Bibliography on LSD" as well as in the "Catalogue of Literature on Delysid" periodically edited by SANDOZ, gives vivid proof of what has been achieved by following this line of policy over nearly two decades. By exercising this kind of "nobile officium" in accordance with the highest standards of medical ethics with all kinds of self-imposed precautions and restrictions, it was possible for many years to avoid the danger of abuse (i.e., use by people neither competent nor qualified), which is always inherent in a compound with exceptional CNS activity.

In spite of all our precautions, cases of LSD abuse have occurred from time to time in varying circumstances completely beyond the control of SANDOZ. Very recently this danger has increased considerably and in some parts of the world has reached the scale of a serious threat to public health. This state of affairs has now reached a critical point for the following reasons: (1) A worldwide spread of misconceptions of LSD has been caused by an increasing amount of publicity aimed at provoking an active interest in laypeople by means of sensational stories and statements; (2) In most countries no adequate legislation exists to control and regulate the production and distribution of substances like LSD; (3) The problem of availability of LSD, once limited on technical grounds, has fundamentally changed with the advent of mass production of lysergic acid by fermentation procedures. Since the last patent on LSD expired in 1963, it is not surprising to find that an increasing number of dealers in fine chemicals are offering LSD

from unknown sources at the high price known to be paid by LSD fanatics.

Taking into consideration all the above-mentioned circumstances and the flood of requests for LSD which has now become uncontrollable, the pharmaceutical management of SANDOZ has decided to stop immediately all further production and distribution of LSD. The same policy will apply to all derivatives or analogues of LSD with hallucinogenic properties as well as to Psilocybin, Psilocin, and their hallucinogenic congeners.

For a while the distribution of LSD and psilocybin was stopped completely by Sandoz.

Most countries had subsequently proclaimed strict regulations concerning possession, distribution, and use of hallucinogens, so that physicians, psychiatric clinics, and research institutes, if they could produce a special permit to work with these substances from the respective national health authorities, could again be supplied with LSD and psilocybin.

In the United States the National Institute of Mental Health (NIMH) undertook the distribution of these agents to licensed research institutes.

All these legislative and official precautions, however, had little influence on LSD

consumption in the drug scene, yet on the other hand hindered and continue to hinder medicinal-psychiatric use and LSD research in biology and neurology, because many researchers dread the red tape that is connected with the procurement of a license for the use of LSD. The bad reputation of LSD—its depiction as an "insanity drug" and a

"satanic invention" - constitutes a further reason why many doctors shunned use of LSD

in their psychiatric practice.

In the course of recent years the uproar of publicity about LSD has quieted, and the consumption of LSD as an inebriant has also diminished, as far as that can be concluded from the rare reports about accidents and other regrettable occurrences following LSD

ingestion. It may be that the decrease of LSD accidents, however, is not simply due to a decline in LSD consumption. Possibly the recreational users, with time, have become more aware of the particular effects and dangers of LSD and more cautious in their use of this drug. Certainly LSD, which was for a time considered in the Western world, above all in the United States, to be the number-one inebriant, has relinquished this leading role to other inebriants such as hashish and the habituating, even physically destructive drugs like heroin and amphetamine. The last-mentioned drugs represent an alarming sociological and public health problem today.

Dangers of Nonmedicinal LSD Experiments

While professional use of LSD in psychiatry entails hardly any risk, the ingestion of this substance outside of medical practice, without medical supervision, is subject to multifarious dangers. These dangers reside, on the one hand, in external circumstances connected with illegal drug use and, on the other hand, in the peculiarity of LSD's psychic effects.

The advocates of uncontrolled, free use of LSD and other hallucinogens base their attitude on two claims: (l) this type of drug produces no addiction, and (2) until now no danger to health from moderate use of hallucinogens has been demonstrated. Both are true. Genuine addiction, characterized by the fact that psychic and often severe physical disturbances appear on withdrawal of the drug, has not been observed, even in cases in which LSD was taken often and over a long period of time. No organic injury or death as a direct consequence of an LSD intoxication has yet been reported. As discussed in greater detail in the chapter "LSD in Animal Experiments and Biological Research," LSD

is actually a relatively nontoxic substance in proportion to its extraordinarily high psychic activity.

Psychotic Reactions

Like the other hallucinogens, however, LSD is dangerous in an entirely different sense.

While the psychic and physical dangers of the addicting narcotics, the opiates, amphetamines, and so forth, appear only with chronic use, the possible danger of LSD

exists in every single experiment. This is because severe disoriented states can appear during any LSD inebriation. It is true that through careful preparation of the experiment and the experimenter such episodes can largely be avoided, but they cannot be excluded with certainty. LSD crises resemble psychotic attacks with a manic or depressive character.

In the manic, hyperactive condition, the feeling of omnipotence or invulnerability can lead to serious casualties. Such accidents have occurred when inebriated persons confused in this way—believing themselves to be invulnerable—walked in front of a moving automobile or jumped out a window in the belief that they were able to fly. This type of LSD casualty, however, is not so common as one might be led to think on the basis of reports that were sensationally exaggerated by the mass media. Nevertheless, such reports must serve as serious warnings.

On the other hand, a report that made the rounds worldwide, in 1966, about an alleged murder committed under the influence on LSD, cannot be true. The suspect, a young man in New York accused of having killed his mother-in-law, explained at his arrest, immediately after the fact, that he knew nothing of the crime and that he had been on an LSD trip for three days. But an LSD inebriation, even with the highest doses, lasts no longer than twelve hours, and repeated ingestion leads to tolerance, which means that extra doses are ineffective. Besides, LSD inebriation is characterized by the fact that the person remembers exactly what he or she has experienced. Presumably the defendant in this case expected leniency for extenuating circumstances, owing to unsoundness of mind.

The danger of a psychotic reaction is especially great if LSD is given to someone without his or her knowledge. This was demonstrated in an episode that took place soon after the discovery of LSD, during the first investigations with the new substance in the Zurich University Psychiatric Clinic, when people were not yet aware of the danger of such jokes. A young doctor, whose colleagues had slipped LSD into his coffee as a lark, wanted to swim across Lake Zurich during the winter at -20!C (-4!F) and had to be prevented by force.