LSD

Lysergic acid diethylamide, commonly known as LSD (from German Lysergsäurediethylamid) and by the nicknames acid and Lucy, is a semisynthetic psychedelic drug derived from ergot, known for its potent psychological effects.

LSD taken orally has an onset of action of 0.4 to 1.0 hours and a duration of 7 to 12 hours. In recreational settings it is commonly administered via tabs of blotter paper. LSD is extremely potent, with noticeable effects at doses as low as 20 micrograms and is sometimes taken in even smaller amounts for microdosing. Despite widespread use, no fatal human overdoses have been documented. LSD is mainly used recreationally or for spiritual purposes. LSD can cause mystical experiences. LSD exerts its effects primarily through high-affinity binding to several serotonin receptors, especially the serotonin 5-HT2A receptor, and to a lesser extent dopamine and adrenergic receptors. Neuroimaging studies indicate that LSD reduces the efficacy of thalamo-cortical information filtering (producing sensory overload), decreases oscillatory power within the default mode network, and flattens hierarchical organization of large-brain activity. At higher doses, it can induce visual and auditory hallucinations, ego dissolution, and anxiety. LSD use can cause adverse psychological effects such as paranoia and delusions and may lead to persistent visual disturbances known as hallucinogen persisting perception disorder (HPPD).

Swiss chemist Albert Hofmann first synthesized LSD in 1938 and discovered its potent psychedelic effects in 1943 after accidental ingestion. It became widely studied in the 1950s and 1960s. The drug was initially explored for psychiatric use due to its structural similarity to serotonin and safety profile. It was used experimentally in psychiatry for treating alcoholism and schizophrenia. By the mid-1960s, LSD became central to the youth counterculture in places like San Francisco and London, influencing art, music, and social movements through events like Acid Tests and figures such as Timothy Leary, Owsley Stanley and Michael Hollingshead. Its psychedelic effects inspired distinct visual art styles and musical innovations, and caused a lasting cultural impact. However, its association with the counterculture movement of the 1960s led to its classification as a Schedule I drug in the United States in 1970. It was also listed as a Schedule I controlled substance by the United Nations in 1971 and remains without approved medical uses.

Despite its legal restrictions, LSD remains influential in scientific and cultural contexts. Research on LSD declined due to cultural controversies by the 1960s, but has resurged since 2009. In 2024, the United States Food and Drug Administration designated LSD (code name MM120 or DT120) as a breakthrough therapy for generalized anxiety disorder. As of 2017, about 10% of people in the United States had used LSD at some point, with 0.7% having used it in the past year. Usage rates have risen, with a 56.4% increase in adult use in the United States from 2015 to 2018.

Uses

Recreational

LSD is commonly used as a recreational drug for its psychedelic effects.

Spiritual

LSD can catalyze intense spiritual experiences and is thus considered an entheogen. Some users have reported out of body experiences. In 1966, Timothy Leary established the League for Spiritual Discovery with LSD as its sacrament. Stanislav Grof has written that religious and mystical experiences observed during LSD sessions appear similar to descriptions in sacred scriptures of great religions of the world and the texts of ancient civilizations.

Medical

LSD currently has no formally approved medical use anywhere in the world.

In Switzerland, a special authorization program allows limited medical use of substances like LSD for patients with serious, treatment-resistant conditions, with patients treated under physician supervision.

Dosing

LSD is an extraordinarily potent substance, and is one of the most potent psychoactive drugs known. This means that it produces its pharmacological effects at very small doses, with its dose range measured in micrograms (μg); that is, millionths of a gram. Noticeable effects can occur with doses of LSD as low as 20 μg, which is around 1/200th the mass of a grain of sand. LSD is approximately 200 times as potent as psilocybin and 5,000 times as potent as mescaline, meaning that it produces effects of similar magnitude at 1/200 and 1/5,000 times the respective doses.

