Self-inflicted neck wounds under influence of lysergic acid diethylamide

A 26-year-old man with no psychiatric history and no suicidal symptoms was found dead in a locked house with large neck wounds. A dropper bottle containing LSD was near the body, and toxicology confirmed acute LSD exposure: LSD at 1460 pg/mL and O-H-LSD at 182 pg/mL in blood, with LSD, nor-LSD, and O-H-LSD in urine at 3670, 201, and 4890 ng/L. This is the first reported case of fatal self-inflicted neck wounds during acute LSD intoxication in a person without prior mental illness. The case is notable given renewed interest in LSD therapy, though the literature has not shown a link between LSD exposure and suicide risk.

Study at a glance

Abstract

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.