Drug Abuse, Lysergic Acid Diethylamide

“Hallucinogen” with primary effects of heightened or distorted mood, thought, and sensory perception. The hallucinogen class includes LSD, mescaline, phencyclidine, and psilocybin. These drugs cause tolerance and psychological drug dependence but not physical drug dependence or withdrawal.

Initially marketed as an anesthetic agent; people began using it for recreational and spiritual purpose in the 1960s. LSD is still illegally used as a major hallucinogen worldwide.

LSD use peaked in the late 1960s, and use has been declining since. The National Survey on Drug Use and Health reports more than 200,000 people using LSD for the first time yearly.

LSD-related hospital visits remain low compared with those related to other major illicit drugs. In 2011, Drug Abuse Warning Network reported more than 1 million emergency department visits for nonalcohol illicit drug use; of these only 4819 were related to LSD.

LSD is semisynthetic and produces psychedelic effects, including distortion of time and perceptions of colored visual patterns and abnormal movements. Psychological effects include dysphoria, euphoria, and changes in emotion and moods. LSD also causes multiple physical effects, including dilation of the pupils, salivation, dry mouth, loss of appetite, nausea, blurred vision, perspiration, hyperglycemia, Htn, tachycardia, and hyperthermia. The mechanism of action of LSD is thought to be predominantly by serotonin neurotransporter interactions. Hallucinogen persisting perception disorder, also known as flashbacks, and psychosis are two long-term effects that can be exacerbated by other drugs, such as sertraline, fluoxetine, and marijuana.

Acute intoxication produces a sympathomimetic effect, including mydriasis, increased body temperature, systemic Htn, tachycardia, anxiety, agitation, vomiting, aspiration, apnea, and unrecognized injuries.

May prolong succinylcholine neuromuscular blockade and delay metabolism of ester local anesthetics (speculated inhibition of plasma cholinesterase).

May potentiate analgesics.

Systemic: Htn, tachycardia, hyperthermia, hyperglycemia, salivation, nausea, vomiting, seizures, and apnea

Serotonin syndrome: Triad of altered mental status, neuromuscular abnormalities, and autonomic hyperactivity

Psychiatric: Hallucinations (visual, auditory, and tactile), labile mood, acute panic attacks, agitation, and hypertonia

LSD is a semisynthetic odorless and colorless product of lysergic acid, a natural substance from the parasitic rye fungus Claviceps purpurea. It is also found naturally in several species of morning glory and Hawaiian baby woodrose plants.

LSD is physiologically well tolerated; severe symptoms from recreational use are uncommon. Only in the setting of large ingestion (>400 mcg) has life-threatening toxicity occurred due to cardiovascular collapse and hyperthermia.

There is high degree of psychological dependence but no evidence of physical dependence or withdrawal symptoms when acutely discontinued.

Classified under Schedule I of the Controlled Substance Act.

Psychological effects begin in 30–60 min and may last 8–12 h.

LSD displays both agonist and antagonist properties at the serotonin (5-HT) receptors, which are similar structurally with dopamine D2 receptors and have clinically related overlap.

The most common route of exposure is via oral with rapid GI absorption.

LSD is not associated with a physical or psychological addiction. Long-term use can result in persistent psychosis and hallucinogen persisting perception disorder (“flashbacks”).