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

This study (2018) analyzed reports from United States poison centers of individuals presenting with LSD or psilocybin consumption and found that serious adverse effects are rare but possible.

Abstract

“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.”

Authors: James B. Leonard, Bruce Anderson & Wendy Klein-Schwartz

Summary

Introduction

Lysergic acid diethylamide (LSD) and psilocybin are serotonergic hallucinogenic compounds currently under study for multiple psychiatric conditions. A systematic review identified 415 patients that had been treated with either LSD or psilocybin for analgesia, anxiety, or severe depression associated with terminal illness.

Psilocybin and LSD have been reported to cause death in patients, and many of these deaths involve concurrent use of other substances. There is also a modest amount of literature describing the common and uncommon effects and associated management sites for patients using psilocybin mushrooms or LSD.

Small studies have evaluated the efficacy of LSD and psilocybin for several psychiatric conditions.

LSD and psilocybin-containing mushrooms have been used primarily recreationally since the 1960s. There is limited data on the clinical toxicities of these substances in a large population of patients, so this study was designed to describe the most frequent acute toxicity and outcomes associated with LSD and psilocybin-containing mushroom exposures.

Methods

This was a retrospective, database study of all single-substance exposures to LSD or psilocybin-containing mushrooms reported to the American Association of Poison Control Centers from 2000 to 2016.

NPDS identified LSD and psilocybin exposures by product code and age 0 – 89 years for patients with known medical outcomes. Reasons for exposure were unintentional, intentional, malicious, contamination or tampering, adverse reactions, unknown reasons, and withdrawal.

Attempting to gain a high, euphoric effect, or some other psychotropic effect is likely the cause of overdose, and is not defined by the DSM-5. Final management site is a composite of two coded fields (management and level of care) and reflects the highest level of care received by the patient. Medical outcomes are coded as standard definitions defined by the NPDS coding manual.

The study examined fatality abstracts from poison centers and determined the relative contribution of the exposure to the fatality. The study was conducted by “Not Human Subject Research” and was conducted using Microsoft Excel.

Results

A total of 19,442 cases of LSD and psilocybin exposure were identified by the NPDS search. Of these, 5883 psilocybin exposures and 3554 LSD exposures were followed to known outcomes and were included in the study.

Most patients were adolescents and young adults, with a median age of 19 years for psilocybin patients and 18 years for LSD patients. Most exposures were either acute (89.1% for LSD, 95.3% for psilocybin mushrooms) or unknown (7.5% for LSD, 2.7% for psilocybin mushrooms).

Most patients with psilocybin mushrooms and LSD had two or fewer related adverse effects, with hallucinations, agitation, tachycardia, mydriasis, confusion, and vomiting being the most common. Males experienced a higher frequency of the most common effects compared with females.

Most patients received two or fewer types of treatment, primarily benzodiazepines, other sedation, and intravenous fluids for LSD and psilocybin mushrooms, respectively.

Most patients were either managed at home or treated/released from an emergency department for psilocybin mushrooms and LSD, and the medical outcome was coded as moderate for most patients. Male patients were more likely to be admitted to critical care units.

Eight patients died after taking psilocybin mushrooms or LSD. Two deaths were caused by trauma, one by status epilepticus, one by meningitis, and one by inadequate information documented to assess any cause of death.

Discussion

This study describes the toxicity and outcomes of psilocybin-containing mushrooms and LSD use reported to poison centers in the US. Males were more likely to experience common effects compared with females, but no differences were identified for serious effects.

Most patients were treated and released from the emergency department. Patients who used LSD had a higher rate of serious effects and were admitted to the hospital more often than those who used psilocybin mushrooms.

Most patients experienced few effects related to their exposure to LSD or psilocybin mushrooms. Hallucinations, agitation, tachycardia, confusion, nausea, and vomiting were the most common effects, and hyperthermia occurred in 2.0% of psilocybin mushroom cases and 3.8% of LSD cases.

Psilocybin and LSD have been used therapeutically for the treatment of multiple psychiatric disorders, with the most common side effects including transient hypertension, increased heart rate, increased systolic blood pressure, anxiety, fear, nausea, and psychological distress.

Some patients required therapy with benzodiazepines for psychological reactions, and only one withdrew due to adverse events. Our data show that these effects are common in the larger population.

Most patients who call poison centers for hallucinogen exposures are experiencing symptoms, usually adverse effects. Asymptomatic patients may also be brought to the poison center by concerned family members or hospitals.

There was a significant decrease in exposures to LSD from 2000 to 2002, which is consistent with data from the adult MTF study. However, the number of cases related to psilocybin mushroom exposures increased until 2004, and then slowly declined from 2004 to 2016.

Inconclusive death abstracts were generally present in the LSD and psilocybin cases, possibly due to inadequate testing, complicated clinical scenarios or lack of information about blood testing. One death was confirmed to have taken psilocybin, but it was unclear how much the psilocybin mushroom ingestion contributed to death.

We did not evaluate dose-related effects, and most patients do not know how much LSD or psilocybin they are actually exposed to.

The limitations of this study include the inability to assess for hallucinogen-persisting perception disorder and the fact that data are dependent on what is reported by the caller, which may be the individual using the psilocybin or LSD, friends/family, or healthcare providers. Clinical effects of LSD and psilocybin mushrooms may be underreported, but analysis of medical outcome and admission site likely reflect the gravity of exposures. The coding system contains a fixed number of clinical effects and any not captured in the database are listed as “other”. This explains the large proportion of “other” effects.

Conclusion

When psilocybin mushrooms or LSD are used by the public, most patients experience one to four related adverse effects. Most patients who require treatment usually receive benzodiazepines or other sedatives.