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What Happens When You Add Other Drugs To Your LSD Trip?

Some drugs just pair well together: coffee and cigarettes, alcohol and cocaine, weed and … pretty much anything. But what happens when you mix other drugs with that infamous sidewinder, LSD?

Tripping on acid can be one of the most profound experiences in some people’s lives. Just a tiny speck of LSD (scientifically known as lysergic acid diethylamide) will trigger an experience that can last 12 hours, depending on the dose and purity. It gives users a teeth-rattling “trip” packed with amplified colors that ripple and flow across their distorted perception of time and space. Ego, or the sense of self, can disintegrate into the soul’s ectoplasmic goo.

Although the drug itself is largely non-toxic, even at extremely high doses, tripping is not without risks. It can put users in dangerous physical situations. Most stories of people jumping or falling off buildings on acid are urban legends, but there are some rare case reports of people dying this way. LSD can trigger a psychotic episode and, very rarely, cause long-term mental changes, such as a condition known as hallucinogen perception persisting disorder. For better or worse, LSD is growing in popularity, which means it’s likely more people are combining acid with other drugs.

LSD and MDMA

One of the most common mixtures, popular since at least the early ‘80s, is “candyflipping,” or mixing LSD and MDMA, also known as “ecstasy” or “Molly.” Effects vary, but many users report this combo gives overwhelming feelings of unbridled euphoria from the MDMA, on top of the weird wonderment from LSD. Some users who have combined these two substances say the effects of MDMA, which typically last about four hours, also seem to be extended by the acid.

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This combo is often sought at raves, with users attempting to get both drugs to “peak” at the same time, usually by taking the MDMA several hours after the LSD kicks in, as they both have different zeniths. Yet, we don’t know much about how physically safe this combination is. There’s limited hard data on LSD and MDMA combos—or any other drug mixed with acid – because research for this kind of thing is extremely expensive and the ethics can be sticky.

“Combining LSD or another psychedelic with MDMA produces a particularly intense trip. The combination has stronger effects than you’d expect from the individual drugs,” said Matthew Baggott, a neuroscientist who studies the pharmacology of psychedelics. “Unfortunately, the combination also increases the toxic effects of MDMA, including on the neurons that make serotonin. Too much dopamine release in a brain that’s already working overtime can produce a lot of oxidative stress [an imbalance in body chemicals that can lead to cell and tissue damage].”

LSD and other psychedelics

LSD and the “classic” psychedelics all share one thing in common: their molecules very closely resemble the neurotransmitter serotonin, which has an impact on mood, perception, appetite and more.

“You can think of it like dance moves. Psychedelics dance with the serotonin receptor and remind it of certain moves that it had forgotten,” Baggott said. “Next, messenger molecules inside the cell copy the moves and the whole party changes. Different psychedelics have different dance moves. And they dance with the receptor for different amounts of time. LSD doesn’t grab a partner as soon as it arrives, but once it starts dancing, it really embraces the receptor and dances for a long time.”

According to Baggott, classical psychedelics like LSD and psilocybin, the active compound in magic mushrooms, have high physiological safety, as long as one doesn’t take dramatic overdoses. “Combining them in reasonable doses is usually also physiologically safe,” he said.

You can’t say that about all drugs—mixing different types of opioids, for example, can be deadly. But there just isn’t that much data to be sure yet what the long-term mental health effects of mixing psychedelics could be.

In the ‘60s, doctors giving people doses of two different psychedelics wasn’t unheard of, before ethical standards in science made institutional review boards unlikely to approve such research.

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For example, in 1964 two researchers at Stanford University, funded by a grant from the National Institute of Health, gave 24 men ages 21 to 40 white capsules containing three different psychedelics: mescaline, psilocybin and LSD. At some point, patients were given a blend of all three, which the researchers noted “appeared to produce an additive effect, the intensity and quality of the clinical syndrome being comparable to full doses of either drug alone.” That is, adding most psychedelics to LSD seems to be fairly synergistic – they produce a combined effect that is greater than the sum of their separate effects.

