Can you overdose on LSD? What 3 case studies teach us

“The evidence is: Any drug can be used and any drug can be abused."

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There is such a thing as a bad trip. But how long do the effects of an LSD overdose last? And are they always so terrible?

Now, by analyzing the bizarre accidental overdoses of three women, scientists have gotten a clearer look at the effects of an LSD overdose, years down the line. Their experiences are telling, to say the least.

Overloading on LSD can trigger hours of vomiting and diarrhea, as well as a host of psychological symptoms, ranging from panic to a sense of doom.

In the cases of these three women, overdosing was, at the time, miserable. But ultimately, the experience may have led to a few positive benefits that lingered years after the drug left their systems.

The case studies are not a blueprint for the health benefits of overdosing on LSD, but they offer unprecedented insight for future research on LSD's mind and body-bending effects.

“The evidence is: Any drug can be used and any drug can be abused. They can be used for healing or harm, depending on the context,” Mark Haden, coauthor of the new case reports and executive director of MAPS Canada (Multidisciplinary Association for Psychedelic Studies), tells Inverse.

Haden and his team published the case reports this week in the Journal of Studies on Alcohol and Drugs.

“I'm not recommending anybody take a massive dose of psychedelic. It is just information that should be used by researchers to help further their understanding of how psychedelics can be used. It’s a piece of the puzzle.”

Can you overdose on LSD?

Since LSD was first discovered 82 years ago in Albert Hofmann’s lab, scientists have sought to understand how much, if any, LSD is safe for humans. After thousands of studies, scientists determined that a safe, clinical dose ranges from 75 to 200 micrograms, Haden says. To put that in context, the average recreational dose is 100 micrograms. Within that range (and in safe environments), most people feel profound psychological effects, with no negative physical side effects.

“There is no single dose we can point to that constitutes an overdose on LSD. This is going to be highly dependent on the safety of the environment,” Matthew Johnson, a leading psychedelic researcher and a professor at Johns Hopkins University, tells Inverse.

Johnson wasn’t involved in publishing the new case reports.

While there may be no clear threshold, one way users can suss out if they are overdosing is if the body’s “toxic response” kicks in, Haden says.

“It's the point at which your body is triggered to get rid of it at all costs.”

When the body detects a toxic invader — a bacteria, drug or allergen, for example — it mounts a major clean-up operation.

“That’s when your body says, ‘We have gotta get this out of here fast," Haden says. Basically, you vomit or have diarrhea until the substance is expelled.

Surviving an LSD overdose

Because scientists can’t exactly jack up study participants on high doses of LSD, they look at real-life overdoses for clues as to what happens to the body and brain during these episodes.

“We are trying to understand how psychedelics interact with the human beast and the pieces that we don't know; We don't know what large dosages do and we don't fully understand toxicity issues,” Haden says.

In the case studies, Haden and his team zeroed in on three women, all of whom accidentally overdosed on massive amounts of LSD. The researchers conducted interviews and collected years of health records, case notes, and collateral reports detailing their experiences, and describe the data in their new reports.

What they found shocked them: On the other side of the distressing physical and mental symptoms the women experienced during their overdose, all three had gained a few surprisingly positive benefits that seemed to last far beyond the bad trip.

At a summer solstice party in the summer of 2000, a 15-year-old female diagnosed with bipolar disorder and a 26-year-old woman, who was unaware she was two weeks pregnant, accidentally took 1000 micrograms of LSD — 10 times the typical recreational dose.

After taking the massive LSD dose at around 10:00 p.m., the teenager curled up in the fetal position, became confused and erratic, suffered a seizure, and was rushed to the hospital. Her symptoms quickly subsided, but from that point on, she experienced significant mood improvements and reductions in mania with psychotic features. Her bipolar disorder markedly improved — a shift that has lasted to the present day, over 20 years after the overdose.

The pregnant woman didn’t vomit, pass out, or have a seizure. Instead, she felt “an intense reaction,” but by the morning, she was able to talk with others and carried on her day as normal. Further, her pregnancy did not seem affected by the experience. She went on to deliver a healthy baby boy, who has shown no developmental problems. The child is now 18 years old, according to the case report.

