Intoxication from LSD and other common hallucinogens
- João Delgado, MD
João Delgado, MD
- Assistant Professor of Emergency Medicine
- University of Connecticut School of Medicine
- Section Editor
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
"Hallucinogen" describes substances whose primary effects include the alteration of sensory perception, mood, and thought patterns. Naturally occurring hallucinogens have been used for millennia as part of ritual and religious activities. The first synthetic hallucinogen, lysergic acid diethylamide (LSD), was synthesized in 1938 by the chemist Albert Hofmann. Its hallucinogenic properties were recognized by accident in 1943 when Dr. Hofmann was inadvertently exposed to LSD while working in his laboratory . LSD was initially marketed as an anesthetic agent and touted as an adjunct for psychoanalysis. In the 1960s, LSD emerged as a recreational drug. Its popularity peaked in the late 1960s and early 1970s and has been declining since. The drug was banned under United States federal law in 1966.
Hallucinogens are used for their so-called psychedelic effects. These desired effects involve heightening or distortion of sensory stimuli and enhancement of feelings and introspection. Most hallucinogens produce sympathomimetic effects, including tachycardia, hypertension, mydriasis, hyperthermia, and diaphoresis, but these are generally mild . Nausea and vomiting are common and often precede the onset of hallucinogenic effects.
The clinical features, diagnosis, and management of intoxication from LSD and other prototypical hallucinogens (including dextromethorphan, some phenethylamines (mescaline, 2C-B, 2C-T-7), psilocybin and other tryptamines, and Salvia divinorum) are reviewed here (table 1). Amphetamines, methamphetamines, MDMA, ketamine, and phencyclidine (PCP) are discussed separately. (See "Methamphetamine intoxication" and "MDMA (ecstasy) intoxication" and "Ketamine poisoning" and "Phencyclidine (PCP) intoxication in adults".)
Lysergic acid diethylamide (LSD) remains the prototypical hallucinogen and the most extensively studied of such drugs. It is estimated that approximately 4.2 million persons in the United States used hallucinogens in 2014, mostly adolescents and young adults . Hallucinogens account for approximately 7 percent of United States emergency department (ED) visits involving illicit drugs . Hallucinogen use occurs worldwide, although the prevalence is generally considered to be low relative to other drugs of abuse . LSD has been supplanted as the most common hallucinogen by "club drugs", synthetic cannabinoids (eg, K2, spice) and naturally occurring hallucinogens, such as psilocybin and Salvia divinorum [5,6]. This is thought to be related to a number of factors, including the decreased supply of LSD, the emergence of "club drugs", such as ecstasy, and the ready availability of other hallucinogens via the internet [7,8].
A hallucination occurs when a person experiences sensory perceptions in the absence of external stimuli. True hallucinations can occur with recreational hallucinogen use. However, the alterations in perception commonly caused by these drugs are more accurately termed illusions because there is often a basis in reality for the sensory perception.
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- HALLUCINOGEN-ASSOCIATED TERMS
- GENERAL CLINICAL FEATURES OF INTOXICATION
- Neuropsychiatric effects
- Vital sign abnormalities
- Serotonin syndrome
- SPECIFIC HALLUCINOGENS
- LSD and other lysergic acid derivatives
- - Sources and dosing
- - Clinical features
- Mescaline, NBOMes, and other phenylethylamines
- Phencyclidine (PCP)
- Psilocybin and other tryptamines
- Salvia divinorum
- DIFFERENTIAL DIAGNOSIS
- LABORATORY AND RADIOGRAPHIC EVALUATION
- Basic measures
- Agitation and dysphoria
- - Benzodiazepines
- - Neuroleptics
- Gastrointestinal decontamination
- Antidotal therapy
- Avoid urinary acidification
- PEDIATRIC CONSIDERATIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS