Mescaline (3,4,5-trimethoxyphenylethylamine) is the hallucinogenic alkaloid found in the Mexican peyote cactus Lophophora williamsii. It is a member of the phenylethylamine class of hallucinogens, and is structurally related to amphetamines. As for LSD, the hallucinogenic action of mescaline is believed to result from HT 2

agonist properties.10 Mescaline, however, is a much weaker hallucinogen than LSD.

The small 8-mm crowns of the peyote cactus are dried and sold as peyote "buttons," each containing approximately 45 mg of mescaline. A typical dose of 200 to 500 mg will require 3 to 12 of these "buttons." Mescaline can be extracted from peyote or be chemically synthesized, but these methods are expensive. Pills or capsules sold on the street as "mescaline" are unlikely to be genuine, 9 and may instead contain LSD or PCP.

Peyote is bitter tasting, and causes significant uncomfortable physical side effects within an hour of ingestion. Initial signs and symptoms, which often include nausea and vomiting, abdominal discomfort, diaphoresis, dizziness, nystagmus, ataxia, and headache, generally resolve after about 2 h. Adrenergic stimulation causes mydriasis, and mild elevations in pulse, blood pressure, and temperature. The hallucinogenic effects, which are very similar to those produced by LSD, begin several hours after ingestion and persist for 6 to 12 hours. Death due to aberrant behavior while under the influence of the drug has occurred, but reports of significant morbidity or mortality due to physiological effects of mescaline are absent from the literature. Patients presenting to the ED due to peyote ingestion can generally be managed supportively. Mescaline is not detected by routine drug screens.

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