Important for taking any substance are set and setting, or being comfortable in your brain and body while tripping in a safe place. “If there is something wrong with your physical or mental setting, mixing psychedelics can enhance all those bad things,” said Ivan Romano, co-founder and co-director at Drugs and Me, a harm reduction research group based in the U.K. “It can take you to a very bad place.”

LSD and alcohol or Xanax

When coming down from a trip, some people might want something to take the edge off. So it’s not uncommon to mix LSD with depressant drugs such as alcohol or benzodiazepines like Xanax, that slow down the nervous system. But this combo can quickly become life-threatening.

“Depressants are very dose-sensitive, so if you take too much you quickly get into dangerous doses,” Romano said. Plus, you’re more at risk of losing your balance and other accidents. “When you mix these two drugs you have the clumsiness of one and all the perceptual distortion of the other. So the risk of injuries and accidents is much higher.”

According to some reports, LSD and alcohol do not synergize together well. “Alcohol tends to mute the effects of LSD more than anything. It just doesn’t work as well,” according to Mitchell Gomez, executive director of DanceSafe, a nonprofit drug education group. This can encourage people to take more LSD, but when the alcohol wears off, you can still be tripping for hours, way more than intended.

“That’s a really sort of nasty spiral you could get into, trying to balance those two substances,” Gomez said. “I’ve actually seen somebody end up in the hospital just from straight alcohol poisoning because of that combination.”

LSD and antidepressants

There are so many different kinds of antidepressants on the market, each with unique biochemical interactions, it can be hard to sum up how they will make a single person feel, let alone by throwing LSD into the equation. However, when acid was first being explored as a psychiatric tool in the ‘50s and ‘60s, many clinical trials combined LSD with an antidepressant. With some antidepressant drug classes, such as SSRIs or MAOIs, the effects of LSD are diminished or don’t come on at all.

For example, in 1964 a researcher named Oscar Resnick at the Worcester Foundation for Experimental Biology in Massachusetts gave four men a small dose of LSD, between 40 and 75 micrograms. All four men had been taking isocarboxazid, an MAOI, for several weeks.

Resnick reported the “experiences produced by LSD-25 were either very markedly attenuated [reduced] or did not develop at all.” A year later, this experiment was reproduced by famed LSD researcher Stanislav Grof, who gave acid to 11 patients taking an MAOI called nialamide. Even doses as high as 400 micrograms failed to produce much and the resistance lasted as long as two weeks after the antidepressant was discontinued.

SSRIs seem to have a similar effect, though the research is also very limited. In a 1996 survey, 28 out of 32 people who took SSRIs and LSD experienced “subjective decrease or virtual elimination” of the trippy effects. It’s theorized that the reason for this cross-tolerance could be that LSD and drugs like Zoloft are influencing the same serotonin receptors in the brain, although in slightly different ways. The competition can diminish the effects of the acid, but it may work differently for other antidepressants.

In contrast, the authors of that survey had previously surveyed ten men, some of whom had taken tricyclic antidepressants. This unique class of antidepressant reportedly made some LSD trips more potent, not less. Users reported “more psychic energy” and “somatic distortion” from the combo, with livelier, perkier, and more elaborated hallucinations, such as seeing the sunrise for over an hour in the middle of the night. Some of these same users reported that after they stopped taking drugs like desipramine or clomipramine, their LSD trips weren’t as strong.

From that same survey, users who took lithium, a different class of antidepressant, also had more intense trips from LSD, but they weren’t pleasant. One subject was so over-stimulated it made for a “tedious and trying experience,” according to the report, while “one subject also experienced auditory hallucinations that were self-critical, accompanied by the inability to form words, both of which had never happened to him before.” These surveys relied on user self-reports, so they aren’t the most reliable sources, but they’re also some of the only research on the subject.

LSD and weed

Cannabis generally blends with most recreational drugs in a positive way, as it’s relatively non-toxic, the effects are manageable for most people and it usually wears off within a few hours. But combining it with LSD is a polarizing activity. Some people love the combo, others hate it, perhaps because the effects can sometimes be unpredictable.

“Smoking cannabis on LSD seems to potentiate the effects of both, so you end up with a sort of stronger effect of both substances,” said Gomez. LSD and weed are synergistic, which means marijuana can make hallucinogenic visuals more intense. It can make you start tripping again if you smoke it as you start to come down.

“It’s actually almost a joke within some psychedelic communities, a sort of classic mistake as you’re coming down off of LSD to be like, ‘Oh, I’m gonna smoke some pot and go to bed and then you do and now you’re like tripping tripping again,” Gomez said. If you’re not expecting that, it can be an overwhelming, uncomfortable experience.

LSD and stimulants

Speed, cocaine and Adderall energize the nervous system and escalate heart rate. LSD can also increase your heart rate, putting extra strain on your cardiovascular system, which could put you at risk for heart attack or stroke. This may not be an issue at manageable doses, but you may end up doing more of a drug than you intended. “When you mix these two drugs there’s a risk of losing track of what you’re doing and then ending up taking too much,” Romano said.

“Back in the 1950s, when therapists were first exploring LSD psychotherapy,” said Baggot, “it was pretty common to give a stimulant as well. It seemed to improve moods and make patients more communicative. Amphetamines do have safety concerns, particularly when they’re used without medical supervision. Higher doses can increase blood pressure and body temperature, and cause brain oxidative stress. Combining LSD and amphetamines increases all these safety concerns.”

Mixing the two can be overstimulating, which might cause anxiety or panic. Adding coke to LSD reportedly kills the pleasurable, trippy aspects of acid, or makes the experience “weird,” so some people avoid it.

Gomez stresses that if you ever plan to combine any two or more drugs together, do as much research as you can, and do it sober. “You don’t want to decide five hours into an LSD trip that you’re gonna try a new drug,” he explained. “That happens pretty often, somebody’s like, ‘Oh, we’re coming down, do you want to snort X, Y or Z?’ That can certainly lead to experiences that people really enjoy and are thankful for. It can also do the opposite. That’s probably a decision you want to make on a clear head.”

Another major issue with mixing any illegal drug is knowing what it actually is. Street drugs are often sold as something they’re not. For example, a hallucinogenic drug called 25I-NBOMe is often sold on blotter paper, resembling LSD. And while there has never been a recorded human death solely caused by taking acid, there have been dozens of deaths attributed to 25I and related compounds.

Despite being relatively non-toxic, LSD is powerful and mixing it with other drugs can be a risky ride.

Want to Quit Smoking? Eat a Magic Mushroom, New Study Says

E arlier this month, Johns Hopkins researchers published in the Journal of Psychopharmacology a stunning success rate in a pilot study using psilocybin, the psychedelic compound in magic mushrooms, to help heavy smokers quit. The 12 of 15 recidivist smokers who managed to stop smoking for six months after three psychedelic sessions represented an 80% success rate—unheard of in the notoriously difficult treatment of tobacco addiction. The most successful current treatment—the drug varenicline, which reduces nicotine cravings—only has a 35% success rate.

This is big news as attention increasingly shifts to the use of psychedelic drugs for improving mental health. In the past decade—after thirty years during which research into possible benefits of psychedelics was virtually forbidden—clinical studies of drugs, including psilocybin, Ketamine, MDMA and LSD, have accelerated. (Never mind the now widespread medical applications of marijuana.) Food and Drug Administration-approved pilot studies and trials have shown such oft-maligned drugs could be used safely under controlled conditions, delivering promising, even extraordinary results, and not just in the treatment of tobacco addiction, but also for disorders such as autism, anxiety, depression and opiate addiction.

The use of MDMA (better known as Ecstasy) to treat Post Traumatic Stress Disorder has had an 80% success rate in early trials. With as many as half a million service men and women returning from wars in Iraq and Afghanistan with debilitating, life-threatening PTSD, better treatments for the disorder are urgently needed. Yet legal prescription of psychedelic therapy is almost certainly more than a decade away.

But for a quirk of history, it might not have been that way.

