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CBRNE - Incapacitating Agents, LSD

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
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
Contributor Information and Disclosures

Updated: Mar 27, 2008

Introduction

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 was also used as a psychotherapeutic agent to help patients overcome inhibitions and explore their subconscious mind. Finally, for over a decade, it was used to treat children with autism. However, its application in psychotherapy decreased as it became a popular drug of abuse in the 1960s. 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.

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. Activation of these receptors 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.

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.1  

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.2  

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.3 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.

Clinical

History

The most common route of exposure is oral. LSD frequently is sprayed onto small squares of paper (ie, "blotter acid") that are decorated with a variety of patterns. Both the drug and paper are eaten. Current street doses typically are 20-80 mcg, considerably less than those used in the 1960s and 1970s. LSD also is sold as tiny tablets (microdots), thin squares of gelatin (windowpanes), liquid, or powder. It may be insufflated, smoked, injected, used sublingually, or instilled into the conjunctiva.

  • Mental effects develop in 30-90 minutes, peak in 3-5 hours, and last 8-12 hours. These include the following:
    • Feeling of inner tension, often relieved by laughing or crying
    • Multiple, simultaneous emotions, such as joy, rage, terror, or panic
    • Religiosity and a feeling of "oneness with the universe"
    • Possible distorted perception of the passage of time
    • Possible magnification or distortion of sounds
    • Illusions (or hallucinations with high doses)
      • Moving patterns of bright colors on people and objects
      • Geometric images within larger images
      • Trails behind moving objects
      • Halos around objects
      • Shapes blending together or melting like wax
    • Synesthesia or the mixing of sensory perception such that the individual may see sounds or feel colors
  • While the effects of LSD often are considered pleasurable to the user, at times they may be profoundly disturbing, resulting in a "bad trip." Novices as well as seasoned users can experience bad trips. Common manifestations include the following:
    • Panic reaction
    • Amplification of unconscious fears
    • Self-aggression
    • Suicidal or homicidal ideation
    • Fear of going insane or of the inability to return to normal
    • Perception of rapid aging of self or others
    • Profound depression

Physical

  • Predominantly sympathomimetic effects develop within 5-10 minutes of ingestion. Findings include the following:
    • Profound mydriasis
    • Hyperactive reflexes
    • Tachycardia
    • Hypertension
    • Tremors
    • Vomiting
    • Diarrhea
    • Piloerection
    • Mild pyrexia
    • Seizures (rare and typically with doses >10 mcg/kg)
    • Intact orientation and cognition
  • In massive overdose, additional signs include the following:
    • Coma (very rare)
    • Respiratory arrest
    • Hyperthermia
    • Coagulopathy

More on CBRNE - Incapacitating Agents, LSD

Overview: CBRNE - Incapacitating Agents, LSD
Differential Diagnoses & Workup: CBRNE - Incapacitating Agents, LSD
Treatment & Medication: CBRNE - Incapacitating Agents, LSD
Follow-up: CBRNE - Incapacitating Agents, LSD
References
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References

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  2. National Institute on Drug Abuse (NIDA). NIDA InfoFacts: High School and Youth Trends. Revised 12/07. National Institutes of Health. Available at http://www.drugabuse.gov/Infofacts/HSYouthtrends.html. Accessed March 25, 2008.

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Further Reading

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Keywords

LSD, D-lysergic acid diethylamide, LSD-25, CAS No 50-37-3, Chemical Abstracts Service No 50-37-3, Registry of Toxic Effects of Chemical Substances No KE4100000, RTECS No KE4100000, cid, acid, boomers, yellow sunshine, beast, heavenly blue, lysergic acid diethylamide, rye fungus, Claviceps purpurea, morning glory seeds, woodrose, hallucinogen, club drug

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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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

CME Editor

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, Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; 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, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

 
 
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