LSD
The serendipitous discovery of psychedelic effects of LYSERGIC ACID DIETHYLAMIDE (LSD) in 1947 culminated in an epidemic of LSD abuse during the 1960s. Imposition of stringent legal and regulatory constraints on the manufacture and distribution of LSD (classified as a Schedule I substance by the FDA), as well as public recognition that psychedelic experiences induced by LSD were a health hazard, has resulted in a significant reduction in LSD abuse. During 1984, relatively few instances of LSD abuse were reported, but the drug still retains some popularity among adolescents and young adults.
LSD is a very potent drug; oral doses as low as 20 (ig may induce profound psychological and physiologic effects. Tachycardia, hypertension, pupillary dilation, tremor, and hyperpyrexia occur within minutes following LSD in oral doses of 0.5 to 2 |xg/kg. A variety of bizarre and often conflicting perceptual and mood changes, including visual illusions, synesthesias, and extreme lability of mood states, occur within one-half hour after LSD intake. The action of LSD can persist for 12 to 18 h even though the half-life of the drug is only 3h.
Tolerance develops rapidly for LSD-induced changes in psychological function when the drug is used one or more times per day over a course of 4 days or more. Abrupt abstinence following continued use does not produce withdrawal signs or symptoms. To date there have been no clinical reports of death caused by the direct effects of LSD.
The most frequent acute medical emergency associated with LSD use is panic episodes which may persist up to 24 h (”the bad trip”). Management of this problem is best accomplished by supportive reassurance (”talking down”) and, if necessary, administration of small doses of anxiolytic drugs. Adverse consequences of chronic LSD use include enhanced risk for schizophreniform psychosis and derangements in memory function, problem solving, and abstract thinking. Treatment of these disorders is best carried out in specialized psychiatric facilities.