Drs. Halpern and Pope Reply

To the Editor: We thank Dr. Bogenschutz for supporting our view that the Internet provides a novel window into assessing current and emerging patterns of illicit drug use. As mentioned in our article, no web-based search will yield the same results over time; hence, Dr. Bogenschutz’s web search yielded interesting further findings since our survey was conducted in December of 1998. Many of the additional hallucinogens and nonhallucinogens that he mentions were noted by us as well but were edited from our final report for brevity.

The dearth of reports in the medical literature about problems with hallucinogens is perhaps unsurprising, given their long history of apparently safe ritual use in many traditional societies. For example, of the 982,856 drug-related emergency room visits reported in 1998, fewer than 5,000 involved LSD, compared to 172,000 related to cocaine (1). However, use of hallucinogens may continue in the United States and elsewhere in larger numbers than we might think. As one authority has commented, “Large numbers of people, mostly young, male and with high intelligence and creative ability are taking hallucinatory drugs without the medical profession being much aware of it. It is only when something goes wrong that the doctor is involved” (2).

We agree with Dr. Bogenschutz that much of the information posted at Internet drug sites is “quite accurate.” Of greater concern is how inadequate our scientific knowledge of these compounds remains. The bulk of the medical literature on hallucinogens is out of date and compromised by multiple methodological limitations. The Internet reveals that there are literally hundreds of drugs with hallucinogenic properties being ingested by humans, most of which have never been medically evaluated for dose range, effect, risk, or abuse liability. Can American psychiatric research continue to remain idle in this area while this “hidden” and ever-expanding pharmacopoeia is disseminated only across public forums like the Internet?