LSD Overdoses: Three Case Reports

Haden and colleagues frame this work within a renewed scientific and clinical interest in psychedelics for conditions such as addiction, PTSD, depression and anxiety. They note that contemporary clinical protocols use doses considered safe and that administering very large doses (for example, 300 mcg or more of LSD) would present greater ethical and safety obstacles in formal trials. Consequently, the authors argue that examination of accidental overdoses in naturalistic settings can provide information about effects and risks at extremely high dosages that cannot easily be obtained in regulated research. This paper presents a retrospective case series of three accidental LSD overdoses, with the aim of documenting acute medical consequences and any subsequent longer-term sequelae. The authors emphasise that these reports may shed light on unexpected outcomes—both harmful and potentially beneficial—associated with very large LSD exposures outside clinical trials.

The study is a retrospective case series of three individual overdose events. Information was gathered from interviews with the individuals involved and with collateral informants (family members, friends, suppliers), together with reviews of available health records, ambulance and emergency department notes, hospital case notes and mental health team documentation. For each case the authors synthesised these sources to reconstruct the event, immediate clinical response and subsequent clinical course. The extracted text does not report formal inclusion or exclusion criteria, nor does it describe any ethical approvals or consent procedures. Toxicological confirmation (blood or urine samples) was not available for these cases; LSD dosages are therefore approximated based on collateral reports, supplier statements and, in one case, weighing of remaining powder. The analysis is descriptive; no statistical methods are reported.

Case 1 (AV): A female first seen by mental health services at age 12 had a long history of mood and psychotic symptoms and was diagnosed ultimately with bipolar I disorder after a full manic episode with psychotic features. Her drug history included regular cannabis use and occasional psychedelic and MDMA use. On 20 June 2000, at age 15, she ingested an estimated 1,100–1,200 mcg of LSD (the supplier reportedly miscalculated doses by a decimal place). Observers described erratic behaviour for several hours and what was interpreted by witnesses and emergency staff as a seizure, although subsequent accounts questioned whether it was a true epileptic event; two EEGs were reported as normal. In the weeks and months after the overdose, mental health team notes documented marked and sustained improvement: the patient was described as stable, with a positive mood balance and no recurrent mania or depression through the following year. AV reported being free of bipolar symptoms for approximately 13 years after the event until experiencing postpartum depression; she discontinued lithium in 2001. The authors report this as a sustained reduction of mania with psychotic features lasting nearly 20 years overall. Case 2 (NM): A 26-year-old woman consumed approximately 500 mcg of LSD at the same summer event, not knowing she was about 2 weeks pregnant. She experienced an intense acute reaction but no loss of consciousness, vomiting, or seizure according to her account. Retrospective follow-up indicates an uncomplicated pregnancy and delivery; her son, now 18 years old at the time of reporting, was described as developmentally normal, academically successful and socially well adjusted. The authors report no obvious teratogenic effects or developmental problems attributable to the early first-trimester exposure. Case 3 (CB): A woman with chronic pain from presumed Lyme-related foot and ankle damage intranasally ingested what she believed was cocaine but was actually LSD powder in September 2015. She reportedly took 55 mg intranasally, which the authors state is approximately 550 times a typical 100 mcg recreational dose. The acute phase included prolonged vomiting, apparent periods of unresponsiveness for about 12 hours, and later lucidity. The patient reported abolition of foot pain the next day and discontinued her prescribed morphine (40–80 mg/day) for 5 days without typical withdrawal symptoms. She subsequently recommenced morphine at a much lower dose while initiating an approximate microdosing regimen of 25 mcg every 3 days. By January 2018 she had discontinued morphine and other pain medications without classical withdrawal; however she reported increased anxiety, depression, social withdrawal and heightened sensitivity following cessation of opioids.

Haden and colleagues present these three case reports as novel observational data on very large, accidental LSD exposures that cannot be tested ethically in clinical trials. They highlight that the events produced heterogeneous outcomes, including what the authors describe as unexpectedly positive sequelae: apparent long-term remission of bipolar symptoms in one individual, absence of observable teratogenic effects after very early first-trimester exposure in another, and marked short-term analgesia with eventual opioid dose reduction and abstinence in the third. The authors acknowledge important limitations to their analysis. The data are anecdotal and retrospective, with no toxicological confirmation because blood or urine samples were not available; LSD dosages are approximated from collateral reports rather than laboratory measurement. Observer reports and medical records vary in detail, and causal inferences cannot be drawn from these isolated cases. Despite these caveats, the investigators position the reports within historical safety literature that characterises LSD as having low direct toxicity, and suggest that these incidents add to the broader, rapidly expanding literature exploring potential therapeutic applications of psychedelics. The authors stop short of causal claims, instead noting unpredictability of effects and the need to interpret these observations cautiously given the methodological constraints.