Adherence (medicine)

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Adherence_(medicine) 

In medicine, patient compliance (also adherence, capacitance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance. Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism. The cost of prescription medication also plays a major role.

Compliance can be confused with concordance, which is the process by which a patient and clinician make decisions together about treatment.

Worldwide, non-compliance is a major obstacle to the effective delivery of health care. 2003 estimates from the World Health Organization indicated that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations with particularly low rates of adherence to therapies for asthma, diabetes, and hypertension. Major barriers to compliance are thought to include the complexity of modern medication regimens, poor "health literacy" and not understanding treatment benefits, occurrence of undiscussed side effects, poor treatment satisfaction, cost of prescription medicine, and poor communication or lack of trust between a patient and his or her health-care provider. Efforts to improve compliance have been aimed at simplifying medication packaging, providing effective medication reminders, improving patient education, and limiting the number of medications prescribed simultaneously. Studies show a great variation in terms of characteristics and effects of interventions to improve medicine adherence. It is still unclear how adherence can consistently be improved in order to promote clinically important effects.

Terminology

In medicine, compliance (synonymous with adherence, capacitance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance.

As of 2003, US health care professionals more commonly used the term "adherence" to a regimen rather than "compliance", because it has been thought to reflect better the diverse reasons for patients not following treatment directions in part or in full. Additionally, the term adherence includes the ability of the patient to take medications as prescribed by their physician with regards to the correct drug, dose, route, timing, and frequency. It has been noted that compliance may only refer to passively following orders. The term adherence is often used to imply a collaborative approach to decision-making and treatment between a patient and clinician.

The term concordance has been used in the United Kingdom to involve a patient in the treatment process to improve compliance, and refers to a 2003 NHS initiative. In this context, the patient is informed about their condition and treatment options, involved in the decision as to which course of action to take, and partially responsible for monitoring and reporting back to the team. Informed intentional non-adherence is when the patient, after understanding the risks and benefits, chooses not to take the treatment.

As of 2005, the preferred terminology remained a matter of debate. As of 2007, concordance has been used to refer specifically to patient adherence to a treatment regimen which the physician sets up collaboratively with the patient, to differentiate it from adherence to a physician-only prescribed treatment regimen. Despite the ongoing debate, adherence has been the preferred term for the World Health Organization, The American Pharmacists Association, and the U.S. National Institutes of Health Adherence Research Network. The Medical Subject Headings of the United States National Library of Medicine defines various terms with the words adherence and compliance. Patient Compliance and Medication Adherence are distinguished under the MeSH tree of Treatment Adherence and Compliance.

Adherence factors

An estimated half of those for whom treatment regimens are prescribed do not follow them as directed.

Side effects

Negative side effects of a medicine can influence adherence.

Health literacy

Cost and poor understanding of the directions for the treatment, referred to as 'health literacy' have been known to be major barriers to treatment adherence. There is robust evidence that education and physical health are correlated. Poor educational attainment is a key factor in the cycle of health inequalities.

Educational qualifications help to determine an individual's position in the labour market, their level of income and therefore their access to resources.

Literacy

In 1999 one fifth of UK adults, nearly seven million people, had problems with basic skills, especially functional literacy and functional numeracy, described as: "The ability to read, write and speak in English, and to use mathematics at a level necessary to function at work and in society in general." This made it impossible for them to effectively take medication, read labels, follow drug regimes, and find out more.

In 2003, 20% of adults in the UK had a long-standing illness or disability and a national study for the UK Department of Health, found more than one-third of people with poor or very poor health had literary skills of Entry Level 3 or below.

Low levels of literacy and numeracy were found to be associated with socio-economic deprivation. Adults in more deprived areas, such as the North East of England, performed at a lower level than those in less deprived areas such as the South East. Local authority tenants and those in poor health were particularly likely to lack basic skills.

A 2002 analysis of over 100 UK local education authority areas found educational attainment at 15–16 years of age to be strongly associated with coronary heart disease and subsequent infant mortality.

A study of the relationship of literacy to asthma knowledge revealed that 31% of asthma patients with a reading level of a ten-year-old knew they needed to see the doctors, even when they were not having an asthma attack, compared to 90% with a high school graduate reading level.

Treatment cost

In 2013 the US National Community Pharmacists Association sampled for one month 1,020 Americans above age 40 for with an ongoing prescription to take medication for a chronic condition and gave a grade C+ on adherence. In 2009, this contributed to an estimated cost of $290 billion annually. In 2012, increase in patient medication cost share was found to be associated with low adherence to medication.

The United States is among the countries with the highest prices of prescription drugs mainly attributed to the government's lack of negotiating lower prices with monopolies in the pharmaceutical industry especially with brand name drugs. In order to manage medication costs, many US patients on long term therapies fail to fill their prescription, skip or reduce doses. According to a Kaiser Family Foundation survey in 2015, about three quarters (73%) of the public think drug prices are unreasonable and blame pharmaceutical companies for setting prices so high. In the same report, half of the public reported that they are taking prescription drugs and a "quarter (25%) of those currently taking prescription medicine report they or a family member have not filled a prescription in the past 12 months due to cost, and 18 percent report cutting pills in half or skipping doses". In a 2009 comparison to Canada, only 8% of adults reported to have skipped their doses or not filling their prescriptions due to the cost of their prescribed medications.

Age

Both young and elderly status have been associated with non-adherence.

The elderly often have multiple health conditions, and around half of all NHS medicines are prescribed for people over retirement age, despite representing only about 20% of the UK population. The recent National Service Framework on the care of older people highlighted the importance of taking and effectively managing medicines in this population. However, elderly individuals may face challenges, including multiple medications with frequent dosing, and potentially decreased dexterity or cognitive functioning. Patient knowledge is a concern that has been observed.

In 1999 Cline et al. identified several gaps in knowledge about medication in elderly patients discharged from hospital. Despite receiving written and verbal information, 27% of older people discharged after heart failure were classed as non-adherent within 30 days. Half the patients surveyed could not recall the dose of the medication that they were prescribed and nearly two-thirds did not know what time of day to take them. A 2001 study by Barat et al. evaluated the medical knowledge and factors of adherence in a population of 75-year-olds living at home. They found that 40% of elderly patients do not know the purpose of their regimen and only 20% knew the consequences of non-adherence. Comprehension, polypharmacy, living arrangement, multiple doctors, and use of compliance aids was correlated with adherence.

In children with asthma self-management compliance is critical and co-morbidities have been noted to affect outcomes; in 2013 it has been suggested that electronic monitoring may help adherence.

Social factors of treatment adherence have been studied in children and adolescents with disorders:

• Young people who felt supported by their family and doctor, and had good motivation, were more likely to comply.
• Young adults may stop taking prescribed medication in order to fit in with their friends, or because they lack insight of their illness.
• Those who did not feel their condition to be a threat to their social well-being were eight times more likely to comply than those who perceived it as such a threat.
• Non-adherence is often encountered among children and young adults; young males are relatively poor at adherence.

Ethnicity

People of different ethnic backgrounds have unique adherence issues through literacy, physiology, culture or poverty. There are few published studies on adherence in medicine taking in ethnic minority communities. Ethnicity and culture influence some health-determining behaviour, such as participation in screening programmes and attendance at follow-up appointments.

Prieto et al emphasised the influence of ethnic and cultural factors on adherence. They pointed out that groups differ in their attitudes, values and beliefs about health and illness. This view could affect adherence, particularly with preventive treatments and medication for asymptomatic conditions. Additionally, some cultures fatalistically attribute their good or poor health to their god(s), and attach less importance to self-care than others.

Measures of adherence may need to be modified for different ethnic or cultural groups. In some cases, it may be advisable to assess patients from a cultural perspective before making decisions about their individual treatment.

Recent studies have shown that black patients and those with non-private insurance are more likely to be labeled as non-adherent. The increased risk is observed even in patients with a controlled A1c, and after controlling for other socioeconomic factors.

Prescription fill rates

Not all patients will fill the prescription at a pharmacy. In a 2010 U.S. study, 20–30% of prescriptions were never filled at the pharmacy. Reasons people do not fill prescriptions include the cost of the medication, A US nationwide survey of 1,010 adults in 2001 found that 22% chose not to fill prescriptions because of the price, which is similar to the 20–30% overall rate of unfilled prescriptions. Other factors are doubting the need for medication, or preference for self-care measures other than medication. Convenience, side effects and lack of demonstrated benefit are also factors.

Medication Possession Ratio

Prescription medical claims records can be used to estimate medication adherence based on fill rate. Patients can be routinely defined as being 'Adherent Patients' if the amount of medication furnished is at least 80% based on days' supply of medication divided by the number of days patient should be consuming the medication. This percentage is called the medication possession ratio (MPR). 2013 work has suggested that a medication possession ratio of 90% or above may be a better threshold for deeming consumption as 'Adherent'.

Two forms of MPR can be calculated, fixed and variable. Calculating either is relatively straightforward, for Variable MPR (VMPR) it is calculated as the number of days' supply divided by the number of elapsed days including the last prescription.

${\displaystyle VMPR={\dfrac {\text{All days' supply}}{\text{Elapsed days (inclusive of last prescription)}}}}$

For the Fixed MPR (FMPR) the calculation is similar but the denominator is the number of days in a year whilst the numerator is constrained to be the number of days' supply within the year that the patient has been prescribed.