The third case is more extreme. A middle-aged-woman mistook LSD powder for cocaine, and snorted 55 milligrams — that’s 550 times the normal recreational dosage of 100 micrograms. For the next 12 hours, her body’s “toxic response” took over — she vomited continually and reports “blacking out.”

After this period, the woman reports feeling “pleasantly high,” although she wasn’t able to communicate coherently. Ten hours after that, she was able to talk with her roommate (who had been watching over her) and seemed coherent. The roommate fed her and stayed with her another 12 hours, until she seemed back to “normal.”

This woman had dealt with chronic pain in her feet and ankles for decades, linked to her Lyme disease. To manage the pain, she took morphine. After the LSD overdose, she cut down on her daily morphine use dramatically, stopping it completely at first, and then later taking a reduced daily dose while also microdosing LSD every three days.

All three cases are anecdotes — they can't tell scientists about the potential positive or negative effects of an LSD overdose among the general population. That’s why you need clinical trials of the drug, Haden says.

But taken together, they do suggest there may be unpredictable, positive benefits to even high doses of LSD.

“I'd like to inspire hope, but certainly you can't make any conclusions from a single case study,” Haden says.

Emotional turbulence

Currently, psychedelic research is exploding, drumming up promising results for everything from PTSD to treatment-resistant depression to alcohol addiction. But the drug is still illegal in much of the world — and no one recommends a high dose of LSD, for any reason.

To date, there are no recorded deaths from overdosing on LSD alone. But that does not mean people can't get hurt.

“Physiologically — and this is a critical distinction — biologically or physiologically, LSD is robustly safe,” Johnson says. “There's essentially no known lethal dose of the compound.”

But behaviorally, it’s a different story. Even taking relatively low doses of LSD, in the wrong setting, is linked to emotional turbulence or changes in behavior that can be dangerous, Haden and Johnson say.

That is why it's critical to take LSD in a safe, controlled setting, under trusted supervision.

"A bad trip is not to be underestimated."

“The main concern is behavioral toxicity — people doing something stupid when they're high like wandering into traffic and into a neighbor's house and getting shot by the police because you're just so out of it, you don't know what you're doing or falling from a height,” Johnson says. These accidents are very rare in recreational use, the researcher says, but they do happen.

“Any intoxicating drug can have these aspects of behavioral toxicity — people doing dumb things and getting hurt, sometimes killed.”

People who have a predisposition, or active psychotic disorders like schizophrenia, may also be at greater risk of long-term harm, Johnson says.

But even when there’s no acute harm, taking LSD can be emotionally challenging.

“A bad trip is not to be underestimated,” Johnson says. He has personally supervised over 100 LSD sessions in the clinical setting, but even rough sessions are not always negative in the long term. Often, people reflect that they learned from these challenging experiences of “facing their demons,” or dealing with issues that are hard to look at within themselves, he says.

“There seems to be something about running the gauntlet of these ordeals that oftentimes people in retrospect see value in," he says. "There are certainly results and lab results suggesting this, but out there, when there are no controls, this can escalate and there are horrific experiences like this that can be harmful.”

Objective: In academic settings around the world, there is a resurgence of interest in using psychedelic substances for the treatment of addictions, posttraumatic stress disorder, depression, anxiety, and other diagnoses. This case series describes the medical consequences of accidental overdoses in three individuals.
Method: Case series of information were gathered from interviews, health records, case notes, and collateral reports.
Results: The first case report documents significant improvements in mood symptoms, including reductions in mania with psychotic features, following an accidental lysergic acid diethylamide (LSD) overdose, changes that have been sustained for almost 20 years. The second case documents how an accidental overdose of LSD early in the first trimester of pregnancy did not negatively affect the course of the pregnancy or have any obvious teratogenic or other negative developmental effects on the child. The third report indicates that intranasal ingestion of 550 times the normal recreational dosage of LSD was not fatal and had positive effects on pain levels and subsequent morphine withdrawal.
Conclusions: There appear to be unpredictable, positive sequelae that ranged from improvements in mental illness symptoms to reduction in physical pain and morphine withdrawal symptoms. Also, an LSD overdose while in early pregnancy did not appear to cause harm to the fetus.
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