The usual dose range of LSD for psychedelic effects is 20 to 200 μg. The typical intermediate and "good effect" dose for a psychedelic experience is 100 μg (range 75–150 μg, while 20 to 50 μg is a low or "minidose" and 200 μg is a high or ego-dissolution dose.) A dose range as wide as 10 to 450 μg has been reported. LSD may also be used in microdosing. In this context, it may be used at subthreshold or microdoses of less than 10 μg.

The extremely high potency of LSD played an essential role in its emergence and popularity during the counterculture of the 1960s due to the economic feasibility of its manufacture, in contrast to the case of mescaline, which had been known for many decades previously but remained relatively little-known.

The doses of LSD present in illicit LSD samples have decreased over time. In the mid-1960s, Owsley Stanley, the most important black market LSD manufacturer in the United States, distributed LSD at a standard concentration of 270 μg, while street samples of the 1970s contained 30 to 300 μg. By the 1980s, the amount had reduced to between 100 and 125 μg, dropping more in the 1990s to the 20 to 80 μg range, and even further in the 2000s.

Effects

LSD produces a variety of physical, psychological, and sensory effects.

Psychological

The primary immediate psychological effects of LSD are visual pseudo-hallucinations and altered thought, often referred to as "trips". These sensory alterations are considered pseudohallucinations because the subject does not perceive the patterns seen as being located in three-dimensional space outside the body. LSD is not considered addictive. An "afterglow" effect, characterized by an improved mood or perceived mental state, may persist for days or weeks following ingestion. Positive experiences, or "good trips", are described as intensely pleasurable and can include feelings of joy, euphoria, an increased appreciation for life, decreased anxiety, a sense of spiritual enlightenment, and a feeling of interconnectedness with the universe.

Negative experiences, commonly known as "bad trips", can induce feelings of fear, agitation, anxiety, panic, and paranoia. While the occurrence of a bad trip is unpredictable, factors such as mood, surroundings, sleep, hydration, and social setting, collectively referred to as "set and setting", can influence the risk and are considered important in minimizing the likelihood of a negative experience.

Uniquely among psychedelics, LSD appears to have two temporally and qualitatively distinct phases of psychoactive effects. These include an initial psychedelic phase associated with serotonin 5-HT2A receptor agonism and a subsequent paranoia- and psychosis-like phase associated with dopamine D2-like receptor agonism. Subsequent research has found that the delayed dopaminergic phase is associated with the highly potent dopamine D4 receptor agonism of LSD's metabolite 13-hydroxy-LSD. The first phase is described as a "psychedelic experience", with "meaningfulness and portentousness" as the primary effects, while the latter phase is "clearly a paranoid state", including feeling "at the least self-centered, and usually suspicious, with ideas of reference or even paranoid convictions". The second phase typically develops about 4 to 6 hours after administration but at times up to 10 hours after administration. Parallels have been drawn between this phase and amphetamine psychosis. There is no indication that similar effects occur with other psychedelics like phenethylamines and simple tryptamines, which lack dopamine receptor agonism. The preceding findings have been described by researchers like Daniel X. Freedman and David E. Nichols.

Sensory

LSD induces an animated sensory experience affecting senses, emotions, memories, time, and awareness. The effects range from subtle perceptual changes to profound cognitive shifts. Alterations in auditory and visual perception are common.

Users may experience enhanced visual phenomena, such as vibrant colors, objects appearing to morph, ripple, or move, and geometric patterns on various surfaces. Changes in the perception of food's texture and taste are also noted, sometimes leading to aversion towards certain foods.

There are reports of inanimate objects appearing animated, with static objects seeming to move in additional spatial dimensions. The auditory effects of LSD may include echo-like distortions of sounds, and an intensified experience of music. Basic visual effects often resemble phosphenes and can be influenced by concentration, thoughts, emotions, or music. Higher doses can lead to more intense sensory perception alterations, including synesthesia, perception of additional dimensions, and temporary dissociation.