Before popular abuse of psychedelics exploded in the 1960s, prompting authorities to impose harsh criminal penalties for possession and halt all scientific investigation of medical use, psychedelics were considered the most promising psychiatric drug in history. In fact, in the Johns Hopkins findings on smoking cessation, there is an unmistakable echo of research done in Canada a half century ago.

Consider this from the lead author of the Johns Hopkins study, Matthew W. Johnson: “Quitting smoking isn’t a simple biological reaction to psilocybin, as with other medications that directly affect nicotine receptors.” Instead, Johnson said, it was the subjective experience the smokers had when taking the psilocybin that changed them— more like a religious conversion than getting a shot of penicillin to cure an infection.

This was exactly the conclusion psychiatrists at a Canadian psychiatric hospital, Humphrey Osmond and Abram Hoffer, reached back in the 1950s when they had great success using LSD therapy to help alcoholics stop drinking. LSD is a synthetic drug, not a natural psychedelic like psilocybin, but the user’s experience of the two is similar, if not identical. Hoffer and Osmond’s LSD treatments proved successful enough that the Canadian government would eventually issue a report saying the method was no longer an experimental treatment for alcoholism, but one that had proven effective.

The new Johns Hopkins smoking study prepped its 15 subjects with four weeks of pretty standard cognitive behavior therapy – things like visualization, keeping journals, focusing on intent to quit and reasons for quitting, etc. But it was the psilocybin that did the heavy lifting. Each participant had three psilocybin sessions, the first a moderate dose, and the final two a high dose. The subjects were encouraged to focus on their anti-smoking intent before taking the psilocybin in each session, otherwise they were simply encouraged to wear eyeshades and earphones (piping in music) and “go inside.” Therapists were there for safety and reassurance if necessary, but there was otherwise little direction—and no negative physiological outcomes. Five of the participants expressed moderate fear during the session (of losing control, losing grip on sanity) and one expressed extreme fear. The researchers reported that all of the anxiety reactions were successfully resolved before the end of the session, and did not preclude a successful outcome.

The 13 participants (80%) who managed to quit and remain smoke free for six months were asked to identify the reasons for their success. The most frequently chosen answer was, “by changing the way you orient yourself toward the future, such that you now act in your long-term holistic benefit, rather than acting in response to immediate desire.”

The answer chosen as the most important was, “by changing the way you prioritize values in life, so that reasons to smoke no longer outweighed reasons to quit.”

These rather basic changes in personality orientation are usually extremely difficult to achieve, in daily life, and in traditional therapy. The fact that such a high proportion of participants managed these perspective shifts is most likely attributable to life-changing mystical-type experiences catalyzed by the psilocybin. Astonishingly, all but two participants (87%) rated at least one psilocybin session among the ten most meaningful experiences of their lives. This tracks with the results of earlier work by the Johns Hopkins team, published in 2006, in which 70% of three dozen healthy people who were given psilocybin with no therapeutic goal described it as “one of the five most significant experiences of their lives.”

Johns Hopkins researchers concluded — just as had their Canadian predecessors half a century earlier — that this was more than incidental to the outcome of the therapy: Those who had a transcendent experience tended to have more success.

Inevitably, the success of studies using psychedelics to treat dangerous conditions like alcoholism, tobacco addiction and PTSD will raise fears that positive news coverage will promote illicit and uncontrolled use. Researchers on these studies are always quick to point out that uncontrolled, self-administration of psychedelics— still a criminal act— not only present the danger of psychological damage, but are unlikely to be effective in treatment without medical supervision.

Still, the dramatically positive experience that so many people in these closely monitored and supervised experiments have had, even healthy people with no psychiatric issues, do raise some interesting questions about the future potential of psychedelics in our culture.

Tom Shroder is an award-winning journalist, editor, and author of Old Souls, a classic study of the intersection between mysticism and science. As editor of The Washington Post Magazine, he conceived and edited two Pulitzer Prize-winning feature stories. His book, ACID TEST: LSD, Ecstasy and the Power to Heal, is out this month.

A new study shows smokers may be able to kick the habit with a little help from psilocybin and three controlled trips ]]>