${\displaystyle FMPR={\dfrac {{\text{All days' supply}}\leq 365}{365}}}$

For medication in tablet form it is relatively straightforward to calculate the number of days' supply based on a prescription. Some medications are less straightforward though because a prescription of a given number of doses may have a variable number of days' supply because the number of doses to be taken per day varies, for example with preventative corticosteroid inhalers prescribed for asthma where the number of inhalations to be taken daily may vary between individuals based on the severity of the disease.

Course completion

Once started, patients seldom follow treatment regimens as directed, and seldom complete the course of treatment. In respect of hypertension, 50% of patients completely drop out of care within a year of diagnosis. Persistence with first-line single antihypertensive drugs is extremely low during the first year of treatment. As far as lipid-lowering treatment is concerned, only one third of patients are compliant with at least 90% of their treatment. Intensification of patient care interventions (e.g. electronic reminders, pharmacist-led interventions, healthcare professional education of patients) improves patient adherence rates to lipid-lowering medicines, as well as total cholesterol and LDL-cholesterol levels.

The World Health Organization (WHO) estimated in 2003 that only 50% of people complete long-term therapy for chronic illnesses as they were prescribed, which puts patient health at risk. For example, in 2002 statin compliance dropped to between 25 and 40% after two years of treatment, with patients taking statins for what they perceive to be preventative reasons being unusually poor compliers.

A wide variety of packaging approaches have been proposed to help patients complete prescribed treatments. These approaches include formats that increase the ease of remembering the dosage regimen as well as different labels for increasing patient understanding of directions. For example, medications are sometimes packed with reminder systems for the day and/or time of the week to take the medicine. Some evidence shows that reminder packaging may improve clinical outcomes such as blood pressure.

A not-for-profit organisation called the Healthcare Compliance Packaging Council of Europe] (HCPC-Europe) was set up between the pharmaceutical industry, the packaging industry with representatives of European patients organisations. The mission of HCPC-Europe is to assist and to educate the healthcare sector in the improvement of patient compliance through the use of packaging solutions. A variety of packaging solutions have been developed by this collaboration.

World Health Organization Barriers to Adherence

The World Health Organization (WHO) groups barriers to medication adherence into five categories; health care team and system-related factors, social and economic factors, condition-related factors, therapy-related factors, and patient-related factors. Common barriers include:

Barrier	Category
Poor Patient-provider Relationship	Health Care Team and System
Inadequate Access to Health Services	Health Care Team and System
High Medication Cost	Social and Economic
Cultural Beliefs	Social and Economic
Level of Symptom Severity	Condition
Availability of Effective Treatments	Condition
Immediacy of Beneficial Effects	Therapy
Side Effects	Therapy
Stigma Surrounding Disease	Patient
Inadequate Knowledge of Treatment	Patient

Improving adherence rates

Role of health care providers

Health care providers play a great role in improving adherence issues. Providers can improve patient interactions through motivational interviewing and active listening. Health care providers should work with patients to devise a plan that is meaningful for the patient's needs. A relationship that offers trust, cooperation, and mutual responsibility can greatly improve the connection between provider and patient for a positive impact. The wording that health care professionals take when sharing health advice may have an impact on adherence and health behaviours, however, further research is needed to understand if positive framing (e.g., the chance of surviving is improved if you go for screening) versus negative framing (e.g., the chance of dying is higher if you do not go for screening) is more effective for specific conditions.

Technology

In 2012 it was predicted that as telemedicine technology improves, physicians will have better capabilities to remotely monitor patients in real-time and to communicate recommendations and medication adjustments using personal mobile devices, such as smartphones, rather than waiting until the next office visit.

Medication Event Monitoring Systems, as in the form of smart medicine bottle tops, smart pharmacy vials or smart blister packages as used in clinical trials and other applications where exact compliance data are required, work without any patient input, and record the time and date the bottle or vial was accessed, or the medication removed from a blister package. The data can be read via proprietary readers, or NFC enabled devices, such as smartphones or tablets. A 2009 study stated that such devices can help improve adherence.

The effectiveness of two-way email communication between health care professionals and their patients has not been adequately assessed.

Mobile phones

As of 2019, 5.15 billion people, which equates to 67% of the global population, have a mobile device and this number is growing. Mobile phones have been used in healthcare and has fostered its own term, mHealth. They have also played a role in improving adherence to medication. For example, text messaging has been used to remind patients to take medication in patients with chronic conditions such as asthma and hypertension. Other examples include the use of smartphones for synchronous and asynchronous Video Observed Therapy (VOT) as a replacement for the currently resource intensive standard of Directly Observed Therapy (DOT) (recommended by the WHO) for Tuberculosis management. Other mHealth interventions for improving adherence to medication include smartphone applications, voice recognition in interactive phone calls and Telepharmacy. Some results show that the use of mHealth improves adherence to medication and is cost-effective, though some reviews report mixed results. Studies show that using mHealth to improve adherence to medication is feasible and accepted by patients. mHealth interventions have also been used alongside other telehealth interventions such as wearable wireless pill sensors, smart pillboxes and smart inhalers

Forms of medication

Depot injections need to be taken less regularly than other forms of medication and a medical professional is involved in the administration of drugs so can increase compliance. Depot's are used for oral contraceptive pill and antipsychotic medication used to treat schizophrenia and bipolar disorder.

Coercion

Sometimes drugs are given involuntarily to ensure compliance. This can occur if an individual has been involuntarily commitment or are subjected to an outpatient commitment order, where failure to take medication will result in detention and involuntary administration of treatment. This can also occur if a patient is not deemed to have mental capacity to consent to treatment in an informed way.

Health and disease management

A WHO study estimates that only 50% of patients with chronic diseases in developed countries follow treatment recommendations.

Asthma non-compliance (28–70% worldwide) increases the risk of severe asthma attacks requiring preventable ER visits and hospitalisations; compliance issues with asthma can be caused by a variety of reasons including: difficult inhaler use, side effects of medications, and cost of the treatment.

Cancer

200,000 new cases of cancer are diagnosed each year in the UK. One in three adults in the UK will develop cancer that can be life-threatening, and 120,000 people will be killed by their cancer each year. This accounts for 25% of all deaths in the UK. However while 90% of cancer pain can be effectively treated, only 40% of patients adhere to their medicines due to poor understanding.

Results of a recent (2016) systematic review found a large proportion of patients struggle to take their oral antineoplastic medications as prescribed. This presents opportunities and challenges for patient education, reviewing and documenting treatment plans, and patient monitoring, especially with the increase in patient cancer treatments at home.

The reasons for non-adherence have been given by patients as follows:

• The poor quality of information available to them about their treatment
• A lack of knowledge as to how to raise concerns whilst on medication
• Concerns about unwanted effects
• Issues about remembering to take medication

Partridge et al (2002) identified evidence to show that adherence rates in cancer treatment are variable, and sometimes surprisingly poor. The following table is a summary of their findings:

Type of Cancer	Measure of non-Adherence	Definition of non-Adherence	Rate of Non-Adherence
Haematological malignancies	Serum levels of drug metabolites	Serum levels below expected threshold	83%
Breast cancer	Self-report	Taking less than 90% of prescribed medicine	47%
Leukemia or non Hodgkin's lymphoma	Level of drug metabolite in urine	Level lower than expected	33%
Leukemia, Hodgkin's disease, non Hodgkin's	Self-report and parent report	More than one missed dose per month	35%
Lymphoma, other malignancies	Serum bioassay	Not described
Hodgkin's disease, acute lymphocytic leukemia (ALL)	Biological markers	Level lower than expected	50%
ALL	Level of drug metabolite in urine	Level lower than expected	42%
ALL	Level of drug metabolites in blood	Level lower than expected	10%
ALL	Level of drug metabolites in blood	Level lower than expected	2%

• Medication event monitoring system - a medication dispenser containing a microchip that records when the container is opened and from Partridge et al (2002)

In 1998, trials evaluating Tamoxifen as a preventative agent have shown dropout rates of around one-third:

• 36% in the Royal Marsden Tamoxifen Chemoprevention Study of 1998
• 29% in the National Surgical Adjuvant Breast and Bowel Project of 1998

In March 1999, the "Adherence in the International Breast Cancer Intervention Study" evaluating the effect of a daily dose of Tamoxifen for five years in at-risk women aged 35–70 years was

• 90% after one year
• 83% after two years
• 74% after four years

Diabetes

Patients with diabetes are at high risk of developing coronary heart disease and usually have related conditions that make their treatment regimens even more complex, such as hypertension, obesity and depression which are also characterised by poor rates of adherence.

• Diabetes non-compliance is 98% in US and the principal cause of complications related to diabetes including nerve damage and kidney failure.
• Among patients with Type 2 Diabetes, adherence was found in less than one third of those prescribed sulphonylureas and/or metformin. Patients taking both drugs achieve only 13% adherence.

