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LSD (lysergic acid diethylamide) is a psychedelic drug that belongs to the hallucinogens or psychedelics category. Mescaline and psilocybin are examples of compounds in this category. The parasitic fungus ergot or Claviceps purpurea, which afflicts rye plants, produces lysergic acid used to make LSD. LSD is a colorless, odorless substance in its purest form. Albert Hoffman created it by accident in 1938 when he accidentally mixed diethylamine with lysergic acid while making a respiratory stimulant (Carhart-Harris et al., 2016; Das, Barnwal, Ramasamy, Sen, & Mondal, 2016; Schmid et al., 2015; Withdrawal.net, 2017). In 1943, it was intentionally produced, and the chemist self-administered it to observe the range of psychrotropic effects in humans as it had been shown to be active in lab animals. He detailed his experiences, and this opened up scientific research on hallucinogens. In 1948, Sandoz AG Company officially distributed LSD under the brand name Delysid to conduct research in psychotherapy and to model psychosis in normal individuals because it was thought to induce the release of pent up burdens from the mind and also produce mental relaxation thus could be used to relieve anxiety. It has been used to treat mood disorders, obsessive-compulsive disorders, alcohol dependence and anxiety due to terminal illnesses, pain and depression among cancer patients when coupled with counseling. Results from therapeutic uses showed discomfort as a short term effect and in the long run improved health conditions were achieved. Its therapeutic use was discontinued in the 1960's by political influence as it had gained popularity as a drug of abuse during the counter culture period (Carhart-Harris et al., 2016; Das et al., 2016; Passie, Halpern, Stichtenoth, Emrich, & Hintzen, 2008; Schmid et al., 2015). The drug continues to be manufactured illegally, and batches from the same manufacturer may not be uniform. Difference in composition and appearance is also observed in samples from different manufacturers. Illegal LSD are bought on the street using alias names such as acid, purple heart, stamp, Lucy, heavenly blue, microdot or the sunshine depending on the locality. It is usually distributed as dried blotter papers soaked in liquid LSD. Also, occurs as tablets, liquid or capsules but may also be incorporated in candies, sugar cubes, and gelatin squares. This gives a wide range of administering options including injection, swallowing or sniffing but oral consumption has been shown as the most effective method (Withdrawal.net, 2017). Doses as low as 3.0µg/Kg body weight have been found to generate the desired effects. Teenagers who are the highest consumers of this drug combine it with other substances particularly ecstasy(MDMA) in what is termed as 'candy flipping' and alcohol to downplay the effects of the acid (Das et al., 2016).
Effects of LSD
LSD generates the sensation of being 'high' popularly known as tripping. Tripping is characterized by symptoms brought about by the disruption of brain cells-serotonin interactions. The drug activates 5HT2A receptors while simultaneously regulating 5HT1A and 5HT2C. Carhart-Harris et al., (2016), links the stimulation of the 5HT2A receptors to increased learning, justifying the creative thinking and enhanced imagination portrayed by users. Tripping symptoms become apparent thirty minutes following administration and these effects may persist for up to twelve hours. They reach peak levels after about two hours before concentration gradually declines. The symptoms present in varying ways depending on an individual's personality and moods (Carhart-Harris et al., 2016; Das et al., 2016). Mental effects elicited are artificial euphoria, visual hallucinations, delusion, paranoia and fear particularly that of losing control, confusion of time and identity, exaggerated perception objects (shapes), panic attacks and emotional instability. Memory loss has also been reported in some cases. These effects are worse in users with underlying mental conditions as their reaction to the drug produces schizophrenic symptoms. This prompted psychiatric researchers to speculate on the presence of a schizotoxin related to LSD, in schizophrenic patients occasioned by the similarity in symptoms. Prolonged use of LSD has been known to predispose an individual to schizophrenia (Carhart-Harris et al., 2016; Schmid et al., 2015).
