Same Molecule, Different People: Selection, Substitution and Setting as Explanations for Divergent Perceptions of LSD Risk
Year: 2026
Type: preprint
Study design: Systematic Review
Abstract: Background. Clinical papers and street experience give different answers to how dangerous lysergic acid diethylamide (LSD) is. This preprint treats safety as a property of a drug in a population in a context, and asks why the two pictures diverge. Four explanations are kept separate: who is exposed, what they are actually exposed to, the conditions of exposure, and who gets measured. Pre-existing psychiatric vulnerability is an effect modifier, not an exoneration. The preprint does not conclude that LSD is safe. Methods. This is a rapid computational evidence synthesis, not a dual-human-reviewer systematic review and not a PROSPERO-registered review. It does not claim PRISMA 2020 compliance. PubMed was searched with a pre-specified Boolean string (1,507 records on 24 October 2026). ClinicalTrials.gov and the openFDA drug/event subset of FAERS were queried. A second pass downloaded public drug-checking reports (Energy Control, DIMS, CanTEST, WEDINOS, KnowYourStuffNZ) and the open full text of a joint Spanish–Dutch checking analysis. Open-access papers were read only when the file was saved. Tiers of evidence were not pooled into one number, and checking services were not pooled into a market share. A probabilistic bias analysis was not run, because the parameters it required were not all retrieved. NSDUH microdata were not downloaded. DrugsData was not downloaded; its terms require written permission before an analysis is published. Results. In 41 interventional LSD trials with eligibility text, psychosis was an exclusion in 39 and a relevant family history in 38. Of 26 completed trials, 4 had posted results and 22 did not. Posted serious events in those four trials were uncommon and were not a psychiatric incidence: one posted death was coded as oesophageal cancer in a trial of life-threatening illness, and one posted psychiatric serious event was a panic attack. Screened healthy-participant papers reported no serious adverse reactions in the samples opened, alongside short-lived flashbacks in 6 of 83 people and no DSM-5 hallucinogen persisting perception disorder in 142. A self-selected survey reported emergency-treatment seeking in 102 of 10,293 past-year LSD users, higher among people with a mental-health diagnosis. A published household-survey analysis did not find an increased rate of the outcomes it measured; that is not a new model. openFDA returned 422 lysergide reports against a database of about 20.7 million. Pre-specified reporting-odds-ratio signals for suicidality, psychotic disorder and mania met a hypothesis-generating rule. They are not incidence and not causation. A market-wide estimate of how often samples sold as LSD are not LSD was not made. Service reports that were opened do give denominators. Energy Control’s 2017–2022 report included 1,097 samples handed in as LSD, 92.4% described as unadulterated and 6.2% as substituted. The 2024 DIMS leaflet said 5% of its LSD samples did not contain LSD, without printing the LSD-sample count. A published joint analysis of Energy Control and DIMS for 2016–2021 covered 1,817 samples expected to contain LSD; any LSD was detected in 1,229 of 1,415 off-line samples and 375 of 402 cryptomarket samples. Those series overlap and were not added. CanTEST monthly sheets were not summed; in one month, 8 of 9 samples expected to be LSD contained LSD and the other contained 25I-NBOMe and 25D-NBOMe. The 2019 Colombia laboratory paper behind a cited 21 of 70 blotters was not open access and was not opened. Conclusions. The retrieved evidence answers different questions about different people. It does not support a general safety claim. The practical question is who is at risk, under which substance identity, and in which setting. If you or someone else is in crisis, call Lifeline on 13 11 14 (Australia) or local emergency services.
Author: Loch, Odin
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7223474850
Cites:
Cited by:
Related to: