What is the treatment for an LSD (lysergic acid diethylamide) overdose?

Treatment for LSD (Lysergic Acid Diethylamide) Overdose

The treatment for LSD overdose is primarily supportive care in a calm environment, as there is no specific antidote for LSD toxicity. 1, 2

Clinical Assessment

Signs and Symptoms of LSD Intoxication

• Psychological symptoms (most common):

  • Anxiety and panic
  • Confusion
  • Visual hallucinations
  • Altered perception of time and space
  • Paranoia
  • Agitation

• Physical symptoms (less common):

  • Dilated pupils
  • Elevated heart rate and blood pressure
  • Hyperthermia (in severe cases)
  • Nausea/vomiting

Management Algorithm

1. Ensure Safety and Stabilization

• Establish airway, breathing, and circulation if compromised
• Place patient in a calm, quiet environment with minimal stimulation
• Remove any dangerous objects from vicinity
• Provide reassurance and verbal de-escalation

2. Pharmacological Management

• For severe agitation or panic:
  • Benzodiazepines are first-line therapy 3
    • Lorazepam 1-2 mg IV/IM or
    • Diazepam 5-10 mg IV/IM
  • Titrate to effect for symptom control
  • Monitor for respiratory depression, especially if patient has co-ingested other substances

3. Supportive Care

• Maintain hydration
• Monitor vital signs
• Observe for at least 6-12 hours until symptoms resolve
• Continuous reassurance that effects are temporary

4. Special Considerations

• Physical restraints should be avoided whenever possible as they have been associated with fatal cardiovascular collapse in agitated patients under the influence of LSD 1
• If restraints are absolutely necessary, avoid prone/hogtied positions and monitor vital signs continuously

Important Clinical Pearls

Medical Safety Profile

• LSD is physiologically non-toxic at standard recreational doses (50-200μg) 1
• Deaths attributed to "LSD toxicity" are typically due to:
  • Behavioral toxicity (accidents, suicide during psychosis)
  • Massive overdoses (extremely rare)
  • Physical restraint complications
  • Misidentified substances (e.g., 25i-NBOMe sold as LSD) 1

Differential Diagnosis

• Rule out other substances that may cause similar symptoms but require different management:
  • Anticholinergic drugs
  • Sympathomimetics (cocaine, amphetamines)
  • Synthetic cannabinoids
  • Other hallucinogens (especially NBOMe compounds)
  • Serotonin syndrome

Monitoring and Disposition

• Most patients recover completely within 24 hours 4
• Approximately 1% of recreational LSD users seek emergency medical treatment 4
• Persistent psychological symptoms beyond 4 weeks are rare but possible 4
• Consider psychiatric evaluation if:
  • Suicidal ideation is present
  • Psychotic symptoms persist after drug effects should have resolved
  • Patient has pre-existing mental health conditions

Risk Factors for Adverse Reactions

• Younger age
• Pre-existing mental health conditions
• Higher frequency of LSD use
• Poor "set and setting" (psychological state and environment) 4

Unlike opioid overdose, there is no specific antidote for LSD, and treatment focuses on managing psychological distress while monitoring for rare but serious complications. Most patients recover completely with supportive care alone.