_________________________________________________________________________ Natural Psychedelics
PEYOTE (MESCALINE) Peyote ( Lophophora williamsii ) is a type of cactus that grows in dry, desert regions of Mexico and Texas. Certain parts of the cactus have been used traditionally in rituals and recreationally as a hallucinogen [64; 93; 94; 95]. Most often, the disc-shaped buttons found on the cactus crown are sliced and dried. The dried buttons can either be chewed or soaked in water to make a tea. The psychoactive effects of peyote are attributed to the chemical mescaline [93]. The entire plant is considered a Schedule I controlled substance by the DEA, although this designation does not apply to the use of this plant in religious ceremonies conducted by the Native American Church [64; 121]. Mechanism of Action Mescaline has known sympathomimetic and hallucinogenic activity that is similar in nature to LSD. However, mescaline is known to be much less potent than LSD. Its effects typically occur within 1 hour of ingestion, peak within about 4 to 6 hours, and seem to last for approximately 12 hours [93]. Clinical Effects Unlike many other psychedelic plants with a long history of ritualistic use, peyote has not gained much traction as a potential therapeutic agent. To date, there is no clinical research evaluating its use for any medical purpose. Safety The most commonly reported adverse effects with peyote are nausea, vomiting, and diarrhea. These effects typically occur within 30 to 60 minutes of ingestion. It has also been reported to cause mydriasis, sweating, tremor, and elevations in blood pressure and heart rate within one hour after ingestion [95; 96]. The hallucinations that occur with peyote have also been associated with anxiety, paranoia, fear, and emotional instability that has the potential to lead to self-inflicted or accidental injury [95; 97; 98]. Mescaline, the major active constituent of peyote, has been reported to cause respiratory depression when used in large doses (20 mg/kg or more) and, rarely, death. Most symptoms seen with mescaline subside within 24 hours of use [95; 96]. Summary There is no known medical use for peyote. Its recreational use can be associated with unpleasant experiences and serious adverse effects. It should not be recommended for any medical purpose. SALVIA DIVINORUM (SALVINORIN A) Salvia divinorum , which is sometimes referred to as diviner’s mint or diviner’s sage, is a plant native to central Mexico. It has traditionally been used in rituals by the Mazatec people in Oaxaca, Mexico. However, it is also popular as a recreational psychedelic [29; 99; 100; 101].
Headaches associated with psilocybin are typically mild to moderate in nature. They have most often been reported to start about seven hours after psilocybin use and last for one to two days [71; 72; 79; 83; 84; 118]. The experience with psilocybin may be patient-dependent and may also be strongly influenced by environment. Some patients in clinical trials have reported experiencing fear, paranoia, anxiety, emotional disorder, and affect lability [76; 78; 88; 90]. These symptoms are generally mild to moderate. However, some patients have also reported experiencing severe anxiety that lasted days to weeks [78; 91]. Similarly, some patients responding to surveys have noted a reduction in feelings of well-being, and while some people have had a remission of suicidal ideation, some have experienced a worsening of suicidality [92]. It should be noted that many patients in these trials had underlying depression or anxiety, potentially confounding these findings. There is very limited information available on the safety of microdosing, an increasingly popular method of administration for psilocybin. A survey of 278 individuals who reported microdosing found that physiological discomfort, including visions, numbness, temperature dysregulation, insomnia, headaches, and gastrointestinal issues, were reported by 18% of people. Impaired focus and cognition, excessive or inadequate energy, increased anxiety, and worsening mood were reported in 2.3% to 8.8% of respondents. However, these were all subjective, anecdotal reports, and some patients were also microdosing with LSD [12]. Interactions Psilocybin should be used with caution in patients taking serotonergic drugs. Psilocybin has known serotonergic activity and may increase the risk for serotonin syndrome. Additionally, psilocybin has demonstrated stimulant activity in the CNS and should be used with caution in patients taking CNS stimulants. Summary Growing research on the use of psilocybin for various mental disorders is encouraging, although findings suggest a more modest benefit than what is often touted in mainstream news. It is important to remember that studies on psilocybin are at risk for response expectancy and that, to date, no studies have identified a method for adequate blinding. Additionally, psilocybin has consistently been studied in conjunction with psychotherapy and provided to patients in a controlled, pleasant environment. Administering psilocybin in this environment allows the patient to be monitored for serious adverse effects and elevations in blood pressure and heart rate. It also provides a positive environment that can influence the psychedelic experience. This context should be kept in mind when interpreting the research.
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MDTX1625
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