LSD Poisoning 

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Aug 2, 2011
 

Background

Lysergic acid diethylamide (LSD) is a synthetic hallucinogen derived from the naturally occurring alkaloid lysergic acid, which is produced by the rye fungus Claviceps purpurea. Other natural sources of lysergic acid include morning glory seeds and the Hawaiian baby woodrose. LSD is a white, odorless, crystalline material that first was synthesized by the Swiss chemist Albert Hofmann in 1938. During the 1950s and early 1960s, the US Army's Chemical Corps and the CIA investigated the use of LSD as an incapacitating agent, one that caused temporary behavioral changes of such magnitude that soldiers were unable to perform their regular duties for hours to days. However, it ultimately was felt to have no practical military application.

The same mind-altering and mind-expanding properties that made LSD appealing as an incapacitating agent led to its application to psychiatry from the 1950s to early 1970s. Because of its ability to produce a so-called model psychosis, it was used in a variety of experiments leading to a proposed biochemical basis for schizophrenia. It also enhanced self-awareness and helped patients to elicit painful memories, making it a potentially useful therapeutic agent. Multiple reports suggested beneficial effects in the treatment of depression, obsessive-compulsive disorder, and sexual dysfunction.[1] For over a decade, it was also used to treat children with autism. However, as it became an increasing popular drug of abuse in the 1960s, restrictions were placed both on LSD research and on its use in psychotherapy.

It currently is categorized as a schedule I drug, indicating high abuse potential, no known medical application, and questionable safety. LSD abuse is currently on the rise. Like methamphetamine, it has become a widely used rave party or club drug.

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Pathophysiology

As a hallucinogen, LSD is 100 times more potent than psilocybin and 5000 times more potent than mescaline. It is believed to induce hallucinations by acting as a partial agonist at the serotonin (5'hydroxytryptamine or 5-HT) receptor 2A subtype in the cerebral cortex, especially on neocortical pyramidal cells. A serotonin-glutamate receptor complex may be involved.[2] Activation leads to increased cortical glutamate levels. LSD also has sympathomimetic properties.

The most common route of exposure is oral, and it is absorbed rapidly from the GI tract. Dermal absorption has not been well documented. LSD can be aerosolized and is absorbed by the lungs provided the particle diameter is 5 micrometers or less. Metabolism is primarily via hydroxylation and conjugation in the liver, with conjugates excreted in the stool. Tolerance develops after 3-4 daily doses. Full sensitivity returns after a similar drug-free interval. No physical dependence and no withdrawal occur.

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Epidemiology

Frequency

United States

According to the 2002 National Survey on Drug Use and Health, 24.2% of young adults aged 18-25 years had used some sort of hallucinogen at least once in their lifetime.[3]

Furthermore, National Institute on Drug Abuse (NIDA) data for 2007 revealed that 3.4% of high school seniors had used LSD at least once in their life, with 2.1% having used it within the past year.[4]

LSD is often used in clubs or raves. Primary motivations given for its use are experimentation, a desire to feel good, and a perceived enhancement of social interactions.

International

No data on international use are available.

Mortality/Morbidity

Very few deaths are attributed exclusively to the pharmacologic effects of LSD. Deaths associated with LSD use are often from trauma resulting from risk-taking behavior while intoxicated. There is also a strong association between accidental injuries and LSD, especially among young users.

Race

In the US, LSD is used predominantly by whites. While use by African Americans and Hispanics is less common, it has been reported in surveys of urban populations, especially in clubs and raves.

Sex

Males use LSD more frequently than females. The typical LSD user is a middle-class, risk-taking, white male in high school or college. However, a recent survey of women attending university-based ambulatory reproductive health clinics revealed that 13% had used LSD in the past.[5] There was also an association between LSD and high-risk sexual behavior.

Age

Of LSD users seen in emergency departments, 50% are younger than 20 years.

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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Alan H Hall, MD, FACEP  Assistant Professor of Emergency Medicine, Division of Toxicology, Texas Tech University Health Sciences Center at El Paso; President, Chief Medical Toxicologist, Toxicology Consulting and Medical Translating Services, Inc

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne White, MD  Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

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