The psychedelic call: analysis of Australian Poisons Information Centre calls associated with classic psychedelics.

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.

A cluster of lysergic acid diethylamide (LSD) poisonings following insufflation of a white powder sold as cocaine.

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.

Does getting high hurt? Characterization of cases of LSD and psilocybin-containing mushroom exposures to national poison centers between 2000 and 2016.

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.

"My friend said it was good LSD": a suicide attempt following analytically confirmed 25I-NBOMe ingestion.

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.

Percutaneous transluminal angioplasty in the treatment of extensive LSD-induced lower extremity vasospasm refractory to pharmacologic therapy.

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.

Common drugs of abuse--Part II.

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.

Rave drugs: pharmacological considerations.

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.

Case report: an ingestion of Hawaiian Baby Woodrose seeds associated with acute psychosis.

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.

Jekyll and Hyde revisited: paradoxes in the appreciation of drug experiences and their effects on creativity.

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.

[Hawaiian baby woodrose: (Psycho-) Pharmacological effects of the seeds of Argyreia nervosa. A case-orientated demonstration]. / Hawaiianische Holzrose: (Psycho-)Pharmakologische Wirkungen der Samen der Argyreia nervosa Eine fallbezogene Darstellung.

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.

[Pharmacokinetic and toxicokinetic parameters of some drugs of abuse]. / Parametry farmakokinetyczne i toksykokinetyczne niektórych srodków uzalezniajacych.

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.

[Nightshade plants act almost like LSD. Poisoning cases are on the rise]. / Nachtschattengewächse wirken fast wie LSD. Vergiftungsfälle häufen sich.

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.

Gas chromatographic/mass spectrometric determination of lysergic acid diethylamide (LSD) in serum samples.

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.

Determination of LSD in blood by capillary electrophoresis with laser-induced fluorescence detection.

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.