Physical

LSD can induce physical effects such as pupil dilation, decreased appetite, increased sweating, and wakefulness. The physical reactions to LSD vary greatly, and some may be a result of its psychological effects. Commonly observed symptoms include increased body temperature, blood sugar, and heart rate, as well as goose bumps, jaw clenching, dry mouth, and hyperreflexia. In cases of adverse reactions, users may experience numbness, weakness, nausea, and tremors.

Onset and duration

The psychoactive effects of LSD last on average between 7 and 11 hours, with a possible range of 4 to 22 hours. Higher doses tend to lead to a longer duration of action. The onset of action when administered orally is 0.4 to 1.0 hours on average, with a possible range of 0.1 to 1.8 hours. The time to peak effects given orally is 2.2 to 2.8 hours on average, with a range of 1.3 to 6.5 hours.

The duration of LSD can be shortened through the use of trip killers or shorteners like ketanserin. In a clinical trial, ketanserin given 1 hour after LSD shortened its duration from 8.5 hours to 3.5 hours or by about 60%.

Adverse effects

LSD, a classical psychedelic, is deemed physiologically safe at standard doses (50–200 μg), and its primary risks lie in psychological effects rather than physiological harm. A 2010 study by David Nutt ranked LSD as significantly less harmful than alcohol, placing it near the bottom of a list assessing the harm of 20 drugs.

Psychological effects

Mental disorders

LSD can induce panic attacks or extreme anxiety, colloquially termed a "bad trip". Despite lower rates of depression and substance abuse found in psychedelic drug users compared to controls, LSD presents heightened risks for individuals with severe mental illnesses like schizophrenia. These hallucinogens can catalyze psychiatric disorders in predisposed individuals, although they do not tend to induce illness in emotionally healthy people.

Suggestibility

While research from the 1960s indicated increased suggestibility under the influence of LSD among both mentally ill and healthy individuals, the CIA and US Department of Defense conducted secret mind control experiments in which LSD was administered to unwitting human subjects as part of secret operations MKUltra and Operation Midnight Climax.

Flashbacks

Flashbacks are psychological episodes where individuals re-experience some of LSD's subjective effects after the drug has worn off, persisting for days or months post-hallucinogen use. These experiences are associated with hallucinogen persisting perception disorder (HPPD), where flashbacks occur intermittently or chronically, causing distress or functional impairment.

The etiology of flashbacks is varied. Some cases are attributed to somatic symptom disorder, where individuals fixate on normal somatic experiences previously unnoticed before drug consumption. Other instances are linked to associative reactions to contextual cues, similar to responses observed in individuals with past trauma or emotional experiences. The risk factors for flashbacks remain unclear, but pre-existing psychopathologies may be significant contributors.

Estimating the prevalence of HPPD is challenging. It is considered rare, with occurrences ranging from 1 in 20 users experiencing the transient and less severe type 1 HPPD, to 1 in 50,000 for the more concerning type 2 HPPD. Contrary to internet rumors, LSD is not stored long-term in the spinal cord or other parts of the body. Pharmacological evidence indicates LSD has a half-life of 175 minutes and is metabolized into water-soluble compounds like 2-oxo-3-hydroxy-LSD, eliminated through urine without evidence of long-term storage. Clinical evidence also suggests that chronic use of SSRIs can potentiate LSD-induced flashbacks, even months after stopping LSD use.

Tolerance

LSD shows significant tachyphylaxis, with tolerance developing 24 hours after administration. The progression of tolerance at intervals shorter than 24 hours remains largely unknown. Tolerance typically resets to baseline after 3–4 days of abstinence. Significant cross-tolerance occurs between LSD, mescaline and psilocybin. A slight cross-tolerance to DMT is observed in humans highly tolerant to LSD. Tolerance to LSD also builds up with consistent use, and is believed to result from serotonin 5-HT2A receptor downregulation. Researchers believe that tolerance returns to baseline after two weeks of not using psychedelics.

