'Trip-killers: a concerning practice associated with psychedelic drug use'

 

Gregory Yates, 

Emily Melon

https://doi.org/10.1136/emermed-2023-213377

Psychedelic drugs such as lysergic acid diethylamide (LSD) and psilocybin (‘magic mushrooms’) induce hallucinations and distort thought-processes. The intensity of a psychedelic ‘trip’ can cause distress, agitation, and even psychosis. A recent report showed that at least 8.4% of drug-related presentations to European emergency departments involve psychedelics.1 This proportion may increase as the clinical use of these agents expands.2

There are multiple ways to control a ‘bad trip’ and avoid hospitalisation. One is to take psychedelics under the supervision of a ‘trip-sitter’—a non-intoxicated friend who can provide psychological support. Another is to use additional psychoactive drugs—‘trip-killers’—to attenuate or prematurely end the psychedelic experience. Trip-killers are not new, but have received increased attention on social media in recent years.3

Information on trip-killers is not available through drug advice services, despite the probable risks they pose. To our knowledge, no relevant papers have been published in the medical literature. It was the aim of our study to gather descriptive data on the use of psychedelic trip killers by analysing posts made on Reddit, a publicly accessible, anonymous social media website. Reddit contains several sub-forums for discussion of recreational drugs, such as ‘r/LSD’ (716 752 users), and ‘r/MDMA’ (237 622 users). The content of Reddit posts has been used previously in psychedelic research.4 Formal ethical approval was not required to conduct this study due to the use of publicly available and anonymous online data.

We conducted a systematic keyword search of the entirety of Reddit using the website’s internal search tool and a site-specific Google query (online supplemental information). We aimed to include English-language threads in which one or more posters had recommended a trip-killer by starting a new thread or responding to an open question from another poster. One hundred and twenty-eight relevant threads were identified (2015–2023) yielding 709 posts from which the following data were extracted: trip-killer(s) recommended, psychedelic drug(s) described, dose(s), safety warning(s). Descriptive statistics were calculated using Microsoft Excel 2016.

Supplemental material

[emermed-2023-213377supp001.pdf]

A summary of results is provided in table 1. Most commonly recommended were benzodiazepines and antipsychotics. Dose ranges can be found in table 2. Trip-killers were mostly discussed in reference to LSD (n=235), psilocybin mushrooms (n=143), and MDMA (3,4-methylenedioxymethamphetamine) (n=21). Only 58 posts contained warnings about the potential adverse effects of trip-killers.

https://emj.bmj.com/content/early/2023/11/21/emermed-2023-213377