Management Of Adverse Reactions

Mild and sometimes even severe episodes ('bad trips') can be managed by reassurance including talk, 'talking the patient down', and physical contact, e.g. hand holding (LSD and mescaline). The objective is to help patients relate their experience to reality and to appreciate that the mental experiences are drug-induced and will abate. Because short-term memory is disrupted the treatment can be very time-consuming since therapists cannot absent themselves without risking relapse. But with phencyclidine such intervention may have the opposite effect, i.e. overstimulation. It is therefore appropriate to sedate all anxious or excited subjects with diazepam (or haloperidol). With sedation the 'premorbid ego' may be rapidly re-established.

If the user's 'bad trip' is due to overdose of an antimuscarinic drug, natural or synthetic, then diazepam is specially preferred, or a neuroleptic with no or minimal antimuscarinic effects, e.g. haloperidol. A dose of an anticholinesterase that penetrates the central nervous system (physostig-

43 Campbell FA et al 2001 Are cannabinoids an effective and safe treatment option in the management of pain? A quantitative systematic review. British Medical Journal 323: 13-16.

44 Tramèr MR et al 2001 Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. British Medical Journal 323:16-20.

mine, tacrine) is effective in severe reaction to an antimuscarinic.

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