Other effects are distortion in movement due to muscular incoordination, color, sound and touch misperception. Physiological effects such as sleeplessness, lack of appetite, dry mouth, shaking and intense attention to certain colors are exhibited. Hyperglycemia, hypertension and tachycardia have also been reported. Some users have shown varying results in the levels of adrenaline. Physical effects that are observed range from unusual body temperatures which may be accompanied by chilling or sweating dilated pupils, dizziness and flushing (Das et al., 2016; Passie et al., 2008). Saliva and mucus production has also been verified. Behavioral changes have also been associated to hallucinogen use, LSD included. Users tend to change their social groups, become secretive and talk/laugh excessively. They also neglect their appearance and appear shabby and develop a rebellious attitude. After effects include a sense of renewal, positivity, and pleasure and only experienced under controlled conditions. It also increases awareness and creativity (Carhart-Harris et al., 2016; Passie et al., 2008). It instills a sense of trust, happiness, and openness. These positive feelings compel users to take more so as to recapture the good feelings. High doses increase the intensity of these effects and also lead to 'bad trips.' This situation is characterized by severe anxiety, delusion disorientation, paranoia, suicidal thoughts, violent tendencies, in addition, to fear losing identity and of death (Das et al., 2016; Schmid et al., 2015). Apart from the bad trips overdosing may occur and is accompanied by vomiting, elevated body temperatures, gastric bleeding, unconsciousness and often it induces a coma. However, no overdosing related deaths have been documented. Withdrawal from the drug does not lead to withdrawal symptoms indicating that LSD is not addictive. Its use does not cause physical dependence, and the urge to continue using it is psychological. The effects generated by LCD have been found to be more pronounced as compared to psilocybin and ketamine (Das et al., 2016; Office of Diversion Control, 2013; Schmid et al., 2015).
Compared to other illegal drugs, LSD users are a comparatively low number. According to a 2014 survey, 287,000 people above twelve years were chronic users which makes up only 0.1% of the US population(Office of Diversion Control, 2013) but up to five million young people below 25 years had experimented with the drug at least once. This shows the drug is a preference of most adolescents and college students to a lesser extent, as the 12-15 age bracket contributed 64% to the 287,000 users. Statistics from a survey conducted by Monitoring the Future group in 2012 shows that use among high school students has been prevalent since 2003 albeit at low levels. The three senior classes reported usage at 1.3%, 1.7% and 2.7% in 8th,10th and 12th grade respectively. A trend of increasing use was observed among those in the 12th grade and teenage boys are also likely to use the drug as compared to girls. LSD is distributed in LSD themed parties and music festivals whose attendees are usually teenagers. In 2014 alone,14.7M millennials had attended such parties where the drug was sold at a rate of ten dollars per dose. Despite these numbers, LSD use still remains unpopular as compared to other substances such as cocaine, marijuana heroine and even alcohol. Its life time prevalence stands at 6-7% among adults (Schmid et al., 2015) .The unpopularity of this drug has been attributed to the complex manufacturing process which would be uneconomical to the black market in terms of financial input and time. Just as the effects, tolerance to the normal doses also sets in very quickly a pattern that is not preferred by drug users. ER admissions due to abuse of LSD are expected to hit the 5000 mark annually since a 2010 survey by The Drug Abuse Warning Network (DAWN ED) had evidence of 3,817 cases for that year (Office of Diversion Control, 2013)
Individuals using LSD tend to neglect their usual activities as their time is spent savoring the after effects of the drug. This could potentially lead to school and college dropout as users are still at the education stage. Prolonged use of the drug results into flashbacks of the bad trips as tolerance sets in. This may initiate depression as the hallucinations, and visual illusions continue to manifest even after months of abstinence. These repeated episodes trigger a psychiatric condition known as Hallucinogen Persisting Perception Disorder (HPPD) (Das et al., 2016).
