We employ a five-step risk scale with values ranging from "very low" to "very high" within six categories: Acute toxicity, Long-term toxicity, Dependence, Cognitive problems, Unpleasant events, and Interactions.
These values are based on qualitative reviews of available knowledge, and should only be viewed as guidelines. They are also relative, so a score of "very low risk" does not mean the substance is risk-free. The scale assumes users are normal, healthy individuals; beware that even drugs which are well-tolerated by most people may nevertheless be harmful to some users. It also assumes normal use patterns; that is, if a given drug is only harmful when used in a certain way, yet is almost never used in that way, then the drug will be considered less harmful compared to a similar drug which is commonly used in a harmful way.
ACUTE LETHALITY
⦿⦾⦾⦾⦾ (Very low risk)
LSD is one of the least lethal drugs when measuring lethality relative to the effective dose. Recent literature estimates that up to 100 milligrams (mg) may be needed for death to occur in humans, which is a thousand times more than a typical recreational dose of 100 micrograms (µg) [1]. In one case, a woman in the US reportedly ingested approximately 55 mg (i.e. 550 recreational doses), resulting only in intermittent loss of consciousness and strong intoxication lasting for several days [2]. Two additional cases have been documented where five and eight people, respectively, ended up in the emergency room after snorting "lines" of pure LSD powder that they had mistaken for cocaine, amounting to several hundred times a typical recreational dose. In both cases, some of the patients of them had to be treated for overheating, rhabdomyolysis, failing respiration, and bleeding tendencies, and could have died without medical intervention; however, all thirteen survived, and were discharged after a short time without any lasting harm [3,4].
LONG-TERM TOXICITY
⦿⦾⦾⦾⦾ (Very low risk)
LSD is remarkably non-toxic to the body compared to most recreational drugs [1]. There is reason to believe that highly frequent LSD use could lead to heart valve fibrosis, as other substances with similar receptor activity are known to have this side effect – albeit only when used several times a week, so there is little reason for concern for people who only use LSD a few times per year [5]. Microdosing LSD several times a week, on the other hand, may be harmful.
DEPENDENCE
⦿⦾⦾⦾⦾ (Very low risk)
LSD is neither addictive nor habit-forming, and daily use is practically impossible due to users rapid building a near-total tolerance, making them essentially immune to the drug's effects for several days after ceasing their use [6,13]. LSD can also reduce cravings for other drugs, an effect with has previously been used to successfully treat alcoholism [7].
COGNITIVE PROBLEMS
⦿⦿⦾⦾⦾ (Low risk)
Science has not found a strong link between poor mental health and psychedelics use; on the contrary, psychedelics use has been found to correlate with better mental health outcomes in general [8–10]. However, one study did find that while use of LSD is not associated with any negative mental health outcomes, it is not associated with the same positive mental health outcomes as use of psilocybin or mescaline [10].
Some people may develop anxiety or delusions under the influence of LSD, particularly with high doses and in unfavorable environments. LSD can also trigger psychosis, but this is uncommon; in two studies of 5,000 and 4,300 people who had collectively taken LSD around 75,000 times in psychotherapy, the average risk of such outcomes was 1.25 per thousand [13]. This being said, people with family histories of psychosis or known vulnerabilities to drug-induced psychosis should still be cautious with LSD.
Some people may experience visual disturbances for some time after using psychedelics, reminiscent of the visual effects of the drug. This is known as hallucinogen persisting perception disorder, often abbreviated as HPPD. It is unclear the what extent this is caused by psychedelic use, as it is also seen with other drugs and in people with anxiety disorders. HPPD usually resolves on its own upon abstinence, but the drug lamotrigine seems to have been effective in treating some cases [11].
UNDESIRABLE EVENTS
⦿⦿⦾⦾⦾ (Low risk)
Psilocybe mushrooms may cause confusion or fear in the user, increasing the risk of accidents in situations where irrational behavior can be dangerous. However, serious accidents following psilocybe mushroom use are rare [7]. The risk of this occurring is greatest when consuming large doses and tripping without supervision. When picking psilocybe semilanceata in nature, there is some risk of picking a lookalike mushroom, some of which are quite poisonous. Therefore, if you plan on picking mushrooms yourself, you should first familiarize yourself thoroughly with the defining characteristics of psilocybe semilanceata and its typical habitat.
INTERACTIONS
⦿⦿⦾⦾⦾ (Low risk)
LSD should not be used by anyone currently taking lithium or tramadol, as this combination can trigger seizures [12]. LSD should also not be used with protease inhibitors like ritonavir or indinavir, as these are known to interact dangerously with the substance ergotamine, a chemical precursor to LSD.
It is not recommended to combine LSD with cannabis unless one is thoroughly familiar and experienced with each drug, as this combination can both significantly enhance the psychedelic effect and lead to confusion and anxiety [15]. Combining LSD with large amounts of alcohol is also not recommended, as this can make one more disoriented and lead to accidents and injuries.
SSRI-based antidepressants tend to block most of the effects of LSD.