Illicit Neurology: Taking Issue When the Other Illicit Shoe Drops

The use of illicit substances for the treatment of brain disorders is nothing new in neurology; it gets revisited periodically as the pendulum of drug regulation swings from one extreme to the other. Many readers may recall hospital inpatient pharmacies at times stocked beer for the treatment of alcohol withdrawal prior to the availability of more effective treatments like benzodiazepines.¹ Prior to hospital pharmacists doubling as inpatient bartenders, the Incan Empire of Peru used coca leaves as a panacea and local anesthetic.² The legalization of recreational marijuana and the use of marijuana for medicinal purposes continues to grow.

Andrew Phillip Huang addresses the use of marijuana for the treatment of movement disorders. Headache is one of the most prominent symptoms of traumatic brain injury and ketamine can be useful for TBI as well as for the treatment of headache disorders not secondary to head trauma. Marianna Vinokur, Fred Cohen, Patrick Sullivan, and Michael J. Marmura address the use of ketamine for the treatment of intractable headache.

Although less commonly used in mainstream medicine than cannabinoids or ketamine, there’s growing evidence that hallucinogens, including psilocybin (mushrooms), N,N-dimethlytrptamine (DMT, ayahuasca), lysergic acid amide (morning glory seeds), lysergic acid diethylamide (LSD), and mesaline (peyote), are effective for the treatment of various neurological and psychiatric disorders. Although physicians cannot legally prescribe or help secure these Schedule I drugs, Brian E. McGeeney addresses use of these drugs and practical advice of how we can best counsel our patients.

Finally, accessing and providing care is not always smooth sailing in the world of prescription drugs, and tends to an even bumpier ride when dealing with illicit treatments. To help us better understand the barriers facing patients using controlled substances for medicinal purposes, Bob Wold, Eileen Brewer, and Kevin Lenaburg provide us with an advocate’s perspective.

We hope that you find this final issue of 2022 enjoyable and enlightening. We are honored and humbled to serve as the Co-Chief Medical Editors of Practical Neurology. Our thanks to the editorial board, authors, peer reviewers, and the staff who have made Practical Neurology a success. As well, we thank Anne E. Sydor, PhD, who served as Editor-in-Chief from January 2018 through October 2022; we wish her all the best in her future endeavors.

The views expressed by the authors in this issue do not represent those of Practical Neurology, the Medical Editorial Board, or commonly held views in clinical practice