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Introduction: The global use of certain classical psychedelics has increased in recent years, but little is known about their spectrum of toxicity within Australia. We aim to describe calls to New South Wales Poisons Information Centre relating to exposures to classical psychedelics including lysergic acid diethylamide, psilocybin, N,N-dimethyltryptamine, ayahuasca, mescaline and ibogaine., Methods: This is a retrospective observational study of calls to New South Wales Poisons Information Centre between January 2014 and December 2022. We identified exposures to classical psychedelics within New South Wales Poisons Information Centre database and measured the annual number of exposures, source of call (hospital, health care worker, member of the public), co-ingested substances, clinical features and advice given., Results: There were 737 calls related to relevant psychedelic exposures; 352 (47.8 per cent) to lysergic acid diethylamide, 347 (47.0 per cent) to psilocybin, 28 (3.8 per cent) to N,N-dimethyltryptamine, 4 (0.5 per cent) to ayahuasca, 4 (0.5 per cent) to mescaline and 2 (0.3 per cent) to ibogaine. Cases were predominantly male (77.2 per cent) and aged between 20 and 74 years (65.6 per cent). Psychedelic calls more than doubled from 45 in 2014 to 105 in 2022 and 625 (85 per cent) of all calls were either from or referred to hospital. Co-ingestion of psychedelics with another substance occurred in 249 (33.8 per cent) of calls and the most frequent clinical features related to single substance psychedelic exposures were hallucinations (27.6 per cent), gastrointestinal symptoms (21.7 per cent) and tachycardia (18.1 per cent). Seizures occurred in 2.9 per cent of single substance psychedelic exposures., Discussion: Increasing incidence of psychedelic exposure calls, including those reporting significant toxicity, likely reflects increasing community use. This may in part be driven by increasing interest in psychedelic assisted psychotherapy trials subsequently increasing public awareness., Conclusion: Relatively high poisoning severity contrasts with safety within clinical trials of psychedelic assisted psychotherapy that may relate to the uncontrolled nature of community use which is mitigated within clinical trial environments. Education about safe use may be useful.

Objective: Adulteration, substitution or contamination of illicit substances can have clinically significant implications when other illicit substances are included. Such circumstances can present as clusters of poisonings, including severe toxicity and death following exposure to unexpected illicit substances. We report a cluster of laboratory-confirmed lysergic acid diethylamide (LSD) in a powder that was sold as cocaine and used recreationally., Methods: The Prescription, Recreational and Illicit Substance Evaluation (PRISE) program established by the New South Wales Ministry of Health includes State-based hospital toxicology services, Poisons Information Centre, Forensic & Analytical Science Service and emergency services to identify clusters of severe and unusual toxicity associated with substance use. PRISE criteria include a known cluster (geographically or situationally related) of people with acute severe toxicity, especially when accompanied by a toxidrome that is inconsistent with the history of exposure. A timely comprehensive drug screen and quantification is performed in eligible cases and the results are related to the clinical features. The need for a public health response is then considered. Four individuals inhaled a white powder that was sold as cocaine and developed severe toxicity that was not consistent with cocaine which prompted transfer to hospital for further management., Results: LSD was confirmed in four subjects, and the concentrations in 3 of the individuals were 0.04-0.06 mg/L which are among the highest reported in the literature. Common clinical features were hallucinations, agitation, vomiting, sedation, hypertension, and mydriasis. One subject required intubation and admission to the intensive care unit, two required overnight admission, and the fourth was discharged following oral diazepam after observation. No subject suffered persistent injury., Conclusions: A close working relationship between pre-hospital emergency services, hospital-based clinical services, public health authorities, and analytical laboratories appears to be advantageous. Favourable clinical outcomes are observed from LSD poisoning despite high exposures with good supportive care.

Competing Interests: All authors have disclosed no conflicts of interest.

