosis with hallucinations and paranoia.” Folks that use marijuana for a long time are showing some signs of psychoses as well, but this hasn’t been sufficiently studied yet. This is important to know in those states that have more relaxed laws around marijuana.
GHB, commonly found in roofies or the date rape drug, causes euphoria and disinhibition. Which is why the rapers love it. In excess it can cause sedation, disorientation, vomiting, muscle twitching and seizures. Unfortunately, I witnessed these effects first hand in college in another girl. She was really disoriented, vomiting repeatedly and couldn’t hardly stand up. We had to call an ambulance.
Organic solvent users are more commonly termed “glue sniffers,” although sniffing lighter fluid, varnishes, paint thinners, nail polish remover also falls into this category. These cause exhilaration, lightheadedness, giddiness, sometimes visual or auditory hallucinations. As they wear off, you’ll get vomiting, a headache and tinnitus. These become toxic with repeated or prolonged exposure which leads to incoordination, confusion, double vision, slurred speech and the bouncing eyes again. These symptoms worsen with more exposure and the respiratory system gets depressed, which can lead to coma. With chronic abuse of paint thinners, the confusion, incoordination and bouncing eyes can become permanent. A chemical called n-hexane, which can be found in some cleaners and glues, can cause a symmetrical numbness in the toes and fingers effecting all types of sensation– touch, pain, temperature and vibration. With prolonged exposure, it can creep up the limbs and cause weakness and autonomic features as well (flushing, sweating). Even after exposure has stopped, the symptoms may progressively get worse for 1-4 months. Then it may take months recover. The symptoms may not completely resolve either. This presents very similarly to Guillain-Barre and often gets misdiagnosed as such.
Finally, we have the performance enhancing drugs. These younger kids present with few neuro signs, so the clue is going to be in their history of being a gym rat, the clinical picture, unusual age and their buff physique. These folks are even harder to get to admit to abuse than your typical abuser. They will take a combination of illicit drugs: steroids, insulin, growth hormone (anabolic effects), amphetamines and cocaine (increase alertness and endurance, decrease fatigue), erythopoeitin (increasing the oxygen carrying ability of the red blood cells for endurance athletes) and beta agonists (fat burning). The steroids can produce high blood pressure and therefore strokes. The erythopoeitin is the more widely dangerous of the drugs. It can cause headaches, strokes, encephalopathy and seizures. Clenbuterol, which is one of the beta agonists, can make more a nasty headache and tremors. Do remember that folks with undiagnosed myotonia congenita may be accidently put in the drug abuser category.
To wrap up this series, I found this article very informative. Meaning the knowledge I’ve gleaned will inform my plan of care and treatment strategies I select when working with illicit drug abusers.