Potential adverse effects

Chart of dependence potential and effective dose/lethal dose of some psychoactive drugs

There have been no documented human deaths from an LSD overdose.

It is physiologically well tolerated and there is no evidence for long-lasting
physiological effects on the brain or other parts of the human organism.
LSD may temporarily impair the ability to make sensible judgments and
understand common dangers, thus making the user more susceptible to
accidents and personal injury. It may cause temporary confusion, difficulty
with abstract thinking, or signs of impaired memory and attention span.

Adverse drug interactions

Mental disorders
LSD may trigger panic attacks or feelings of extreme anxiety, colloquially
referred to as a "bad trip". No real prolonged effects have been proven;
however, people with such conditions as schizophrenia and depression can
worsen with LSD.

Suggestibility
While publicly available documents indicate that the CIA and Department of
Defense have discontinued research into the use of LSD as a means of mind
control, research from the 1960s suggests there exists evidence that both
mentally ill and healthy people are more suggestible while under its
influence.

Psychosis
There are some cases of LSD inducing a psychosis in people who appeared to
be healthy before taking LSD.
Estimates of the prevalence of LSD-induced prolonged psychosis lasting over
48 hours have been made by surveying researchers and therapists who had
administered LSD:

Cohen (1960) estimated 0.8 per 1,000 volunteers (the single case among
approximately 1250 study volunteers was the identical twin of a person
with schizophrenia, and he recovered within 5 days) and 1.8 per 1,000
psychiatric patients (7 cases among approximately 3850 patients, of
which 2 cases had schizophrenia or previous hallucinatory experience, 1
case had unknown outcome, 1 case had incomplete recovery, and 5 cases
recovered within up to 6 months).
Malleson (1971) reported no cases of psychosis among experimental
subjects (170 volunteers who received a total of 450 LSD sessions) and
estimated 9 per 1,000 among psychiatric patients (37 cases among 4300
patients, of which 8 details are unknown, 10 appeared chronic, and 19
recovered completely within up to 3 months).

In neither survey study was it possible to compare the rate of lasting

psychosis in these volunteers and patients receiving LSD with the rate of
psychosis found in other groups of research volunteers or in other methods
of psychiatric treatment (for example, those receiving placebo).
Cohen (1960) noted:
The hallucinogenic experience is so striking that many subsequent
disturbances may be attributed to it without further justification. The
highly suggestible or hysterical individual would tend to focus on his
LSD experience to explain subsequent illness. Patients have
complained that their LSD exposure produced migraine headaches and
attacks of influenza up to a year later. One Chinese girl became
paraplegic and ascribed that catastrophe to LSD. It so happened that
these people were all in the control group and had received nothing
but tap water.
According to data from the National Survey on Drug Use and Health
(conducted by the National Institute on Drug Abuse), drawing from

130,152 respondents (17,486 of which used LSD), LSD use is associated

with a slightly lower risk of psychosis and other mental illness.

Flashbacks and HPPD

"Flashbacks" are a reported psychological phenomenon in which an
individual experiences an episode of some of LSD's subjective effects long
after the drug has worn off, usually in the days after typical doses. In
some rarer cases, flashbacks have lasted longer, but are generally shortlived and mild compared to the actual LSD "trip". Flashbacks can
incorporate both positive and negative aspects of LSD trips, and are
typically elicited by triggers such as alcohol or cannabis use, stress,
caffeine, or sleepiness. Flashbacks have proven difficult to study and are
no longer officially recognized as a psychiatric syndrome. However,
colloquial usage of the term persists and usually refers to any drug-free
experience reminiscent of psychedelic drug effects, with the typical
connotation that the episodes are of short duration.
No definitive explanation is currently available for these experiences. Any
attempt at explanation must reflect several observations: first, over 70
percent of LSD users claim never to have "flashed back"; second, the
phenomenon does appear linked with LSD use, though a causal
connection has not been established; and third, a higher proportion of
psychiatric patients report flashbacks than other users. Several studies
have tried to determine how likely a user of LSD, not suffering from
known psychiatric conditions, is to experience flashbacks. The larger
studies include Blumenfeld's in 1971 and Naditch and Fenwick's in 1977,
which arrived at figures of 20% and 28%, respectively. Interestingly, the
experiments by Sidney Cohen in 1960 did not report a single "flashback"
phenomenon.
Although flashbacks themselves are not recognized as a medical
syndrome, there is a recognized syndrome called Hallucinogen Persisting
Perception Disorder (HPPD) in which LSD-like visual changes are not
temporary and brief, as they are in flashbacks, but instead are persistent,
and cause clinically significant impairment or distress. HPPD differs from
flashbacks in that it is persistent and apparently entirely visual (although
mood and anxiety disorders are sometimes diagnosed in the same

individuals). A recent review suggests that HPPD (as defined in the DSMIV) is rare and affects only a distinctly vulnerable subpopulation of
users.[64] However, it is possible that the prevalence of HPPD is
underestimated because most of the diagnoses are applied to people
who are willing to admit to their health care practitioner that they have
previously used psychotropics, and presumably many people are
reluctant to admit this.[65]
There is no consensus regarding the nature and causes of HPPD (or
flashbacks). A study of 44 HPPD subjects who had previously ingested LSD
showed EEG abnormalities.[66] Given that some symptoms have
environmental triggers, it may represent a failure to adjust visual
processing to changing environmental conditions. There are no
explanations for why only some individuals develop HPPD. Explanations
in terms of LSD physically remaining in the body for months or years after
consumption have been discounted by experimental evidence.[59] Some
say HPPD is a manifestation of post-traumatic stress disorder, not related
to the direct action of LSD on brain chemistry, and varies according to the
susceptibility of the individual to the disorder. Many emotionally intense
experiences can lead to flashbacks when a person is reminded acutely of
the original experience. However, not all published case reports of HPPD
appear to describe an anxious hyper-vigilant state reminiscent of posttraumatic stress disorder. Instead, some cases appear to involve only
visual symptoms.[59]

