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A bad trip the right way

The movie 'Death at a Funeral' accurately shows what a 'hallucinogenic concoction' might do.

September 10, 2007|Marc Siegel | Special to The Times

"Death at a Funeral," directed by Frank Oz, Sidney Kimmel Entertainment, U.S. release date Aug. 17.

The premise: The family patriarch has died. His niece Martha (Daisy Donovan) is bringing her fiancé, Simon (Alan Tudyk), to the funeral, where he will see his future father-in-law. Simon is so nervous that Martha offers him a supposed Valium from her brother's pill bottle. But the pill is actually "a hallucinogenic concoction of stuff like acid, mescaline, a little ketamine" (her brother's a pharmacology student). Simon takes one and a few minutes later, on the way to the funeral, is overwhelmed by giggling and euphoric hallucinations.

He sees colors, especially green, as accentuated, thinks his hands and feet have grown, sees a dog that isn't there, and, at the funeral, believes the coffin has moved. At one point, he strips naked and climbs out onto a roof. When he sees Martha being kissed by another man, his mood changes abruptly, and he considers jumping. Martha talks him out of it and is told by her brother that the effects of the drug will last for about eight hours. Later, five of the hallucinogenic pills are mistakenly given to the dead man's former lover, Peter (Peter Dinklage), but he survives.

The medical questions: How long does it take hallucinogens to begin to work? Would the effects last eight hours? What are the specific effects on the body of LSD, mescaline and ketamine? Are mood swings -- from euphoria to suicidal behavior -- realistic? Are there potential toxicities in a combination of pills?

The reality: Despite being a farce, "Death at a Funeral" accurately portrays many of the medical realities of mixed hallucinogens, and the onset of the drugs' effects could well be within several minutes. Hallucinations distort shapes, movements and the passage of time. "Good trips" may include euphoria and heightened understanding; "bad trips" may involve terror and despair.

LSD, which typically lasts for eight hours, alters perception and cognition while causing wild emotional shifts and intensifying the senses. Ketamine (a PCP-like drug known in recreational drug circles as "Special K") lasts at most a few hours. That drug, an anesthetic (numbing) agent, leaves users semiconscious. "They lose their coordination while at the same time feeling they are stronger and impervious to pain," says Jim Adams, an associate professor of molecular pharmacology and toxicology at USC. This paradox is the reason ketamine users often die from drowning, Adams says, and it may explain why Simon believes he can climb around the roof so easily. One rationale for mixing in mescaline, a much less potent hallucinogen than LSD, is that it tends to make the hallucinations last several hours longer, Adams says. This appears to be the case for Simon, who shows no signs of improvement over the course of the film.

Simon's mood swing from euphoria to severe depression is entirely consistent with the effects of LSD, Adams says, pointing out that "most of the deaths from LSD in the 1960s were from people jumping off rooftops."

Dr. Timothy Fong, assistant clinical professor of psychiatry and co-director of the addiction medicine clinic at UCLA, says the confusion of senses that Simon experiences, in which he can see and smell colors, a phenomenon known as synthesia, is classic for LSD. The sudden suicidal behavior that Simon experiences might be due to the drug's unmasking of an underlying psychiatric illness (such as bipolar disorder).

According to the National Institute on Drug Abuse, 13 million to 17 million Americans have tried hallucinogens. But mortality is generally because of risk-taking behavior. Deaths from the pharmacological affects, no matter how high the dose, are extremely rare.

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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University's School of Medicine. He is also the author of "False Alarm: The Truth About the Epidemic of Fear." In the Unreal World, he explains the medical facts behind the media fiction. He can be reached at marc@doctorsiegel.com.

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