A New Hallucinogen: "Legal LSD"

A novel psychoactive substance, or "legal high," that has hallucinogenic effects and potentially severe adverse effects is being sold to partygoers as lysergic acid diethylamide (LSD).

Although the use of 25I-NBOMe, also known as "legal LSD," is currently relatively rare, it is sold under various names and in a range of forms, making it difficult for users to know what they are taking and for clinicians to develop effective treatments.

Rising Tide of Novel Psychoactives

The most commonly seen novel psychoactive substances are synthetic cannabinoids and synthetic cathinones, as well as the novel phenethylamine 25I-NBOMe, or 4-iodo-2,5- dimethoxyphenyl-N-(2-methoxybenzyl) phenylamine.

25I-NBOMe, or 4-iodo-2,5- dimethoxyphenyl-N-(2-methoxybenzyl) phenylamine was first synthesized for research on the serotonin-2a receptor. It became popular as a recreational drug in 2011. It is sold online as legal LSD or LSD, and is ingested orally or sublingually, typically on blotting paper.

Typical doses are 0.5 to 1 mg. Peak effects, which include hallucinations and euphoria, occur after 20 minutes and last for 3 to 13 hours. Several cases of toxicity with 25I-NBOMe have been reported, along with adverse effects such as delirium, aggressive behavior, self-harm, and paranoia.

Dr Ezquiaga and colleagues investigated the prevalence and characteristics of 25I-NBOMe in Spain by using data from Energy Control, a Spanish harm-reduction nongovernmental organization whose workers go to clubs and raves (a type of large dance party), where they offer advice to drug users and also offer to analyze whatever drugs the partygoers are taking.

Between 2009 and 2015, 21,198 samples were received by Energy Control and analyzed by gas chromatography–mass spectrometry, 56 of which were 25I-NBOMe.

Hard to Keep Up

The samples of 25I-NBOMe were first detected in 2012. The number of such samples peaked at 19 in 2013. Usage then dipped but remained stable to the end of the study period, when 15 samples were detected.

In 42.8% of cases, 25I-NBOMe was bought as LSD; in 21.4% of cases, it was bought as 25I-NBOMe; in 7.1% of cases, as 25I-NBOH; in another 7.1%, as 25C-NBOMe; and in the remaining 21.4% of cases, as other substances.

The most common form of delivery was blotting paper, found in 37.5% of cases, followed by powder form in 33.9% of samples and liquid form in 10.7%. Curiously, in 5.3% of cases, the drug was sold in gummy bears (a form of candy).

The use of novel psychoactive substances is increasing every year, but our knowledge is not growing at the same speed as their development, which means that we still don't have any urine tests to detect novel psychoactive substances, we still don't have treatments to solve the toxicity, we don't have specific treatments, and we still have a lack of information about the pharmacology.

The Internet has become the most important marketplace for these substances, a development that represents a major shift from the manner in which illicit drugs have been bought and sold in the past.

Potential Brain Damage

Highlighting the fact that a substantial proportion of individuals who bought 25I-NBOMe thought they were buying LSD and the potential implications in the future to cause damage to the brain is cause for concern.