Other aspects that drive medicine adherence rates is the idea of perceived self-efficacy and risk assessment in managing diabetes symptoms and decision making surrounding rigorous medication regiments. Perceived control and self-efficacy not only significantly correlate with each other, but also with diabetes distress psychological symptoms and have been directly related to better medication adherence outcomes. Various external factors also impact diabetic patients' self-management behaviors including health-related knowledge/beliefs, problem-solving skills, and self-regulatory skills, which all impact perceived control over diabetic symptoms.

Additionally, it is crucial to understand the decision-making processes that drive diabetics in their choices surrounding risks of not adhering to their medication. While patient decision aids (PtDAs), sets of tools used to help individuals engage with their clinicians in making decisions about their healthcare options, have been useful in decreasing decisional conflict, improving transfer of diabetes treatment knowledge, and achieving greater risk perception for disease complications, their efficacy in medication adherence has been less substantial. Therefore, the risk perception and decision-making processes surrounding diabetes medication adherence are multi-faceted and complex with socioeconomic implications as well. For example, immigrant health disparities in diabetic outcomes have been associated with a lower risk perception amongst foreign-born adults in the United States compared to their native-born counterparts, which leads to fewer protective lifestyle and treatment changes crucial for combatting diabetes. Additionally, variations in patients' perceptions of time (i.e. taking rigorous, costly medication in the present for abstract beneficial future outcomes can conflict with patients' preferences for immediate versus delayed gratification) may also present severe consequences for adherence as diabetes medication often requires systematic, routine administration.

Hypertension

• Hypertension non-compliance (93% in US, 70% in UK) is the main cause of uncontrolled hypertension-associated heart attack and stroke.
• In 1975, only about 50% took at least 80% of their prescribed anti-hypertensive medications.

As a result of poor compliance, 75% of patients with a diagnosis of hypertension do not achieve optimum blood-pressure control.

Mental illness

A 2003 review found that 41–59% of patients prescribed antipsychotics took the medication prescribed to them infrequently or not at all. Sometimes non-adherence is due to lack of insight, but psychotic disorders can be episodic and antipsychotics are then use prophylacticly to reduce the likelihood of relapse rather than treat symptoms and in some cases individuals will have no further episodes despite not using antipsychotics. A 2006 review investigated the effects of compliance therapy for schizophrenia: and found no clear evidence to suggest that compliance therapy was beneficial for people with schizophrenia and related syndromes.

Rheumatoid arthritis

A longitudinal study has shown that adherence with treatment about 60%. The predictors of adherence were found to be more of psychological, communication and logistic nature rather than sociodemographic or clinical factors. The following factors were identified as independent predictors of adherence:

• the type of treatment prescribed
• agreement on treatment
• having received information on treatment adaptation
• clinician perception of patient trust

History of lysergic acid diethylamide

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/History_of_lysergic_acid_diethylamide 

 

LSD blotter paper

The psychedelic drug (or entheogen) lysergic acid diethylamide (LSD) was first synthesized on November 16, 1938, by the Swiss chemist Albert Hofmann in the Sandoz (now Novartis) laboratories in Basel, Switzerland. It was not until five years later on April 19, 1943, that the psychedelic properties were found.

Discovery

Albert Hofmann, born in Switzerland, joined the pharmaceutical-chemical department of Sandoz Laboratories, located in Basel, as a co-worker with professor Arthur Stoll, founder and director of the pharmaceutical department. He began studying the medicinal plant squill and the fungus ergot as part of a program to purify and synthesize active constituents for use as pharmaceuticals. His main contribution was to elucidate the chemical structure of the common nucleus of Scilla glycosides (an active principle of Mediterranean squill). While researching lysergic acid derivatives, Hofmann first synthesized LSD on November 16, 1938. The main intention of the synthesis was to obtain a respiratory and circulatory stimulant (an analeptic). It was set aside for five years, until April 16, 1943, when Hofmann decided to take a second look at it. While re-synthesizing LSD, he accidentally absorbed a small amount of the drug and discovered its powerful effects. He described what he felt as being:

... affected by a remarkable restlessness, combined with a slight dizziness. At home I lay down and sank into a not unpleasant intoxicated-like condition, characterized by an extremely stimulated imagination. In a dreamlike state, with eyes closed (I found the daylight to be unpleasantly glaring), I perceived an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopic play of colors. After about two hours this condition faded away.

