Editing LSD (section)

==Overdose==
There have been no documented fatal human overdoses from LSD,<ref name="PassieHalpernStrichtenoth2008" /><ref name="Lipow22">{{cite journal |journal=Transformative Medicine |title=NBOMe Toxicity and Fatalities: A Review of the Literature |volume=1 |issue=1 |date=March 2022 |vauthors=Lipow M, Kaleem SZ, Espiridion E |pages=12–18 |s2cid=247888583 |doi=10.54299/tmed/msot8578 |doi-access=free |issn=2831-8978}}</ref> although there has been no "comprehensive review since the 1950s" and "almost no legal clinical research since the 1970s".<ref name="PassieHalpernStrichtenoth2008" /> A 5{{nbsp}}mg overdose of LSD (50{{nbsp}}times the usual dose) produced severe [[nausea]] and [[vomiting]] along with behavioral and emotional disturbances.<ref name="Shulgin1976" /><ref name="ReynoldsPeterson1966">{{cite journal | vauthors = Reynolds HH, Peterson GK | title = Psychophysiological effects of a large non-experimental dose of LSD-25 | journal = Psychol Rep | volume = 19 | issue = 1 | pages = 287–290 | date = August 1966 | pmid = 5942100 | doi = 10.2466/pr0.1966.19.1.287 | url = }}</ref> Eight individuals who had accidentally consumed an exceedingly high amount of LSD, mistaking it for [[cocaine]], and had gastric levels of 1,000–7,000{{nbsp}}μg/100{{nbsp}}mL LSD tartrate and [[blood plasma]] levels up to 26{{nbsp}}μg/mL, had suffered from [[Coma#Causes|comatose states]], vomiting, respiratory problems, [[hyperthermia]], and light [[gastrointestinal bleeding]]; however, all of them survived without residual effects upon hospital intervention.<ref name="PassieHalpernStrichtenoth2008" /><ref>{{cite journal | vauthors = Klock JC, Boerner U, Becker CE | title = Coma, Hyperthermia and Bleeding Associated with Massive LSD Overdose: A Report of Eight Cases | journal = The Western Journal of Medicine | date = March 1974 | volume = 120 | issue = 3 | pages = 183–188 | pmid = 4816396 | pmc = 1129381}}</ref>

Individuals experiencing a bad trip after LSD intoxication may present with severe anxiety and tachycardia, often accompanied by phases of psychotic agitation and varying degrees of delusions.<ref name="pmid29408722" /> Cases of death on a bad trip have been reported due to [[hogtie#Human uses|prone maximal restraint]] (commonly known as a hogtie) and [[positional asphyxia]] when the individuals were restrained by [[law enforcement personnel]].<ref name="pmid29408722" />

Massive doses are largely managed by [[symptomatic treatment]]s, and agitation can be addressed with [[benzodiazepine]]s.<ref name="Medscape">{{EMedicine|article|1011615|LSD Toxicity Treatment & Management|treatment}}</ref><ref>{{cite journal |journal=Frontiers in Neuroscience |vauthors=Zawilska JB, Kacela M, Adamowicz P |doi=10.3389/fnins.2020.00078 |date=26 February 2020 |volume=14 |pmid=32174803 |title=NBOMes–Highly Potent and Toxic Alternatives of LSD |page=78 |pmc=7054380 |doi-access=free}}</ref> Reassurance in a [[Set and setting|calm, safe environment]] is beneficial.<ref>{{Cite journal |vauthors=Hartogsohn I |date=2017 |title=Constructing drug effects: A history of set and setting |journal=Drug Science, Policy and Law |language=en |volume=3 |pages=205032451668332 |doi=10.1177/2050324516683325 |s2cid=53373205 |issn=2050-3245 |doi-access=free}}</ref> [[Typical antipsychotic|Antipsychotics]] such as [[haloperidol]] are not recommended as they may have adverse [[Psychotomimetism|psychotomimetic effects]].<ref name="Medscape" /> Gastrointestinal decontamination with [[Activated charcoal (medication)|activated charcoal]] is of little use due to the rapid absorption of LSD, unless done within 30–60 minutes of ingesting exceedingly huge amounts.<ref name="Medscape" /> Administration of [[anticoagulants]], [[vasodilators]], and [[sympatholytics]] may be useful for treating [[ergotism]].<ref name="Medscape" />

