Author: Gary Jackson

Hallucinogens: Side Effects, Withdrawal, Overdose & Treatment

If you’re concerned about law enforcement getting involved, you don’t need to mention the substances used over the phone (though it’s best to give them as much information as possible). Just be sure to tell them about specific symptoms so they can send the appropriate response. Hallucinogens like acid can make you do things you wouldn’t normally do. For some folks, it causes extreme mood swings that may lead to aggressive and violent behavior. Some people experience an LSD hangover or comedown instead of or after the afterglow. How your trip goes and how much you took can dictate how you’ll feel when you’re coming down.

The effects of LSD typically kick in within 20 to 90 minutes and peak around 2 to 3 hours in, but this can vary from person to person. These trips have been described as everything from a spiritual awakening to a trip to the depths of hell (aka the dreaded “bad trip”). The emergency and referral resources listed above are available to individuals located in the United States and are not operated by the National Institute on Drug Abuse (NIDA). NIDA is a biomedical research organization and does not provide personalized medical advice, treatment, counseling, or legal consultation. Information provided by NIDA is not a substitute for professional medical care or legal consultation. Among people aged 12 or older in 2020, 0.2% (or about 493,000 people) had a hallucinogen use disorder in the past 12 months.

Hallucinogens: Types, Effects & Dangers

Those with a predisposition towards psychotic illnesses (i.e. personal or family history of schizophrenia or bipolar disorder) are generally excluded from clinical treatment with psychedelics (Johnson et al., 2008). With such screening, no psychotic episodes have been documented in modern clinical trials to the best of our knowledge. In contrast, scientific research consistently assesses psychedelics as much less harmful to the user as well as to society compared to alcohol and almost all other controlled substances. In their seminal comparative drug harms studies, using Multi-Criteria Decision Analysis (MCDA), Nutt et al. (2010) ranked LSD among the drugs with the lowest harms, both for the individual and to society and ‘magic mushrooms’ received the lowest overall harm score (Nutt et al., 2010). These findings have been replicated in the Netherlands (Van Amsterdam and Van den Brink, 2010, Europe (Van Amsterdam et al., 2015) and Australia (Bonomo et al., 2019). Carhart-Harris and Nutt’s (2013) survey of both substance users and other experts, again placed LSD and psilocybin in the lowest harm categories, and Morgan et al.’s (2010) survey of drug users further confirmed these findings.

Therefore, this may not need to comply with the standard protocols required to enable a new chemical entity (NCE) to reach patients with a fully evaluated safety profile. Shahid et al. (2020) provide an extensive description of this process from drug target selection to testing in animal models, Phase I to Phase IV clinical studies to post-marketing surveillance and risk management. PAP drug development currently involves plant medicines that have been used safely by indigenous populations for thousands of years, by western populations over successive generations and currently in clinical trials for many psychiatric disorders in controlled situations. Such molecules do not require the same development steps as NCEs, as considerable information regarding their safety and efficacy already exists. Most researchers now consider classic psychedelics to be non-toxic, that is, they do not damage mammalian organ systems, and as physiologically safe, even in very high doses (Gable, 2004; Halpern et al., 2005; Halpern and Pope, 1999; Malcolm and Thomas, 2021; Nichols, 2004). No long-term neurocognitive deficits have been reported by participants in the contemporary era of research (please see Aday et al., 2020b for a recent review).

What are hallucinogens?

In the West, psilocybin was first isolated in 1958 (Hofmann et al., 1958). The first RCT comparing psilocybin to a conventional selective serotonin reuptake inhibitor (SSRI) antidepressant found the former to be as efficient at reducing symptoms of depression, and with fewer side effects (Carhart-Harris et al., 2021). However, sample sizes remain small, and further research – using rigorous methodologies to address issues, such as blinding – is required to further understand the (long-term) effectiveness of these treatments. Your chances of experiencing long-term effects, including persistent psychotic symptoms, is higher if you ingest large doses of acid or have a preexisting mental health condition, such as schizophrenia. The drugs also affect parts of the brain that control other vital functions, including sleep, hunger and mood. A subclass of hallucinogens called dissociative drugs makes people feel disconnected from their
body or environment.

• Coming down from it causes a numbing effect that can cause a person to become agitated and irrational.
• However, there have been cases of death by overdose of psychedelics with the majority from LSD (Fysh et al., 1985; Nichols and Grob, 2018) and psilocybin (Lim et al., 2012; Van Amsterdam et al., 2011) – probably because these are the most widely used.
• Once a hallucinogen is injected, it targets the neural circuits in the brain that use the neurotransmitter serotonin.
• A fatal overdose from LSD is unlikely, but adverse effects that require medical intervention are possible, especially when someone takes a large amount.

Psychedelic use does not conform to the profile of clinical features representing other types of dependencies, for example, opioids (Morgenstern et al., 1994). Very few hallucinogen users experience an inability to cut down or control use, a key indicator of dependence. HUD is relatively uncommon, with a low risk of development following exposure to hallucinogens (Shalit et al., 2019). The vast majority of hallucinogen users do not transition to hallucinogen dependence (Stone et al., 2006).

Adverse effects of psychedelics: From anecdotes and misinformation to systematic science

Looking at the self-reported incidence of emergency medical treatment (EMT) sought for LSD and ‘magic mushrooms’, EMT is consistently low, and less than 1% of users report seeking help (Global Drug Survey (GDS), 2019). In comparison to other recreational drugs, psychedelics rank as the lowest in the United States, with 1.9 emergency department visits per 100,000 in 2011 (Substance Abuse and Mental Health Services Administration (SAMHSA), 2017). In relation to hospital admissions, SAMHSA (2017) shows that the rate of ‘hallucinogens’ as the primary substance is at 0.1% of hospital admissions. Looking at psilocybin, Gable (1993) concluded that it carries a lower dependence risk than caffeine, and being among the lowest risks of death of all major substance abuse categories.

The use of these hallucinogens can cause serious harm to you and the people around you. If you have questions about the use of hallucinogens or you think you may be experiencing substance use disorder, reach out to your healthcare provider for help. Hallucinogens, or psychedelics, are a group of drugs that alter a person’s perception of reality. Types of hallucinogens include LSD, peyote, PCP, psilocybin and others. Nearly all hallucinogens are illegal, and researchers don’t consider any amount of use safe. Psilocybin-containing mushrooms have been used for religious purposes throughout Mesoamerica for centuries (McKenna and Riba, 2016), with mushroom-shaped artefacts dating back to at least 500 BC (Guerra-Doce, 2015).

How is NIDA advancing research on psychedelic and dissociative drugs?

Setting is likely a key influence of the progress of a psychedelic experience, as is the dose used, with a higher dose more likely to lead to these experiences (Johnson et al., 2014). Understanding the specific circumstances and individuals in which psychedelics may lead to challenging experiences will have important implications for future clinical research and harm reduction strategies. Hallucinogen dependence is a separate category to HUD, based on generic substance use dependence criteria, several of which do not apply to hallucinogens. Withdrawal symptoms and signs are not established for hallucinogens, and so this criterion is not included. In hallucinogen abuse, hallucinogens are used but much less often than in hallucinogen dependence. Diagnostic criteria include a pattern of pathological use, the impairment of social or occupational functioning due to use, and duration of disturbance of at least 1 month.