Introduction
● LSD is a hallucinogen (psychedelic drug) which was first synthesized form Lysergic Acid obtained from alkaloids produced by the fungus Claviceps purpurea growth on rye grain.
● Its hallucinogenic effects first described by the Swiss Chemist Albert Hofmann.
● It is also the synthetic diethylamide derivative of ergot alkaloids.
● But now a days, LSD was prepared in the laboratory and typically sold in the market as liquid-impregnated blotting paper or sugar cubes, tiny tablets (“microdots”), gelatin squares (“window panes”), liquid, or powder for addiction purpose.
● The drug is colourless, tasteless and odourless and water- soluble white powder.
● LSD is the most powerful hallucinogens.
● The melting point of this drug is 80-85 degree Celsius.
● LSD is a highly potent drug.
● The normal dose for going on a trip is about 1 to 2 microgram per kilogram of body weight through addiction-prone individual may tolerate upto 4 microgram of the drug.
Administration
- It is administered orally often placed in sugar cubes or blotter papers.
- It is also administered through injection.
- Lysergic acid diethylamide (LSD) is always ingested.
- Other common mode of intake includes intranasal, sublingual, smoking, conjuctival instillation.
Fatal Dose
- The usual dose of abuse is 100 to 300 micrograms.
- Doses over 0.2 mg/kg are potentially lethal.
Effects
● LSD is one of the most powerful psychotic drugs discovered. The drug affects entire human metabolism which may result in complete disorganization of the individual’s body working and may result in complete chaos and horror. The effect is pronounced upon psychotic personalities. The main features of the experiences described are-
● The subject experiences vivid hallucination in perception of sound, colour and visual distortions.
● The subject loses the sense of time and space.
● The subject is unable to discriminate between right and wrong.
The subject loses sense of cause and effects.
● The effect of the drug appears in about half an hour and lasts for several hours. In some cases, it creates permanent defect in the personality of the subject.
Addiction
● The drug is not used like other drugs for addiction. It is too drastic.
● A single dose has in some cases caused disturbance for over a year.
● The exact nature of its action on human body and mind is not yet fully known.
● It is possible that it may be causing damage to some organs possibly to brain parts.
● It therefore, needs strict control and preventive measures against its abuse.
Mode of Action
● LSD is structurally related to serotonin (5-hydroxytryptamine) and is an agonist at the 5-HT1 receptor.
● Serotonin modulates many psychological and physiological processes including mood, personality, affect, appetite, sexual desire, motor function, temperature regulation, pain perception, and sleep induction.
● LSD inhibits central raphe neurons of brainstem through stimulation of 5-HT1A receptors, which are coupled to adenylcyclase.
● It is also an agonist at 5-HT2A, 2C receptors, which are not located presynaptically on serotonergic cell bodies but on certain subpopulations of neurons in postsynaptic regions.
● The majority of 5-HT2 receptors in the brain are located in the cerebral cortex.
● Animal experiments have shown that LSD is anatomically distributed maximally in the visual and auditory cortex, and the limbic cortex (besides the pituitary, pineal, and hypothalamic areas), which parallels the finding of high concentration of 5-HT2 receptors in human cerebral cortex.
● Recent studies also suggest that activation of D1 (dopamine) receptors may contribute to the neurochemical effects of LSD.
Metabolism
● LSD is metabolized in the liver to three or four different metabolic products. 60-80% is excreted into the bile.
● The route of metabolism is hepatic hydroxylation.
Sign and Symptoms
1. Acute Poisoning
Physical Signs and Symptoms
- Mydriasis
- Hippus
- Vertigo
- Tachycardia
- Hypertension
- Sweating
- Piloerection
- Hyperthermia
- Tachypnoea
- Muscle weakness
- Ataxia
- Hyperactivity
- Coma
Psychological Signs and Symptoms
- Euphoria
- Dysphoria
- Vivid hallucinations
- Synaesthesias
- Bizarre perceptual changes: People’s faces and body parts appear distorted.
- Sounds may be magnified and distorted.
- Colours seem brighter with halos around objects.
- Depersonalisation
- Hallucinating person may feel as if he is observing an event instead of being involved in it.
2. Chronic Poisoning
● Prolonged psychotic reactions which are mainly schizophrenic in nature.
● Severe depression.
● Flashback phenomena: The person re-lives the LSD experience periodically in the absence of drug intake for months or years.
● Post-hallucinogen perception disorder- It includes-
● Associated anxiety, panic, and depression are common.
● Pareidolias—images of faces on floor and walls, floating faces hovering in space.
● Aeropsia—visualisation of air in the form of numerous vibrating pinpoint-sized molecules.
Detection and Forensic Examination
● LSD gives grey colour with sulphuric acid and formaldehyde.
● It also gives grey green colour with ammonium molybdate and brown colour with ammonium vanadate.
Others
● Thin Layer Chromatography
● Gas Liquid chromatography
● Radioimmunoassay of serum or urine (limit of detection 0.1ng/ml).
● HPTLC (high performance thin layer chromatography) can detect LSD in urine in concentrations less than 1 mcg/litre.
● HPLC (high pressure/performance liquid chromatography) of serum and urine.
● GC-MS (gas chromatography-mass spectrometry) can confirm positive LSD urine levels to a lower limit of 5 pg/ml.
Treatment
● Avoid gut decontamination as LSD is ingested in microquantities and rapidly absorbed, rendering decontamination procedures totally redundant.
● Do not use restraints in agitated patient because it will only exacerbate the condition.
● Because of the short half-life and few serious medical reactions, elimination enhancement procedures such as haemodialysis, haemoperfusion, etc., are not warranted.
● Treat acute panic attacks with quiet environment andreassurance.
● Supportive care and administration of diazepam (5–10 mg IV) or haloperidol in severe cases.
● Treat acute psychotic reactions with cautious administration of neuroleptics such as haloperidol.
● Avoid phenothiazines which can cause hypotension, sedation, extrapyramidal reactions, lowered seizure threshold, and potentiation of anticholinergic effects.
● Treat flashbacks with psychotherapy, anti-anxiety agents, and neuroleptics.
● Treat post-hallucinogen perception disorder with longlasting benzodiazepines such as clonazepam, and to lesser extent anticonvulsants such as valproic acid and carbamazepine.
● The patient must be instructed not to consume alcohol, cannabis, caffeine, and other drugs which can intensify the disorder.
References
- Dr. K.S. Narayan Reddy. The essential of forensic medicine and toxicology.34th edition.
- VV Pillay.Modern medical toxicology.4th edition.
- Richard Saferstein. Criminalistics-An introduction to forensic science. 11th Edition.
