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Nichols DE, Grob CS. 
“Is LSD Toxic?”. 
Forensic Science International. 2018;284:141-145.
LSD (lysergic acid diethylamide) was discovered almost 75 years ago, and has been the object of episodic controversy since then. While initially explored as an adjunctive psychiatric treatment, its recreational use by the general public has persisted and on occasion has been associated with adverse outcomes, particularly when the drug is taken under suboptimal conditions. LSD’s potential to cause psychological disturbance (bad trips) has been long understood, and has rarely been associated with accidental deaths and suicide. From a physiological perspective, however, LSD is known to be non-toxic and medically safe when taken at standard dosages (50–200 mg). The scientific literature, along with recent media reports, have unfortunately implicated "LSD toxicity" in five cases of sudden death. On close examination, however, two of these fatalities were associated with ingestion of massive overdoses, two were evidently in individuals with psychological agitation after taking standard doses of LSD who were then placed in maximal physical restraint positions (hogtied) by police, following which they suffered fatal cardiovascular collapse, and one case of extreme hyperthermia leading to death that was likely caused by a drug substituted for LSD with strong effects on central nervous system temperature regulation (e.g. 25i-NBOMe). Given the renewed interest in the therapeutic potential of LSD and other psychedelic drugs, it is important that an accurate understanding be established of the true causes of such fatalities that had been erroneously attributed to LSD toxicity, including massive overdoses, excessive physical restraints, and psychoactive drugs other than LSD.
Comments and Responses to this Article
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Feb 4, 2018 22:47
exciteddelirium #

Another in a growing series of recognitions by folks outside emergency departments that "excited delirium", (aka "agitated delirium" or "restraint asphyxia" or Erowid's very unpleasant term "sudden police-triggered death syndrome").

It is super important for people outside the field of clinical toxicology incorporate the knowledge that health risks can be related to how we treat people once we've intervened. Restraining people who do not want to be restrained can actually result in their death. And death isn't the only type of outcome.

We can blame it on the excited person or we can try to add to the future versions of civil society that physically restraining people who resist and do not want to be restrained is itself harmful.
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