Treating Parkinson’s

L-dopa is a hallucinogen. Patients and their caregivers should be warned. Usually, they’re not warned.

Parkinson’s Disease (and a variety of other conditions, including stroke in the basal ganglia) that produce Parkinson’s like symptoms — tremor, facial rigidity, shuffling gait, and sometimes cognitive losses) is among the least pleasant aspects of aging.

The good news is that L-Dopa (available alone, or in combination with carbidopa under the tradename Synamet) is fairly effective at treating the symptoms of Parkinson’s.

The bad news is that L-Dopa is more or less a hallucinogen for many patients.

The worse news is that the pharmaceutical manufacturers have decided to be coy about that particular side-effect, whether for fear of scaring off potential patients or for fear of creating an abuse problem and risking having the drug made a controlled substance I’m not sure.

As a result, it isn’t routine to warn people taking L-Dopa for the first time that they may become delusional. The result is that they, and their caregivers, are subjected to avoidable worry and suffering. In some cases, no doubt, the delusions lead to an inappropriate psychiatric diagnosis and treatment with anti-psychotics such as haldoperidol.

Since the problem isn’t widely acknowledged, there’s not much research on its extent or management. Would it help to warn the patient? Would it help to have someone experienced in dealing with users of the more conventional hallucinogens around as a hand-holder? Do patients develop tolerance to the delusion-inducing properties of the drug? Is it possible for patients to gain insight about the falsity of their beliefs? (Users of LSD or other non-medical hallucinogens, even when they’re seeing — or even talking to — little green men, tend to be aware that the LGMs aren’t part of consensus reality.)

I don’t know the answers to any of those questions, but I’m pretty sure that it would help some if caregivers and family members were aware of the problem. No, Granny isn’t going bonkers: that’s just the medicine talking. If you can’t talk her out of her delusions, try cutting back on the dosage, or switching to one of the alternative drug, such as amantadine or bromocryptine.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: