Self-inflicted neck wounds under influence of lysergic acid diethylamide

Abstract

Rationale: Lysergic acid diethylamide (LSD) is a highly potent psychedelic drug derived from ergot alkaloids. The available literature data derived from controlled studies or usage in a medical setting seem reassuring; however the literature contains very rare cases of fatal self-inflicted injuries associated with LSD exposure. The behavioral disorder that created the conditions conducive to death is a maladaptive or irrational response to the psychiatric manifestations induced by the substance. Patient concern: Here, we report the case of a 26-year-old man found dead with large neck wounds in a locked house. No medical history other than recreational use of alcohol and narcotics was reported as well as any history of psychotic disease. The entirety of the other investigations carried out did not demonstrate the presence of a third party at the place of death and a dropper bottle containing LSD was found near the body. Diagnosis: We report the first case of fatal self-inflicted neck wounds with a cutting instrument in the context of acute exposure to LSD in a patient with no psychiatric history and without suicidal symptoms at the time of the self-aggressive act. Intervention and outcomes: In the present work, we used a validated method using liquid chromatography coupled with mass spectrometry for simultaneous quantification of LSD and its metabolites (O-H-LSD and Nor-LSD) in whole blood and urine samples. LSD and O-H-LSD were respectively found at 1460 and 182 pg/mL in blood. In the urine, the concentrations of LSD, nor-LSD, O-H-LSD were, respectively, 3670, 201, and 4890 ng/L. Lessons: This observation is particularly relevant in view of the resurgence of interest in the therapeutic use of LSD, notwithstanding the fact that the literature has not demonstrated a link between suicidal risk and acute or chronic exposure to LSD.

Suicidal cut‐throat wound during LSD intoxication

“…A similar kind of case was reported previously mentioning a self‐inflicted neck injury under the influence of it. 9 Another literature reported four cases of severe self‐induced wounds (3 enucleations and 1 emasculation) associated with LSD exposure. 10 …”

“…A similar kind of case F I G U R E 1 Transverse cut-throat wound with hesitation cuts, damage in carotid vessels, and neck structure was reported previously mentioning a self-inflicted neck injury under the influence of it. 9 Another literature reported four cases of severe self-induced wounds (3 enucleations and 1 emasculation) associated with LSD exposure. 10 Another report mentioned a 20-year-old undergraduate male student who jumped from a height under the influence the LSD without any history of severe psychopathology.…”

Pharmacologic Similarities and Differences Among Hallucinogens

“…Impaired cognition, including intense negative hallucinations, sometimes result in physical restraint by law enforcement or emergency medical providers, which has rarely been tied to fatalities even when the plasma concentration of the ingested substance was relatively low 38,102,103 . These risks may be increased when multiple substances are ingested together 41,104–110 . Attempted and completed suicides have been documented 104–106,110 …”

“…These risks may be increased when multiple substances are ingested together 41,104–110 . Attempted and completed suicides have been documented 104–106,110 …”

Unraveling the In Vitro Toxicity Profile of Psychedelic 2C Phenethylamines and Their N-Benzylphenethylamine (NBOMe) Analogues

“…Reports of psilocybin, DMT, mescaline or LSD deaths resulting from overdose are unknown, including with high doses [ 3 , 4 , 5 , 6 ]. However, fatal accidents related to dangerous behavior after use have been reported [ 7 , 8 ]. Despite the safety profile and therapeutic potential of classic psychedelics, they were included in Schedule I of the Controlled Substances Act of 1970, mostly due to their growing popularity as recreational drugs.…”