Background: Lysergic acid diethylamide (LSD) and psilocybin are serotonergic hallucinogens that are used primarily for recreational abuse. Small studies evaluated the efficacy of LSD and psilocybin for several psychiatric conditions. There are limited safety or toxicity data for either of these substances, especially in large populations., Methods: This was a retrospective analysis of single-substance exposures of LSD or psilocybin-containing mushrooms (PcMs) reported to United States poison centers from 1 January 2000 to 31 December 2016. The study describes the most frequent toxicities, management sites, and medical outcomes., Results: A total of 5883 PcM and 3554 LSD exposures were included. Most patients were between 13 and 29 years of age (83.9% PcM, 88.9% LSD) and primarily male (77.9% PcM, 74.1% LSD). Most common clinical effects were hallucinations (45.8% PcM, 37.4% LSD), agitation (24.1% PcM, 42.4% LSD), and tachycardia (18.0% PcM, 38.6% LSD). Serious clinical effects were infrequent, but included hyperthermia, seizures, coma, increased serum creatinine, and cardiac arrest. Most patients were treated and released from the emergency department. More LSD patients were admitted to critical care and non-critical care units than PcM patients. Moderate effect was the most frequent outcome for both substances (61.0% PcM, 62.3% LSD)., Conclusion: These data find that LSD and PcM use occurs primarily in adolescents and young adults, who experience mild to moderate adverse effects. Serious effects are infrequent but can occur. While most LSD and PcM users require only emergency department management, LSD use is more likely to require medical admission.

A new class of synthetic hallucinogens called NBOMe has emerged, and reports of adverse effects are beginning to appear. We report on a case of a suicide attempt after LSD ingestion which was analytically determined to be 25I-NBOMe instead. Clinicians need to have a high index of suspicion for possible NBOMe ingestion in patients reporting the recent use of LSD or other hallucinogens.

Ergot poisoning is an uncommon but recognized cause of peripheral vascular ischemia and lower extremity gangrene. The traditional management of ergot-related vasospasm includes withdrawal of the inciting compound and supportive care. The authors report a rare case of ergotism related to lysergic acid diethylamide (LSD) ingestion and describe unconventional treatment of associated extensive lower extremity vasospasm with use of balloon percutaneous transluminal angioplasty.

Drug abuse affects a significant number of individuals of all ages. Health care practitioners must be knowledgeable about both the physiological effects of such drugs and the impact of drug-seeking behavior on their patients.

An increasingly prevalent component of today's adolescent and young adult culture are the rave or club drugs, such as Ecstasy, Rohypnol, gamma-hydroxybutyric acid, ketamine, Fry, lysergic acid diethylamide (LSD), and methamphetamine. Considering the incidence of accidental injury in this age group, young patients admitted to the operating room in emergency situations may be under the influence of one of these drugs. Each of these illicit drugs has distinct adverse physiological effects that may be compounded by the administration of anesthetic agents. Thus, it is important for the anesthetist to be cognizant of these drugs, their effects, and the potential risk factors they pose.

An 18 year old male ingested Hawaiian Baby Woodrose seeds (containing the hallucinogen lysergic acid) and required hospitalization for psychotic behavior. This is the second documented case of an acute psychosis ascribed to ingestion of this plant, and it is suggested that Hawaiian Baby Woodrose ingestion should be present in the differential diagnosis when dealing with the acutely psychotic young adult patient.

The seeds of the Hawaiian baby woodrose ( Argyreia nervosa) are used by adolescents as a supposed hallucinogenic drug. These seeds are legally available and broadly sold. The active components are alkaloids structurally related to lysergic acid diethylamide (LSD). However, the psychic effects are very different from those of LSD and are dominated by rather sedative, uncomfortable autonomic disturbances similar to the effects of scopolamine. The (psycho)pharmacological profile is described on the basis of the active substances lysergacidamide and lysergacidethylamide (and their isomers). It is shown that neither the substances themselves nor the mixture are able to evoke LSD-like perceptual variances. The exposure of Argyreia nervosa is described focusing on potential fetal distress by contained ergometrine and the case history of an intoxication.

Historically, states of intoxication--like dreams and madness--are seen in either one of two opposed ways. The intoxicated are either "possessed" or "under the influence" of an external agency, or revealing hidden feelings or truths (in vino veritas). Along the same lines, artists who worked during LSD, mescalin or psilocybin intoxication often refer to feelings of either being "possessed" or "liberated," a difference that can be explained partly by their expectations and partly by their evaluations, which both tend to conform to the cultural dichotomy in interpreting the irrational. Both interpretations, however, tend to obscure not only the other, but also-it is posited-the paradoxical nature of the drug experience itself. Analysis of a protocol shows that intoxication might comprise feelings of "possession" as well as "liberation" almost simultaneously, and mediumistic and some psychedelic art shows stylistic traits that can be seen as the visual expressions of both these feelings. It seems that the "demoniacal" and "psychedelic" mode come together in experiential reality, only to be divided in the cultural sphere.

This article outlines the main pharmacokinetic and toxicokinetic parameters of selected addicting compounds often being abused. Described parameters affect the way the compounds behave in the body. The article shows the usual dosage and "therapeutic", toxic and fatal concentrations. Knowledge of described parameters is important in the process of detoxication in patients poisoned with this group of psychoactive compounds.

Intoxicated states can be induced not only by the typical narcotic drugs, but also by other psychotropic substances, such as the thorn-apple and angel's trumpet. In recent times there has been an increase in the reported number of cases of such intoxications. Clinical symptoms, toxicological analysis and possible forms of treatment are discussed.

The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, Valencia and Gran Canaria during 1994 were retrospectively analyzed. Seventy-three emergencies related to the consumption of design drugs, hallucinogens or amphetamines (100 times lower than because of opiates or cocaine) were recorded. Apart from the responsible drug for the emergency visit, in most cases the usual consumption of other substances was mentioned. Acute psychopathological reactions predominated. Three patients were admitted and five were derived to other hospitals; the remaining patients improved and were discharged. The number of emergencies on account of these drugs is relatively low, with a proportion of less than one in 10,000 emergencies attended in these areas and might not radically change if the current predominant consumption pattern is maintained.

A sensitive method for the detection and quantification of lysergic acid diethylamide (LSD) in serum samples is described. After liquid-liquid extraction the trimethylsilyl derivative of LSD is detected by gas chromatography-mass spectrometry. Experiments with spiked samples resulted in a recovery of 76%, the coefficient of variation was 9.3%. Excellent linearity was obtained over the range 0.1-10 ng ml-1. Additionally experiments demonstrating the light sensitivity of LSD are presented together with casuistics.

Capillary electrophoresis (CE) with HeCd laser-induced fluorescence (LIF) detection and its application in forensic toxicology is demonstrated by the determination of D-lysergic acid diethylamide (LSD) in blood. Following precipitation of proteins, washing of the evaporated supernatant and extraction, the residue was reconstituted in methanol and injected electrokinetically (10 s, 10 kV). The total analysis time for quantification of LSD was 8 min using a citrate-methanol buffer, pH 4.0. With this buffer system it is possible to separate LSD, nor-LSD, iso-LSD and iso-nor-LSD. Using a specific sample preparation, electrokinetic injection, extended light path (bubble cell) capillaries and especially LIF detection (lambda(ex) 325 nm, lambda(em) 435 nm), a limit of detection of 0.1-0.2 ng LSD per ml blood could be obtained. The limit of quantitation was about 0.4-0.5 ng/ml. The quantitative evaluation for LSD was carried out using methylergometrine as internal standard. The precision expressed as coefficient of variation (C.V.) and accuracy of the method were <20% and 86-110%, respectively. The application of the method to human blood samples from two forensic cases and a comparison with radioimmunoassay demonstrated that the results were consistent.

Intoxication and overdose are common presenting complaints to the emergency department. Acute intoxication with lysergic acid diethylamide (LSD) has become a relatively rare event, especially when compared with the incidence of ethanol and cocaine intoxication. We recently had an outbreak of presumed LSD intoxications occurring over one weekend. All patients had attended a performance by the musical group The Grateful Dead. At present, LSD intoxication or overdose can only be suspected based on clinical findings because there are no readily available rapid laboratory tests for detecting either the parent compound or the metabolites of the drug. The clinical findings and outcomes of five patients with suspected LSD intoxication are presented. The pharmacological effects of LSD and treatment modalities of intoxication are reviewed. All patients were treated conservatively based on clinical signs and symptoms. Only one patient required hospital admission for combative behavior that was initially refractory to pharmacological restraint.