The psychiatric manifestation may warrant admission in rehabilitation centers (Withdrawal.net, 2017). Apart from missing out on the educational endeavors, this will have financial implications on immediate families. This may put pressure on the resources at disposal, non-attendance of school after fees has been catered for shows an unjustified loss of resources. Stigma may also arise as the society looks down upon individuals suffering from drug abuse (Withdrawal.net, 2017). This isolation and rejection may worsen the paranoia, depression and may compel patients to actualize the suicidal thoughts. Some effects such as distorted movement receive religious gratification as religious extremists term this as intoxication by God. Such perceptions and beliefs encourage the continued intake of LSD without factoring in the long term effects (Das et al., 2016; Schmid et al., 2015) .Use of LSD has been contraindicated in epilepsy, pregnancy where it has been linked to teratogenicity, cardiovascular disorders due to extreme excitement (Das et al., 2016).
Teenagers continue using the drug following the appealing experiences told by celebrities who have publicly admitted to drug use. Hoffman, the originator of the drug admits to feeling renewed and experiencing an inner joy after his experimentation with the drug.US celebrities such as the late Steve Jobs spoke positively about their encounter with LSD. The Beatles, a music group also released the song 'Lucy in the sky with diamonds' in praise of the substance. Since celebrities are idolized by the public, teens tend to mimic them in an attempt of feeling what the celebrities described. Today, LSD use continues to increases and this has been blamed on the social media where experiences are widely shared and teenagers as they have access to internet enabled devices get this message and are driven to experiment by the alluring narrations (Office of Diversion Control, 2013).
As the Drug Enforcement Administration classifies LSD in the Controlled Substances Act as a Schedule 1 substance and its derivatives under Schedule 3(Office of Diversion Control, 2013), this makes the drug a candidate for abuse and also illegal. Manufacturers and distributors are thus liable to legal action when caught in possession of LSD and its associated substances. This categorization also portrays that the drug has not been found to be medically beneficial nor have safety level been established, from a legal perspective. Use has been restricted to qualified practitioners after the introduction of Hallucinogen regulations in 1967 (Das et al., 2016).
LSD is not addictive, and its use does not cause extreme health effects, and thus supportive care is the approach used to manage the effects. The first step of treatment is to get clean and rid the body of the ergot poisoning and intoxication. This is usually takes close to thirty six hours and the procedure involves refraining former users from accessing and using the drug. Close monitoring is a necessity to help manage the withdrawal symptoms. Gastrointestinal extraction (stomach pumping) is not necessary except if high doses are ingested with a short span of time before admission into a facility or the ER(Office of Diversion Control, 2013; Rega, 2015; Withdrawal.net, 2017).
The next step is to manage the withdrawal symptoms. Anticoagulants, vasodilators, and sympatholytic are given intravenously to neutralize the effects of the drug that continue to be elicited (Rega, 2015; Withdrawal.net, 2017). To treat agitation, patients are administered with benzodiazepines to specifically arrest panic attacks . If the heightened imagination is negatively affecting the patients, ketanserin could be given to attenuate the effects of stimulation of the5HT2A receptors,as this drug is antagonistic to these receptors. Patients should be monitored to check for anxiety as this drug may cancel out the positive after effects of LSD (Carhart-Harris et al., 2016). Antipsychotic tranquilizers like Thorazine are given to tone down the adverse effects of LSD and to helps the patients relax.To ease the effects of HPPD particularly the recurrence of flashbacks, antidepressant medicines are issued. Difficult breathing is improved through respiratory support, and if the condition is delicate, endotracheal intubation is applied. Hypotension is corrected with fluids and pressors where necessary (Rega, 2015).
Because of the violence tendencies of LSD users, reassuring them within calm a environment free from stress assists in stabilizing their emotions. Guidelines on how to handle these patients are given to caregivers and adherence to them guarantees a safe environment for both the patient and the caregivers. Assisting them to gain the initiative to stop usage and see the negative effects of the drug is a strategy being employed in advocating for behavior change. Counseling has been used to treat depression which may have arisen due to withdrawal or may have been the driving factor to LSD use. The sessions allow patients to talk about their issues and learn ways to cope and move on without depending on the acid (Rega, 2015; Withdrawal.net, 2017). Psychotherapy has been identified as a way of confronting and overcoming the confusion, guilt and fear brought about by the residual flashbacks. Physical restraining and sedation are not part of the treatment as these cases do not require such extreme measures. Also to avoid hyperthermia and rhabdomyolysis, physical restraint is not used (Rega, 2015).
