Written by SMH Emergency Clinical Pharmacist Jeremy Lund
Question — What drug was researched by the CIA as a truth-telling serum, credited by Paul McCartney as inspiration for several Beatles' songs, and cited by Steve Jobs as one of the most profound experiences of his lifetime?
The answer? LSD — aka “acid,” or the less commonly known “lysergic acid diethylamide.”
While these anecdotes paint LSD in a positive light, ingesting the hallucinogenic drug actually can be dangerous, and a recent increase in suspected LSD cases at Sarasota Memorial Hospital has care providers concerned.
What is LSD?
LSD is a type of hallucinogen, a category of substances that includes both natural and synthetic sources that cause people to hallucinate after ingestion; these range from mushrooms and plants to LSD. First manufactured in a laboratory almost 75 years ago, LSD became widely popular for recreational use in the early 1960s, before being banned in 1966. The illegal drug fell out of favor in the 1970s but had a comeback in the ’90s before fading away again in the early 2000s.
Now, nearly two decades later, SMH is seeing a rise in the number of Emergency Room (ER) patients who are agitated or violent after having ingested “a small piece of paper.” The cases all point to LSD ingestion as the cause. Only a fraction of LSD users ever seek medical care while under the influence of the hallucinogen, so the recent uptick at SMH likely means that LSD use is becoming more widespread in our community, particularly among teenagers.
Is LSD Dangerous?
Pure LSD is not “toxic” at common doses, but ingesting it comes with inherent risks, including potential overdose.
LSD is typically dosed in a very small amount onto an absorbent paper called blotter paper. Unless a user is manufacturing the acid, they likely have little certainty about what is on the small piece of paper they let melt it their mouth. A minimum “effective” dose of LSD is about 25 micrograms, but there are other chemicals that can be used to mimic LSD in this very small amount. Most of these are amphetamines (or what's called an “NBOMe”), which can be much more toxic and even have been associated with deaths.
Because LSD’s effective dose is so minimal, it’s easy for someone to take too much and overdose without even realizing it, until it is too late.
LSD’s chemical structure is similar to serotonin, a chemical in the brain that contributes to a sense of well-being and happiness. People who overdose on acid can develop serotonin syndrome, in addition to intense hallucinations. The risk is higher for those who take LSD while already on medications that affect sertonergic activity, such as antidepressants, Zyban/Wellbutrin, pain medicines, and cough and cold medicines.
LSD hallucinations can lead the user to behave in risky or dangerous ways. For example, LSD users have followed hallucinations into traffic, unaware of the speeding cars.
Many refer to the act of being under the influence of LSD as “tripping,” and when pleasurable hallucinations turn bad, the experience is commonly called a “bad trip.” During a bad trip, an LSD user is likely to become agitated, even violent, depending on what they are hallucinating. If the hallucinations are frightening, the user may react violently, thinking they are protecting themselves from harm but in reality, they are hurting others who were not a threat.
Another adverse effect of LSD is the phenomenon called “flashback.” This is when a person randomly has hallucinations while sober that are similar to what they experienced while tripping, even if they had not ingested LSD in years.
Signs of LSD Use to Look For
A person who is under the influence of LSD or another hallucinogen will likely have these symptoms:
- Fast heart rate
- Profuse sweating
- Breathing fast
- Elevated temperature
- Large pupils
Keep in mind that the effects of hallucinogens vary widely, and many users do not need medical care. Those who do are typically agitated and violent due to bad trips, or they have experienced some sort of trauma due to acting on their hallucinations.
In an emergency room, patients who are agitated or combative due to suspected LSD ingestion are typically given sedating medications and observed in the hospital for one to two days, while the hallucinogenic effect wears off and he or she is stabilized. (An LSD trip usually lasts 12 hours or less.) Aside from serious overdoses, most return to their baseline function at this point.
What to Do if You Suspect LSD Use
If you suspect someone is actively under the influence of LSD or another hallucinogen, and —
- You are concerned they harm themselves or others, reach out to Poison Control at 1-800-222-1222 or call 911 in an emergency.
- There is no medical or safety concern, remain calm as LSD users can be sensitive to the mood of others around them. Encourage him/her to stay in a safe place where they can't harm themselves or others. If they are having a bad trip, it’s a good idea to stay with them, turn off bright lights and loud noises.
Unlike with alcohol or other substances, you cannot “sober up” someone under the influence of LSD with water, coffee or food; these will not shorten the duration of the “trip” or lessen the intensity of the symptoms or hallucinations.
Outside of a hospital, the only remedy for a bad trip is time.
Sarasota Memorial Emergency Care/Toxicology Clinical Pharmacist Jeremy Lund, PharmD, MS, BCCCP, BCPS, has treated numerous emergency cases of accidental poisonings and chemical exposures, including those involving synthetic cannabinoids, synthetic hallucinogens and pediatric poisoning.