Our material consists of the patients treated for poisonings with street-drugs in Clinic of Acute Poisonings, Lódź, Poland during the period 1993-1996. During the time of 4 years, the number of hospitalised patients have grown up 4.5 times. The structure of used drugs has also changed. Up to 1993 the most popular were opiates derivatives and narcotic analgetics-morphine derivatives. In 1996 almost all narcotics are common, opiates (both natural and synthetic), cocaine, LSD, amphetamine and commonly used (by youngsters especially) Cannabis sativa (marihuana etc). The most common sources of poisoning in our material were opiates and amphetamine, followed by tetrahydrocannabinol derivatives-marijuana.

Poison Centre in Wrocław is appointed to the treatment of the most serious cases of poisoning in the Lower Silesia country. Drug addicts merely make 3% of all patients undergoing a treatment. Only few of them show symptoms of severe poisonings with drugs of abuse. Majority of these patients does not require specialised toxicological treatment and nor they agree for detoxification. New chemicals of abuse, like marijuana or LSD, appearing nowadays on Polish illegal market, does not make a toxicological problem in our region yet.

The resurgence of the use of LSD by a young, inexperienced population increases the likelihood of the occurrence of adverse psychedelic reactions. While the treatment of choice remains supportive, nonjudgmental talkdown, intramuscular lorazepam and haloperidol offer invaluable and specific adjuncts to care.

Serum and urine specimens of 31 patients with suspected lysergic acid diethylamide (LSD) intoxication were analyzed for LSD by both radioimmunoassay (RIA) and high-pressure liquid chromatography (HPLC). The RIA assay, using 0.1 ng/mL as the limit of detection instead of the manufacturer's recommendation of 0.5 ng/mL, was positive for LSD in 13 blood and urine specimens from 14 patients. Results were compared to HPLC analysis using methysergide instead of lysergol as the internal standard and a limit of detection of 0.5 ng/mL. HPLC detected LSD in 9 of 13 serum specimens and 11 of 13 urine specimens that had tested positive by RIA. Of 18 patients with a final clinical diagnosis of LSD intoxication, LSD was detected by RIA in 14 patients and by HPLC in 11 patients. For 13 other cases in which the final diagnosis was a condition other than LSD intoxication, serum and urine assays for LSD were negative in all cases by both techniques. LSD assays have not been generally available in clinical laboratories. We conclude that the qualitative determination of LSD in either serum or urine by a commercially available radioimmunoassay has made it possible to provide reliable laboratory confirmation of LSD intoxication.

Previous research by the author (Slade, 1972, 1973) and others has suggested that psychological stress plays an important role in triggering off the experience of auditory hallucinations. Clearly, however, predispositional factors are involved as well. The present study is an attempt to investigate some of the psychological factors which may predispose the individual to such experiences. A battery of tests involving cognitive, personality and mental imagery variables and the verbal transformation effect was administered to two small groups of psychotic patients differing only in respect of a history of auditory hallucinations and a normal control group. The main conclusion was that the results lend direct support to the proposition of Mintz & Alpert (1972) that a combination of vivid mental imagery and poor reality-testing in the auditory modality provides the basic predisposition for the experience of auditory hallucinations.

Almost all of the drugs of abuse can be identified in bodily fluids, and attempts should be made to do so. These specific drug assays help to document intoxication but do not aid in the emergency management of an acutely intoxicated patient. There are no specific antidotes for the drugs of abuse; symptomatic, detailed medical care is the cornerstone to the successful management of the patient.

Published lysergide (LSD) levels in body fluids are summarised, together with the results of 20 cases in which we determined LSD in body fluids by radioimmunoassay. The validity of methods used for LSD analysis is discussed.

Drug abuse is a prevalent problem in society and often occurs as abuse of multiple substances. The authors present a model for understanding the clinical symptomatology and course of substance-induced organic mental disorders and present a hypothesis that explains how various factors might interact to produce the disorder. A clinical case is used to illustrate the use of this approach and suggestions are made for the diagnosis and treatment of these disorders.