The lethal oral dose of LSD in humans is estimated at 100&nbsp;mg, based on LD<sub>50</sub> and lethal blood concentrations observed in rodent studies.<ref name="pmid29408722" />

===Designer drug overdose===
Many [[Designer drug|novel psychoactive substances]] of [[25-NB]] (NBOMe) series, such as [[25I-NBOMe]] and [[25B-NBOMe]], are regularly sold as LSD in blotter papers.<ref name="pmid30261175">{{cite journal |journal=Biochemical Pharmacology |vauthors=Eshleman AJ, Wolfrum KM, Reed JF, Kim SO, Johnson RA, Janowsky A |title=Neurochemical pharmacology of psychoactive substituted N-benzylphenethylamines: High potency agonists at 5-HT2A receptors |doi=10.1016/j.bcp.2018.09.024 |pmid=30261175 |pmc=6298744 |volume=158 |pages=27–34 |date=December 2018}}</ref><ref>{{cite journal |journal=Journal of Analytical Toxicology |doi=10.1093/jat/bkv073 |pmc=4570937 |pmid=26378135 |title=Analysis of 25I-NBOMe, 25B-NBOMe, 25C-NBOMe and Other Dimethoxyphenyl-N-[(2-Methoxyphenyl) Methyl]Ethanamine Derivatives on Blotter Paper |vauthors=Poklis JL, Raso SA, Alford KN, Poklis A, Peace MR |date=Oct 2015 |volume=39 |issue=8 |pages=617–623}}</ref> NBOMe compounds are often associated with life-threatening toxicity and death.<ref name="pmid30261175"/><ref name="pmid35343858">{{cite journal |journal=[[Clinical Toxicology]] |title=A cluster of 25B-NBOH poisonings following exposure to powder sold as lysergic acid diethylamide (LSD) |vauthors=Ivory ST, Rotella J, Schumann J, Greene SL |pages=966–969 |date=28 March 2022 |volume=60 |issue=8 |doi=10.1080/15563650.2022.2053150 |pmid=35343858 |s2cid=247764056}}</ref> Fatalities involved in NBOMe intoxication suggest that a significant number of individuals ingested the substance which they believed was LSD,<ref name="pmid31915427">{{cite journal |journal=Frontiers in Pharmacology |date=12 December 2019 |vauthors=Miliano C, Marti M, Pintori N, Castelli MP, Tirri M, Arfè R, De Luca MA |title=Neurochemical and Behavioral Profiling in Male and Female Rats of the Psychedelic Agent 25I-NBOMe |volume=10 |page=1406 |pmid=31915427 |pmc=6921684 |doi=10.3389/fphar.2019.01406 |doi-access=free}}</ref> and researchers report that "users familiar with LSD may have a false sense of security when ingesting NBOMe inadvertently".<ref name="Lipow22"/> Researchers state that the alleged physiological toxicity of LSD is likely due to psychoactive substances other than LSD.<ref name="pmid29408722"/>