Complete withdrawal from LSD use us the main goal of management and treatment. This can only be achieved if the mental dependence is eliminated so that recovering persons do not feel the need to recapture the blissful experiences. Researchers have suggested different ways to achieve this. Building and maintaining personal relationships provides an avenue for venting out issues that could breed depression if let unshared. These close relationships also assist in checking a person's behavior so that they do not reuse or relapse. If relapse is missed, behavioral change may alert friends and family which prompts timely interventions. Focusing on advancing one's career keeps the mind busy and occupies with no room to accumulate stress (Withdrawal.net, 2017).
Though its manufacture was by accident, LSD has shown viable interaction with elements of the brain. Previous studies have highlighted its potential in psychotherapy and the understanding of mental ailments. The setback to continued research on the medical benefits of this drug was its banning due to abuse and uncontrolled use in the late 1960s.However,as its recreational use continue to increase especially among teenager, research should start afresh to validate its potential use as a psychiatric intervention.
Teenagers should also be openly educated on the dangers of LSD as they assume it is better compared to the hard drugs. Awareness campaigns should be taken to high schools and colleges so as to minimize use and prevent the onset of serious effects such as depression, schizophrenia and recurrent flashbacks as these symptoms will lead to a dysfunctional generation if the topic is left unchecked. Users should also be encouraged to seek professional treatment to complete heal from the dependence and effects. Recovered users should also speak their experiences to the public so as to motivate the young people, dispel the exaggerated goodness portrayed by celebrities and help a young soul from making wrong choices in attempting to cope with their difficult situations. Parents and adult relatives should be vigilant and close to their teenage children and relatives so as to create a trust environment where issues can be talked about and any notice changes of possible LSD in time to avert the severe effects.
Carhart-Harris, R. L., Kaelen, M., Bolstridge, M., Williams, T. M., Williams, L. T., Underwood, R., ' Nutt, D. J. (2016). The paradoxical psychological effects of lysergic acid diethylamide (LSD). Psychological Medicine, (February), 1'12. http://doi.org/10.1017/S0033291715002901
Das, S., Barnwal, P., Ramasamy, A., Sen, S., & Mondal, S. (2016). Lysergic acid diethylamide: a drug of 'use'? Therapeutic Advances in Psychopharmacology, 6(3), 214'228. http://doi.org/10.1177/2045125316640440
Office of Diversion Control, D. (2013). D-LYSERGIC ACID DIETHYLAMIDE (Street Names: LSD, Acid, Blotter Acid, Window Pane). Drug Enforcement Administration, 1. Retrieved from https://www.deadiversion.usdoj.gov/drug_chem_info/lsd.pdf
Passie, T., Halpern, J. H., Stichtenoth, D. O., Emrich, H. M., & Hintzen, A. (2008). The pharmacology of lysergic acid diethylamide: A review. CNS Neuroscience and Therapeutics. http://doi.org/10.1111/j.1755-5949.2008.00059.x
Rega, P. P. (2015). LSD Toxicity Treatment & Management. Retrieved April 18, 2017, from http://emedicine.medscape.com/article/1011615-treatment
Schmid, Y., Enzler, F., Gasser, P., Grouzmann, E., Preller, K. H., Vollenweider, F. X., ' Liechti, M. E. (2015). Acute effects of lysergic acid diethylamide in healthy subjects. Biological Psychiatry, 78(8), 544'553. http://doi.org/10.1016/j.biopsych.2014.11.015
Withdrawal.net. (2017). LSD Withdrawal Signs, Symptoms, Detox & Treatments Options. Retrieved April 18, 2017, from http://www.withdrawal.net/learn/lsd/
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