Eight patients were seen within 15 minutes of intranasal self-administration of large amounts of pure D-lysergic acid diethylamide (LSD) tartrate powder. Emesis and collapse occurred along with signs of sympathetic overactivity, hyperthermia, coma and respiratory arrest. Mild generalized bleeding occurred in several patients and evidence of platelet dysfunction was present in all. Serum and gastric concentrations of LSD tartrate ranged from 2.1 to 26 nanograms per ml and 1,000 to 7,000 mug per 100 ml, respectively. With supportive care, all patients recovered. Massive LSD overdose in man is life-threatening and produces striking and distinctive manifestations.

The evaluation and management of the violent patient in emergency settings is a complicated task for emergency psychiatric specialists. Etiologic considerations must be carefully weighed. The interplay of biologic, psychologic, and social factors has to be clearly recognized. Psychiatrists and physicians staffing emergency departments must be facile with the application of psychopharmacologic treatment. In addition, a familiarity and comfort with physical restraint must be developed. Interview styles and stances that diverge from traditional psychiatric "examining" should be employed. There is no sure-fire way to prevent violence, but adhering to the above principles should help to minimize violence as well as allow staff to comfort this most difficult aspect of emergency psychiatry.

This study assessed the roles of expectancy and autonomic arousal in inducing psychedelic flashbacks under conditions of mild sensory deprivation. Subjects with and without previous flashbacks participated. During the first experimental session, subjects were given a drug which they were told would induce flashbacks, and during the second, a drug which was alleged to induce only autonomic arousal. Ephedrine sulfate (causing autonomic changes) or placebo actually was given in counterbalanced order. Subjects of both groups experienced many more psychedelic sensations when they expected flashbacks. Drug effect was nonsignificant. These findings support the view that flashbacks are not "caused" by psychedelic drugs, but by the tendency of some drug users to mislabel and selectively attend to relevant aspects of naturally occurring altered states of consciousness.

Seventy-seven (0.24%) of 32,005 admissions to the Massachusetts General Hospital pediatric service during the period 1962 to 1973 were due to accidental poisoning. In 27 cases, mostly involving children less than 6 years of age, psychotropic drugs were implicated. These included sedative-hypnotics in six cases, phenytoin in two, major tranquilizers in five, antidepressants in three, stimulants or hallucinogens in three, and drug mixtures in eight. Toxicologic analyses contributed little to diagnosis and initial management. Except for one child who ingested ferrous sulfate, no patient was seriously intoxicated, and all recovered rapidly without sequelae. Although referral of serious poisoning cases to another hospital may have biased the results, the findings suggest that accidental psychotropic drug poisoning is not a major source of childhood morbidity.

Radioimmunoassay, high-performance liquid chromatography and capillary gas chromatography-mass spectrometry were used to detect and measure LSD in the first reported case of fatal poisoning by LSD. The levels found in ante-mortem serum and plasma and in post-mortem blood, liver blood and stomach contents are given.

Acute renal failure is a known sequel to rhabdomyolysis, both traumatic and non-traumatic. Two patients who had been placed in straitjackets after taking lysergide (LSD) developed acute renal failure and rhabdomyolysis. One subsequently died. The rhabdomyolysis probably resulted from a combination of severe restraint and the violent movements induced by the drug. The use of straitjackets cannot be considered to be completely safe in such cases.

The effects of LSD are characterized by a number of disturbances of perception and experience, which can be observed in the fields of visual, spatial and temporal perception and of affectivity. We also see disturbances of experience, which can otherwise be observed only in psychoses, for example reduction or change of cognitive functions, but also depersonalization and euphoria. In atypical courses of intoxication ("horror-trips") anxiety and excitement are predominant. Atypical courses of intoxication may be interrupted by "talk down" and additional application of tranquilizers. In a certain number of LSD-users in our clinic we saw psychoses. We classify them into flash-backs, exogenic (toxic) psychoses and so-called "endoform psychoses". The latter implies three possible constellations: accidental coincidence of LSD-use and psychosis; pre-existing psychosis with symptomatic use of LSD as an attempt of self-treatment; finally the onset of a psychosis may be triggered by the use of the halluzinogen. From the symptomatological cross-section they cannot reliably be distinguished from real schizophrenia. An independent nosological unit "LSD-psychosis" does not seem to exist.