This article originally appeared on VICE US.
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.
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.
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 - the 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.
You can, of course, test your drugs at home using kits you can purchase online but they may not always identify all the present compounds. Or, if you’re feeling science-y and can wait a few weeks, you can mail a drug sample to EcstasyData.org, an organization supported by DanceSafe. It helps to ask about doses and purity from your drug connection, but even they may not know what they’re selling. More LSD harm reduction tips can be found here, here’s a drug combinations chart from TripSit.Me and Drugs and Me has a “calculator” that gives a general idea how these drugs interact.
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