Uterine contractions
Early pharmacological testing by Sandoz in laboratory animals showed
that LSD can stimulate uterine contractions, with efficacy comparable
to ergobasine, the active uterotonic component of the ergot fungus.
(Hofmann's work on ergot derivatives also produced a modified form
of ergobasine which became a widely accepted medication used
in obstetrics, under the trade name Methergine.) Therefore, LSD use by
pregnant women could be dangerous and is contraindicated.[5] However,
the relevance of these animal studies to humans is unclear, and a 2008
medical reference guide to drugs in pregnancy and lactation stated, "It
appears unlikely that pure LSD administered in a controlled condition is
an abortifacient."[67]

Genetic
Beginning in 1967, studies raised concerns that LSD might produce
genetic damage[68] or developmental abnormalities in fetuses. However,
these initial reports were based on in vitro studies or were poorly
controlled and have not been substantiated. In studies
of chromosomal changes in human users and in monkeys, the balance of
evidence suggests no increase in chromosomal damage. For
example, white blood cells of people who had been given LSD in a clinical
setting were examined for visible chromosomal abnormalities; overall,
there appeared to be no lasting changes.[68] Several studies have been
conducted using illicit LSD users and provide a less clear picture.
Interpretation of these data is generally complicated by factors such as
the unknown chemical composition of street LSD, concurrent use of
other psychoactive drugs, and diseases such as hepatitis in the sampled
populations. It seems possible the small number of genetic abnormalities
reported in users of street LSD is either coincidental or related to factors
other than a toxic effect of pure LSD.[68] A 2008 medical review concluded,
"The available data suggest that pure LSD does not cause chromosomal
abnormalities, spontaneous abortions, or congenital malformations. In
1969 Moseley (now Gottschalk) working at the University of California,
Riverside, under Edward Crellin Pauling, using e. coli ligase mutant strain
obtained results indicating no breakage and that therapeutically high
doses actually reduced breakage."[67]

Alteration of gene expression

Chronic administration of LSD alters gene expression profiles in
the medial prefrontal cortex. Evidence form studies in rodents
demonstrates
that
chronic
LSD
affects
the
expression
of DRD2, GABRB1, NR2A, Krox20, ATP5D, NDUFA1, NPY,
and BDNF,
among others. Many processes identified as altered by chronic LSD are
also implicated in the pathogenesis of schizophrenia.

Legal status
The United Nations Convention on Psychotropic Substances (adopted in
1971) requires its parties to prohibit LSD. Hence, it is illegal in all parties to
the convention, which includes the United States, Australia, New Zealand,

and most of Europe. However, enforcement of extant laws varies from

country to country. Medical and scientific research with LSD in humans is
permitted under the 1971 UN Convention.[117]

Canada
In Canada, LSD is a controlled substance under Schedule III of the Controlled
Drugs and Substances Act.[118] Every person who seeks to obtain the
substance, without disclosing authorization to obtain such substances 30
days before obtaining another prescription from a practitioner, is guilty of an
indictable offense and liable to imprisonment for a term not exceeding 3
years. Possession for purpose of trafficking is an indictable offense
punishable by imprisonment for 10 years.

United Kingdom
In the United Kingdom, LSD is a Schedule 1 Class 'A' drug. This means it has
no recognised legitimate uses and possession of the drug without a license is
punishable with 7 years imprisonment and/or an unlimited fine, and
trafficking is punishable with life imprisonment and an unlimited fine (see
main article on drug punishments Misuse of Drugs Act 1971).
In 2000, after consultation with members of the Royal College of
Psychiatrists' Faculty of Substance Misuse, the UK Police Foundation issued
the Runciman Report which recommended "the transfer of LSD from Class A
to Class B".[119]
In November 2009, the UK Transform Drug Policy Foundation released in the
House of Commons a guidebooks to the legal regulation of drugs, After the
War on Drugs: Blueprint for Regulation, which details options for regulated
distribution and sale of LSD and other psychedelics.[120]

United States
LSD is Schedule I in the United States, according to the Controlled Substances
Act of 1970.[121] This means LSD is illegal to manufacture, buy, possess,
process, or distribute without a DEA license. By classifying LSD as a Schedule I
substance, theDrug Enforcement Administration holds that LSD meets the
following three criteria: it is deemed to have a high potential for abuse; it has
no legitimate medical use in treatment; and there is a lack of accepted safety
for its use under medical supervision. There are no documented deaths from
chemical toxicity; most LSD deaths are a result of behavioral toxicity.[122]

There can also be substantial discrepancies between the amount of chemical

LSD that one possesses and the amount of possession with which one can be
charged in the U.S. This is because LSD is almost always present in a medium
(e.g. blotter or neutral liquid), and the amount that can be considered with
respect to sentencing is the total mass of the drug and its medium. This
discrepancy was the subject of 1995 United States Supreme Court case, Neal
v. U.S.[123]
Lysergic acid and lysergic acid amide, LSD precursors, are both classified
in Schedule III of the Controlled Substances Act. Ergotamine tartrate, a
precursor to lysergic acid, is regulated under the Chemical Diversion and
Trafficking Act.
http://en.wikipedia.org/wiki/Lysergic_acid_diethylamide