Addiction and dependence liability

LSD is widely considered to be non-addictive, despite its potential for abuse. Attempts to train laboratory animals to self-administer LSD have been largely unsuccessful. Although tolerance to LSD builds up rapidly, a withdrawal syndrome does not appear, suggesting that a potential syndrome does not necessarily relate to the possibility of acquiring rapid tolerance to a substance. A report examining substance use disorder for DSM-IV noted that almost no hallucinogens produced dependence, unlike psychoactive drugs of other classes such as stimulants and depressants.

Cancer and pregnancy

The mutagenic potential of LSD is unclear. Overall, the evidence points to limited or no effect at commonly used doses. Studies showed no evidence of teratogenic or mutagenic effects.

Long-term effects

A potential risk of frequent repeated long-term use of LSD and other serotonergic psychedelics is cardiac fibrosis and valvulopathy due to serotonin 5-HT2B receptor agonism. This may also be the case with microdosing. However, the risks are theoretical, and more research is needed to see if these complications can actually occur with psychedelics. A preliminary animal study found that chronic microdosing of LSD did not result in heart structure changes or valvulopathy in rodents. Research appears to be mixed on whether LSD is a potent serotonin 5-HT2B receptor agonist or not, with some studies finding it to be essentially inactive.

Interactions

Some psychedelics, including LSD, are metabolized by the cytochrome P450 enzyme CYP2D6. Concurrent use of selective serotonin reuptake inhibitors (SSRIs), some of which are potent inhibitors of CYP2D6, with LSD may heighten the risk of serotonin syndrome. Chronic usage of SSRIs, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) is believed to diminish the subjective effects of psychedelics, likely due to 5-HT2A receptor downregulation or desensitization induced by elevated serotonin levels. Contrary to the preceding notions however, a clinical study found that administration of LSD to people taking paroxetine, an SSRI and strong CYP2D6 inhibitor, increased LSD exposure by about 1.5-fold, was well-tolerated, and did not modify the pleasant subjective effects or physiological effects of LSD, whereas negative effects of LSD, including "bad drug effect", anxiety, and nausea, were reduced. Similarly, a clinical study with LSD found that LSD levels were 75% higher in people with non-functional CYP2D6 (poor metabolizers) compared to those with functional CYP2D6. In contrast to certain other psychedelics, MAOIs do not inhibit the metabolism of or potentiate the effects of LSD and instead reduce its effects. Interactions between psychedelics and antipsychotics or anticonvulsants are not well-documented; however, co-use with mood stabilizers like lithium may induce seizures and dissociative effects, particularly in individuals with bipolar disorder. Lithium notably intensifies LSD reactions, potentially leading to acute comatose states when combined.

Overdose

LSD at typical recreational doses (~50–250 μg) is considered to be very safe in terms of toxicity, with not a single toxicity-related death having been reported at such doses despite many millions of exposures. In addition, LSD is considered to be a relatively non-toxic drug in overdose. It is estimated, based on animal studies and human case reports, that the lethal dose of LSD in humans is approximately 100 mg, or about 1,000 times the usual recreational dose of 100 μg. There have been a handful of reported cases of fatal overdose with LSD as of 2024. However, critical review of the literature by David E. Nichols found that of five identified cases, one was not consistent with the effects of LSD but instead may have been another drug like 25I-NBOMe, two involved normal doses of LSD in individuals who were placed in maximal physical restraint (hogtied) by police followed by presumed positional asphyxia and fatal cardiovascular collapse (hogtying being a practice that is associated with accidental death generally). Two were associated with massive LSD overdose involving doses of possibly more than 300 mg. Besides death due to toxicity, LSD is rarely associated with death via suicide, accidents, or violent encounters due to induction of abnormal behavior.