"Bicycle Day"

LSD blotter commemorating Bicycle Day
Type	Secular
Celebrations	Consumption of lysergic acid diethylamide (LSD)
Observances	Honors the anniversary of the first ever acid trip, undergone by Swiss chemist Dr. Albert Hofmann on April 19, 1943 in Basel, Switzerland.
Date	April 19
Next time	19 April 2023
Frequency	Annual

On April 19, 1943, Hofmann ingested 0.25 milligrams (250 micrograms) of the substance. Less than one hour later, Hofmann experienced sudden and intense changes in perception. He asked his laboratory assistant to escort him home. As was customary in Basel, they made the journey by bicycle. On the way, Hofmann's condition rapidly deteriorated as he struggled with feelings of anxiety, alternating in his beliefs that the next-door neighbor was a malevolent witch, that he was going insane, and that the LSD had poisoned him. When the house doctor arrived, however, he could detect no physical abnormalities, save for a pair of incredibly dilated pupils. Hofmann was reassured, and soon his terror began to give way to a sense of good fortune and enjoyment, as he later wrote:

... Little by little I could begin to enjoy the unprecedented colors and plays of shapes that persisted behind my closed eyes. Kaleidoscopic, fantastic images surged in on me, alternating, variegated, opening and then closing themselves in circles and spirals, exploding in colored fountains, rearranging and hybridizing themselves in constant flux ...

The events of the first LSD trip, now known as "Bicycle Day", after the bicycle ride home, proved to Hofmann that he had indeed made a significant discovery: a psychoactive substance with extraordinary potency, capable of causing significant shifts of consciousness in incredibly low doses. (The term trip was first coined by US Army scientists during the 1950s when they were experimenting with LSD.) Hofmann foresaw the drug as a powerful psychiatric tool; because of its intense and introspective nature, he could not imagine anyone using it recreationally. Bicycle Day is increasingly observed in psychedelic communities as a day to celebrate the discovery of LSD.

The celebration of Bicycle Day originated in DeKalb, Illinois, in 1985, when Thomas B. Roberts, then a professor at Northern Illinois University, invented the name "Bicycle Day" when he founded the first celebration at his home. Several years later, he sent an announcement made by one of his students to friends and Internet lists, thus propagating the idea and the celebration. His original intent was to commemorate Hofmann's original, accidental exposure on April 16, but that date fell midweek and was not a good time for the party, so he chose the 19th to honor Hofmann's first intentional exposure.

Psychiatric use

See also: Psychedelic therapy

LSD was introduced as a commercial medication under the trade-name Delysid for various psychiatric uses in 1947.

LSD was brought to the attention of the United States in 1949 by Sandoz Laboratories because they believed LSD might have clinical applications.

Throughout the 1950s, mainstream media reported on research into LSD and its growing use in psychiatry, and undergraduate psychology students taking LSD as part of their education described the effects of the drug. Time magazine published six positive reports on LSD between 1954 and 1959.

LSD was originally perceived as a psychotomimetic capable of producing model psychosis. By the mid-1950s, LSD research was being conducted in major American medical centers, where researchers used LSD as a means of temporarily replicating the effects of mental illness. One of the leading authorities on LSD during the 1950s in the United States was the psychoanalyst Sidney Cohen. Cohen first took the drug on October 12, 1955, and expected to have an unpleasant trip, but was surprised when he experienced "no confused, disoriented delirium." He reported that the "problems and strivings, the worries and frustrations of everyday life vanished; in their place was a majestic, sunlit, heavenly inner quietude." Cohen immediately began his own experiments with LSD with the help of Aldous Huxley whom he had met in 1955. In 1957, with the help of psychologist Betty Eisner, Cohen began experimenting on whether or not LSD might have a helpful effect in facilitating psychotherapy, curing alcoholism, and enhancing creativity. Between 1957 and 1958, they treated 22 patients who had minor personality disorders. LSD was also given to artists in order to track their mental deterioration, but Huxley believed LSD might enhance their creativity. Between 1958 and 1962, psychiatrist Oscar Janiger tested LSD on more than 100 painters, writers, and composers.

In one study in the late 1950s, Dr. Humphry Osmond gave LSD to alcoholics in Alcoholics Anonymous who had failed to quit drinking. After one year, around 50% of the study group had not had a drink—a success rate that has never been duplicated by any other means. Bill Wilson, the founder of Alcoholics Anonymous, participated in medically supervised experiments on the effects of LSD on alcoholism and believed LSD could be used to cure alcoholics.

In the United Kingdom the use of LSD was pioneered by Dr. Ronald A. Sandison in 1952, at Powick Hospital, Worcestershire. A special LSD unit was set up in 1958. After Sandison left the hospital in 1964, medical superintendent Arthur Spencer took over and continued the clinical use of the drug until it was withdrawn in 1965. In all, 683 patients were treated with LSD in 13,785 separate sessions at Powick, but Spencer was the last member of the medical staff to use it.

From the late 1940s through the mid-1970s, extensive research and testing was conducted on LSD. During a 15-year period beginning in 1950, research on LSD and other hallucinogens generated over 1,000 scientific papers, several dozen books, and six international conferences. Overall, LSD was prescribed as treatment to over 40,000 patients. Film star Cary Grant was one of many men during the 1950s and 1960s who were given LSD in concert with psychotherapy. Many psychiatrists began taking the drug recreationally and sharing it with friends. Dr. Leary's experiments (see Timothy Leary below) spread LSD usage to a much wider segment of the general populace.

