B-302 Psychedelics and Dissociative Anesthetics: Concentrations in Suspected Impaired Driving Investigations, 2024

In 2024, among 328 suspected driving-under-the-influence cases, the most common psychedelic or dissociative drug detected was phencyclidine (PCP, 220 cases), followed by MDMA (81 cases) and ketamine (22 cases). LSD and psilocin were found in only 2 and 5 cases, respectively. Drug concentrations varied widely, with ketamine ranging from 25 to 880 ng/mL, LSD from 3 to 9.8 ng/mL, PCP from 6 to 270 ng/mL, and MDMA from 5.5 to 850 ng/mL. Most drivers also had other central nervous system depressants in their blood. The findings highlight safety concerns for driving as psychedelic therapies become more available.

Study at a glance

Abstract

Abstract Background Psychedelic and dissociative drugs, including psilocybin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA), and ketamine, have garnered significant interest for their therapeutic potential in treating various mental health disorders. However, their psychoactive properties pose substantial risks when used in contexts requiring unimpaired cognitive and motor functions, such as driving. Psychedelics are known for their ability to induce profound alterations in sensory perception, thought patterns, and emotions. Dissociative drugs can produce a sense of detachment from the body and surroundings, leading to an altered reality and a range of experiences, from mild dissociation to complete anesthesia. This study aimed to determine the prevalence, type, and concentration of psychedelic and dissociative drugs, including phencyclidine (PCP), which is not currently being investigated for medical purposes, in suspected driving under the influence of drugs (DUID) cases. Methods Blood specimens from suspected DUID cases submitted to NMS Labs between January 2024 and December 2024 were evaluated for the presence of psychedelic and dissociative drugs. Toxicological analyses were performed as a screen with subsequent confirmation. The screening and confirmation reporting limits for the psychedelic and dissociative drugs are in parentheses. Specimens were screened by High Performance Liquid Chromatography/Time of Flight/Mass Spectrometry (LC/TOF/MS) for ketamine (10 ng/mL), LSD (2 ng/mL), psilocin (active hallucinogenic component of psilocybin, 10 ng/mL), and/or Enzyme-Linked Immunosorbent Assay (ELISA) for MDMA (20 ng/mL) and PCP (10 ng/mL). Confirmation testing was performed using High-Performance Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS) for ketamine (20 mg/mL), LSD (0.2 ng/mL), psilocin (10 ng/mL), MDMA (5 ng/mL), and PCP (5 ng/mL). Results During 2024, NMS Labs detected psychedelic and dissociative drugs in 328 suspected DUID cases: ketamine (n = 22), LSD (n = 2), PCP (n = 220), psilocin (n = 5), and MDMA (n = 81). Because LC/TOF/MS screening was performed only at the client’s request, ketamine, LSD, and psilocin positivity may be underestimated. The psychedelic and dissociative drug concentrations ranged from 25 to 880 ng/mL for ketamine (mean: 272 ng/mL, median: 61 ng/mL), 3 to 9.8 ng/mL for LSD (mean/median: 6.4 ng/mL), 6 to 270 ng/mL for PCP (mean: 50 ng/mL, median: 44 ng/mL), and 5.5 to 850 ng/mL for MDMA (mean: 124 ng/mL, median: 44 ng/mL). Psilocin concentrations were not determined due to analyte instability. Two drivers had more than one psychedelic or dissociative drug present in their blood samples. Additionally, most cases were positive for other substances that could further impact psychomotor function, including other CNS depressants. Conclusion While the future of psychedelic drugs for mental health treatments looks promising, it also raises important considerations for driving. The altered states induced by psychedelics and dissociatives can impair cognitive functions, motor skills, and judgment, thereby affecting a person’s ability to operate a vehicle safely. The data from this study can help inform future health and public safety considerations as psychedelic therapies become available to the public.