NBOMe compounds are reported to have a bitter taste,<ref name="Lipow22"/> are not active orally,{{efn|The [[Potency (pharmacology)|potency]] of ''N''-benzylphenethylamines via buccal, sublingual, or nasal absorption is 50–100 greater (by weight) than oral route compared to the parent [[2C-x]] compounds.<ref name="pmid24519542">{{cite journal |journal=Neurochemical Research |date=14 February 2014 |vauthors=Leth-Petersen S, Bundgaard C, Hansen M, Carnerup MA, Kehler J, Kristensen JL |title=Correlating the Metabolic Stability of Psychedelic 5-HT2A Agonists with Anecdotal Reports of Human Oral Bioavailability |volume=39 |issue=10 |pages=2018–2023 |doi=10.1007/s11064-014-1253-y |pmid=24519542| s2cid=254857910}}</ref> Researches hypothesize the low oral metabolic stability of ''N''-benzylphenethylamines is likely causing the low bioavailability on the oral route, although the metabolic profile of this compounds remains unpredictable; therefore researches state that the fatalities linked to these substances may partly be explained by differences in the metabolism between individuals.<ref name="pmid24519542"/>}} and are usually taken sublingually.<ref name="pmid28097528">{{cite book |title=Neuropharmacology of New Psychoactive Substances |vauthors=Halberstadt AL |doi=10.1007/7854_2016_64 |date=18 January 2017 |isbn=978-3-319-52444-3 |publisher=Springer |chapter=Pharmacology and Toxicology of N-Benzylphenethylamine ("NBOMe") Hallucinogens |series=Current Topics in Behavioral Neurosciences |volume=32 |pages=283–311 |pmid=28097528}}</ref> When NBOMes are administered sublingually, [[numbness]] of the tongue and mouth followed by a metallic chemical taste was observed, and researchers describe this physical side effect as one of the main discriminants between NBOMe compounds and LSD.<ref>{{cite journal |vauthors=Duffau B, Camargo C, Kogan M, Fuentes E, Kennedy Cassels B |journal=Journal of Chromatographic Science |volume=54 |issue=7 |date=August 2016 |pages=1153–1158 |title=Analysis of 25 C NBOMe in Seized Blotters by HPTLC and GC–MS |pmc=4941995 |pmid=27406128 |doi=10.1093/chromsci/bmw095 |doi-access=free}}</ref><ref>{{cite journal |pmid=25105138 |pmc=4106087 |doi=10.1155/2014/734749 |title=25C-NBOMe: preliminary data on pharmacology, psychoactive effects, and toxicity of a new potent and dangerous hallucinogenic drug |journal=BioMed Research International |date=3 July 2014 |vauthors=Francesco SB, Ornella C, Gabriella A, Giuseppe V, Rita S, Flaminia BP, Eduardo C, Pierluigi S, Giovanni M, Guiseppe B, Fabrizio S |volume=2014 |page=734749 |doi-access=free}}</ref><ref>{{cite book |title=Novel Psychoactive Substances: Classification, Pharmacology and Toxicology |chapter=Pharmacology and toxicology of N-Benzyl-phenylethylamines (25X-NBOMe) hallucinogens |vauthors=Potts AJ, ((Thomas SHL)), Hill SL |veditors=Dargan P, Wood D |doi=10.1016/B978-0-12-818788-3.00008-5 |isbn=978-0-12-818788-3 |pages=279–300 |edition=2nd |publisher=Academic Press |date=September 2021 |s2cid=240583877}}</ref> Despite its high potency, recreational doses of LSD have only produced low incidents of acute toxicity, but NBOMe compounds have extremely different safety profiles.<ref name="Lipow22"/><ref name="pmid35343858"/> Testing with [[Ehrlich's reagent]] gives a positive result for LSD and a negative result for NBOMe compounds.<ref>{{Cite journal | vauthors = Díaz Moreno M, Alarcón Ayala N, Estrada Y, Morris V, Quintero J |date=November 2022 |title=Échele Cabeza as a harm reduction project and activist movement in Colombia |url=https://www.emerald.com/insight/content/doi/10.1108/DHS-07-2022-0026/full/html |journal=[[Drugs, Habits and Social Policy]] |language=en |volume=23 |issue=3 |pages=263–276 |doi=10.1108/DHS-07-2022-0026 |issn=2752-6739}}</ref><ref>{{cite journal | vauthors = Clancy L, Philp M, Shimmon R, Fu S | title = Development and validation of a color spot test method for the presumptive detection of 25-NBOMe compounds | journal = Drug Testing and Analysis | volume = 13 | issue = 5 | pages = 929–943 | date = May 2021 | pmid = 32744773 | doi = 10.1002/dta.2905 }}</ref>