Sandoz halted LSD production in August 1965 after growing governmental protests at its proliferation among the general populace. The National Institute of Mental Health in the United States distributed LSD on a limited basis for scientific research. Scientific study of LSD largely ceased by about 1980 as research funding declined, and governments became wary of permitting such research, fearing that the results of the research might encourage illicit LSD use. By the end of the 20th century, there were few authorized researchers left, and their efforts were mostly directed towards establishing approved protocols for further work with LSD in easing the suffering of the dying and with drug addicts and alcoholics.

A 2014 study showed evidence that LSD can have therapeutic benefits in treating anxiety associated with life-threatening diseases. Rick Doblin, an American drug researcher, described the work as "a proof of concept" that he hoped would "break these substances out of the mold of the counterculture and bring them back to the lab as part of a psychedelic renaissance."

Eight subjects received a full 200-microgram dose of LSD while four others received one-tenth as much. Participants then took part in two LSD-assisted therapy sessions two to three weeks apart. Subjects who took the full dose experienced reductions in anxiety averaging 20 per cent while those given the low dose reported becoming more anxious.

When subjects taking the low dose were switched to the full dose they too showed reduced anxiety, with the positive effects lasting for up to a year. The effects of the drug itself lasted for up to 10 hours with participants talking to Dr Gasser throughout the experience.

"These results indicate that when administered safely in a methodologically rigorous medically supervised psychotherapeutic setting, LSD can reduce anxiety," the study concludes, "suggesting that larger controlled studies are warranted."

Resistance and prohibition

LSD blotter

 

See also: Prohibition (drugs), Controlled Substances Act, and Convention on Psychotropic Substances

By the mid-1960s the backlash against the use of LSD and its perceived corrosive effects on cultural values resulted in governmental action to restrict the availability of the drug by making use of it illegal. LSD was declared a "Schedule I" substance, legally designating that the drug has a "high potential for abuse" and is without any "currently accepted medical use in treatment." LSD was removed from legal circulation. The United States Drug Enforcement Administration claimed:

Although the initial observations on the benefits of LSD were highly optimistic, empirical data developed subsequently proved less promising ... Its use in scientific research has been extensive and its use has been widespread. Although the study of LSD and other hallucinogens increased the awareness of how chemicals could affect the mind, its use in psychotherapy largely has been debunked. It produces no aphrodisiac effects, does not increase creativity, has no lasting positive effect in treating alcoholics or criminals, does not produce a 'model psychosis', and does not generate immediate personality change.

However, drug studies have confirmed that the powerful hallucinogenic effects of this drug can produce profound adverse reactions, such as acute panic reactions, psychotic crises, and "flashbacks", especially in users ill-equipped to deal with such trauma.

The governors of Nevada and California each signed bills into law on May 30, 1966, that make them the first two American states to outlaw the manufacture, sale, and possession of the drug. The law went into effect immediately in Nevada, and on October 6, 1966, in California. Other U.S. states and many other countries soon followed with similar bans.

Influential individuals

Aldous Huxley

Renowned British intellectual Aldous Huxley was one of the most important figures in the early history of LSD. He was a figure of high repute in the world of letters and had become internationally famous through his novels Crome Yellow, Antic Hay and his dystopian novel Brave New World. His experiments with psychedelic drugs (initially mescaline) and his descriptions of them in his writings did much to spread awareness of psychedelic drugs to the general public and arguably helped to glamorize their recreational use, although Huxley himself treated them very seriously.

Huxley was introduced to psychedelic drugs in 1953 by a friend, psychiatrist Humphry Osmond. Osmond had become interested in hallucinogens and their relationship to mental illness in the 1940s. During the 1950s, he completed extensive studies of a number of drugs, including mescaline and LSD. As noted above, Osmond had some remarkable success in treating alcoholics with LSD.

In May 1953 Osmond gave Huxley his first dose of mescaline at the Huxley home. In 1954 Huxley recorded his experiences in the landmark book The Doors of Perception; the title was drawn from a quotation by British artist and poet William Blake. Huxley tried LSD for the first time in 1955, obtained from "Captain" Al Hubbard.

Alfred Hubbard

Alfred Matthew Hubbard is reputed to have introduced more than 6,000 people to LSD, including scientists, politicians, intelligence officials, diplomats, and church figures. He became known as the original "Captain Trips", travelling about with a leather case containing pharmaceutically pure LSD, mescaline, and psilocybin. He became a 'freelance' apostle for LSD in the early 1950s after supposedly receiving an angelic vision telling him that something important to the future of mankind would soon be coming. When he read about LSD the next year, he immediately sought and acquired LSD, which he tried for himself in 1951.