In one well-known 1974 case series, 8 people accidentally insufflated two "lines" of nearly pure LSD powder that they thought were cocaine. The exact doses of LSD were unknown, but were considered to be massive. For context, a typical "line" of cocaine for insufflation is 50 to 100 mg. The individuals reported to the hospital within 10 to 15 minutes, with five of them comatose, three requiring intubation and mechanical ventilation, and the conscious individuals experiencing severe hallucinogenic effects, among other toxic symptoms. All of them completely recovered within 12 hours and there were no deaths. A subsequent 2020 case similarly involved accidental insufflation of a confirmed 55 mg dose of LSD instead of cocaine, which was without adverse health consequences. In other reports, a 5 mg overdose of LSD produced severe nausea and vomiting along with severe behavioral disturbances, while a 10 mg overdose was also non-fatal.

Despite acting as non-selective serotonin receptor agonists, major psychedelics like LSD and psilocybin do not cause serotonin syndrome even with extreme overdose. This is thought to be because they act as partial agonists of serotonin receptors like the serotonin 5-HT2A receptor relative to serotonin itself. Conversely, NBOMe psychedelics like 25I-NBOMe are more efficacious and have been uniquely associated with serotonin syndrome-like toxicity. A 2018 retrospective analysis of 3,554 LSD-only exposures reported to poison control centers in the United States between 2000 and 2016 found that serious toxicity was infrequent. Common adverse effects (2.4–42%) included agitation or irritability, tachycardia, hallucinations or delusions, confusion, pupil dilation, hypertension, drowsiness or lethargy, elevated creatine phosphokinase (CPK), nausea and vomiting, and others. Selected serious adverse effects included fever or hyperthermia in 3.8%, single seizure in 2.4%, coma in 1.4%, elevated creatinine in 1.4%, multiple seizures in 1.2%, rhabdomyolysis in 1.1%, respiratory depression in 0.9%, cardiac conduction disorder in 0.5%, and status epilepticus in 0.4%. There is a case report of severe neurological sequelae following a single typical recreational dose of LSD involving seizure and cardiorespiratory arrest. In general, psychedelics like LSD may rarely cause seizures in some individuals.

The median lethal dose (LD50) of LSD in animals varies and is 50 to 60 mg/kg in mice, 16.5 mg/kg in rats, and 0.3 mg/kg in rabbits all given by injection. A well-known 1962 instance of an elephant named Tusko given 297 mg (~0.1 mg/kg) LSD by intramuscular injection proved fatal. These findings suggest that elephants may be much more sensitive to LSD in overdose than humans and other species. However, this instance has been mired in criticism and controversy due to miscalculation of LSD dose and concomitant post-LSD administration of promazine and pentobarbital. The experiment was repeated in two elephants with similar doses of LSD in 1984 without incident.

Massive doses of LSD are largely managed by symptomatic treatments, and agitation can be addressed with benzodiazepines. Reassurance in a calm, safe environment is beneficial. Antipsychotics such as haloperidol are not recommended as they may have adverse effects. Gastrointestinal decontamination with activated charcoal is of little use due to the rapid absorption of LSD, unless performed within 30 to 60 minutes of ingesting exceedingly huge amounts. Administration of anticoagulants, vasodilators, and sympatholytics may be useful for treating ergotism.

LSD substitute overdose

Although LSD is relatively safe in overdose, 25-NB (NBOMe) psychedelics like 25I-NBOMe and 25B-NBOMe are often sold as "LSD" and are highly toxic in overdose, with many reported severe intoxications and deaths. Owing to their high potency analogous to LSD, these drugs are also regularly sold as "LSD" in blotter papers. Fatalities involved in NBOMe intoxication suggest that a significant number of individuals ingested the substance which they believed was LSD, and researchers report that "users familiar with LSD may have a false sense of security when ingesting NBOMe inadvertently". Researchers state that the alleged physiological toxicity of LSD is likely due to psychoactive substances other than LSD.