A cluster of lysergic acid diethylamide (LSD) poisonings following insufflation of a white powder sold as cocaine.
Darren M Roberts, Kulanka H Premachandra, Betty S. Chan, Robin Auld, Thanjira Jiranantakan, Christopher Ewers, Catherine McDonald, Vanessa Shaw, Jared A Brown
Clinical Toxicology November 2021 DOI: 10.1080/15563650.2021.1904140 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 4 |
| Population | People who inhaled a white powder sold as cocaine and developed severe toxicity |
| Topics | LSD |
| Keywords | Adulteration Cluster Contamination Overdose Poisoning Public health |
| Key findings | In four people who inhaled powder sold as cocaine, LSD was confirmed at concentrations of 0.04–0.06 mg/L in three, among the highest reported. All survived without persistent injury, though one needed intubation and intensive care and two were admitted overnight. The authors argue that coordinated pre-hospital, hospital, public health, and laboratory responses are advantageous and that good supportive care yields favourable outcomes despite high LSD exposure. |
Abstract
Adulteration, substitution or contamination of illicit substances can have clinically significant implications when other illicit substances are included. Such circumstances can present as clusters of poisonings, including severe toxicity and death following exposure to unexpected illicit substances. We report a cluster of laboratory-confirmed lysergic acid diethylamide (LSD) in a powder that was sold as cocaine and used recreationally. The Prescription, Recreational and Illicit Substance Evaluation (PRISE) program established by the New South Wales Ministry of Health includes State-based hospital toxicology services, Poisons Information Centre, Forensic & Analytical Science Service and emergency services to identify clusters of severe and unusual toxicity associated with substance use. PRISE criteria include a known cluster (geographically or situationally related) of people with acute severe toxicity, especially when accompanied by a toxidrome that is inconsistent with the history of exposure. A timely comprehensive drug screen and quantification is performed in eligible cases and the results are related to the clinical features. The need for a public health response is then considered. Four individuals inhaled a white powder that was sold as cocaine and developed severe toxicity that was not consistent with cocaine which prompted transfer to hospital for further management. LSD was confirmed in four subjects, and the concentrations in 3 of the individuals were 0.04-0.06 mg/L which are among the highest reported in the literature. Common clinical features were hallucinations, agitation, vomiting, sedation, hypertension, and mydriasis. One subject required intubation and admission to the intensive care unit, two required overnight admission, and the fourth was discharged following oral diazepam after observation. No subject suffered persistent injury. A close working relationship between pre-hospital emergency services, hospital-based clinical services, public health authorities, and analytical laboratories appears to be advantageous. Favourable clinical outcomes are observed from LSD poisoning despite high exposures with good supportive care.
Comparable studies
Other case reports and case series on LSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lasting Neuropsychiatric Sequelae of (??)Methylenedioxymethamphetamine (???Ecstasy???) in Recreational Users Persons who ingested large doses of MDMA | 1991 | Case study | n = 2 |
| Further Studies in the Therapeutic Value of Lysergic Acid Diethylamide in Mental Illness Patients with mental illness | 1957 | Case series | |
| Coma, Hyperthermia, and Bleeding Associated with Massive LSD Overdose a Report of Eight Cases People who self-administered large amounts of pure LSD powder intranasally | 1975 | Case series | n = 8 |
| Using a MDMA- and LSD-Group Therapy Model in Clinical Practice in Switzerland and Highlighting the Treatment of Trauma-Related Disorders Patients with chronic complex post-traumatic stress disorder (c-PTSD), dissociative,... | 2022 | Case series | |
| Persistent Palinopsia Following Ingestion of Lysergic Acid Diethylamide (LSD) Patients who developed persistent palinopsia after LSD ingestion | 1996 | Case series | n = 3 |
Citations in the library
Cited by 4
- Mechanisms and molecular targets surrounding the potential therapeutic effects of psychedelics. Molecular Psychiatry September 1, 2023
- Cellular rules underlying psychedelic control of prefrontal pyramidal neurons bioRxiv (Cold Spring Harbor Laboratory) October 23, 2023
- A retrospective study of the characteristics and toxicology of cases of lysergic acid diethylamide (LSD)‐ and psilocybin‐related death in Australia Addiction May 21, 2024
- Lysergic Acid Amide (LSA), an LSD Analog: Systematic Review of Pharmacological Effects, Adverse Outcomes, and Therapeutic Potentials. Pharmacy July 21, 2025
Cites 11
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- Acute dose-dependent effects of lysergic acid diethylamide in a double-blind placebo-controlled study in healthy subjects Neuropsychopharmacology October 15, 2020
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and 6 more in the library