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ARTICLE |

Management of "Bad Trips" in an Evolving Drug Scene FREE

Robert L. Taylor, MD; John I. Maurer, MD; Jared R. Tinklenberg, MD
[+] Author Affiliations

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JAMA. 1970;213(3):422-425. doi:10.1001/jama.1970.03170290018003
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"Bad trips" arise out of an increasingly complex drug scene. Rational therapy must consider completely, social, psychological and physiological factors. Complexity results from the development of new drugs, indiscriminate ingestion, contamination, and adulteration. Drug-induced psychological changes occasionally lead to fatal behavior. Bad trips from anticholinergic compounds may be seriously worsened by phenothiazine treatment. Protection of the patient from dangerous behavior is fundamental to treatment. A clear history is invaluable but should be augmented by physical and mental examinations. Treatment begins with establishment of verbal contact without the use of tranquilizers, if possible. Reassurance and reality defining are often sufficient. With severe ego disruption, medication in combination with verbal interaction may be required. Administration of phenothiazines or sedatives helps to reestablish the observing ego with rapid dissolution of perceptual distortion and reestablishment of the premorbid ego functioning in most cases. Optimal treatment includes a follow-up visit.

REFERENCES

Smith DE, Fort J, Craton DL:  Psychoactive drugs , in Drug Abuse Papers 1969. Berkeley, Calif, Continuing Education in Criminology, University Extension, University of California, 1969;, p 10.
Smith DE:  Changing drug patterns on the Haight-Ashbury , Calif Med 110:151-157, 1969;.
Unwin JR:  Illicit drug use among Canadian youth . Canad Med Assoc J 98 (pt (2) ):449-454, 1968;.
Gershon S, Neubauer H, Sundland DM:  Interaction between some anticholinergic agents and phenothiazines . Clin Pharmacol Ther 6:749-756, 1965;.
Snyder SH, Faillace L, Hollister L:  2,5-dimethoxy-4-methyl-amphetamine (STP): A new hallucinogenic drug . Science 158:669-670, 1967;.
Solursh LP, Clement WR:  Hallucinogenic drug abuse: Manifestations and management . Canad Med Assoc J 98:407-410, 1968;.
Unwin JR:  Illicit drug use among Canadian youth . Canad Med Assoc J 98 (pt (1) ): 402-413, 1968.
Smith DE (ed): Drug Abuse Papers 1969. Berkeley, Calif, Continuing Education in Criminology, University Extension, University of California, 1969;.
Hollister LE: Chemical Psychoses. Springfield, Ill, Charles C Thomas Publisher, 1968;.
Weil AT, Zinberg, NE, Nelson JM:  Chemical and psychological effects of marijuana in man , Science 162:1234-1242, 1968;.
Crowell EB, Ketchum JS:  The treatment of scopolamine-induced delirium with physostigmine . Clin Pharmacol Ther 8:409-414, 1967;.

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Smith DE, Fort J, Craton DL:  Psychoactive drugs , in Drug Abuse Papers 1969. Berkeley, Calif, Continuing Education in Criminology, University Extension, University of California, 1969;, p 10.
Smith DE:  Changing drug patterns on the Haight-Ashbury , Calif Med 110:151-157, 1969;.
Unwin JR:  Illicit drug use among Canadian youth . Canad Med Assoc J 98 (pt (2) ):449-454, 1968;.
Gershon S, Neubauer H, Sundland DM:  Interaction between some anticholinergic agents and phenothiazines . Clin Pharmacol Ther 6:749-756, 1965;.
Snyder SH, Faillace L, Hollister L:  2,5-dimethoxy-4-methyl-amphetamine (STP): A new hallucinogenic drug . Science 158:669-670, 1967;.
Solursh LP, Clement WR:  Hallucinogenic drug abuse: Manifestations and management . Canad Med Assoc J 98:407-410, 1968;.
Unwin JR:  Illicit drug use among Canadian youth . Canad Med Assoc J 98 (pt (1) ): 402-413, 1968.
Smith DE (ed): Drug Abuse Papers 1969. Berkeley, Calif, Continuing Education in Criminology, University Extension, University of California, 1969;.
Hollister LE: Chemical Psychoses. Springfield, Ill, Charles C Thomas Publisher, 1968;.
Weil AT, Zinberg, NE, Nelson JM:  Chemical and psychological effects of marijuana in man , Science 162:1234-1242, 1968;.
Crowell EB, Ketchum JS:  The treatment of scopolamine-induced delirium with physostigmine . Clin Pharmacol Ther 8:409-414, 1967;.
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