Although he had no medical training, Hubbard collaborated on running psychedelic sessions with LSD with Ross McLean at Vancouver's Hollywood Hospital, with psychiatrists Abram Hoffer and Humphry Osmond; with Myron Stolaroff at the International Federation for Advanced Study in Menlo Park, California; and with Willis Harman at the Stanford Research Institute (SRI). At various times over the next 20 years, Hubbard also reportedly worked for the Canadian Special Services, the U.S. Justice Department and the U.S. Bureau of Alcohol, Tobacco & Firearms. It is also rumored that he was involved with the CIA's MK-ULTRA project. How his government positions actually interacted with his work with LSD is unknown.

Harold A. Abramson

In 1955, Time magazine reported:

"In Manhattan, Psychiatrist Harold A. Abramson of the Cold Spring Harbor Biological Laboratory has developed a technique of serving dinner to a group of subjects, topping off the meal with a liqueur glass containing 40 micrograms of LSD."

This mention in America's most popular newsweekly is noteworthy because Abramson was not a psychiatrist or even a psychologist, but was an allergist who was a key participant in the CIA MK-ULTRA mind-control program.

R. Gordon Wasson

In 1957, R. Gordon Wasson, the vice president of J.P. Morgan, published an article in Life magazine extolling the virtues of magic mushrooms. This prompted Albert Hofmann to isolate psilocybin in 1958 for distribution by Sandoz with its product LSD in the U.S., further raising interest in LSD in the mass media. Following Wasson's report, Timothy Leary visited Mexico to experience the mushrooms.

Timothy Leary

DEA agents Howard Safir (left) and Don Strange (right) with Leary in custody (1972)

Dr. Timothy Leary, a lecturer in psychology at Harvard University, was the most prominent pro-LSD researcher. Leary claimed that using LSD with the right dosage, set (one's emotional mindset at time of ingestion), and setting, preferably with the guidance of professionals, could alter behavior in dramatic and beneficial ways. Leary began conducting experiments with psilocybin in 1960 on himself and a number of Harvard graduate students after trying hallucinogenic mushrooms used in Native American religious rituals while visiting Mexico. His group began conducting experiments on state prisoners, where they claimed a 90% success rate preventing repeat offenses.

Later reexamination of Leary's data reveals his results to be skewed, whether intentionally or not; the percent of men in the study who ended up back in prison later in life was approximately 2% lower than the usual rate. Leary was later introduced to LSD, and he then incorporated that drug into his research as his mental catalyst of choice. Leary claimed that his experiments produced no murders, suicides, psychotic breaks, or bad trips. Almost all of Leary's participants reported profound mystical experiences which they felt had a tremendously positive effect on their lives. While it is true that Leary's experiments did not lead to any murders, he willfully chose to ignore the bad trips which occurred, as well as the attempted suicide of a woman the day after she was given mescaline by Leary.

By 1962, the Harvard faculty's disapproval with Leary's experiments reached critical mass. Leary was informed that the CIA was monitoring his research (see Government experiments below). Many of the other faculty members had harbored reservations about Leary's research, and parents began complaining to the university about Leary's distribution of hallucinogenic drugs to their children. Further, many undergraduate students who were not part of Leary's research program heard of the profound experiences other students had undergone and began taking LSD for recreational purposes, which was not illegal at the time . Leary described LSD as a potent aphrodisiac in an interview with Playboy magazine. Leary left the university for an extended amount of time during the spring semester, thus failing to fulfill his duties as professor. Leary and another Harvard psychologist, Richard Alpert, were dismissed from the university in 1963.

In 1964, they published The Psychedelic Experience: A Manual Based on the Tibetan Book of the Dead, which argued that the psychedelic experience paralleled the death/rebirth experience described in the Bardo Thodol (Tibetan Book of the Dead). Leary and Alpert, unfazed by their dismissals, relocated first to Mexico, but were expelled from the country by the Mexican government. They then set up at a large private mansion owned by William Hitchcock, named after the small town in New York State where it is located, Millbrook, where they continued their experiments. Their research lost its controlled scientific character as the experiments transformed into LSD parties. Leary later wrote, "We saw ourselves as anthropologists from the twenty-first century inhabiting a time module set somewhere in the Dark Ages of the 1960s. On this space colony, we were attempting to create a new paganism and a new dedication to life as art."

A judge who expressed dislike for Leary's books sentenced him to 30 years in prison for possession of half a marijuana cigarette in violation of the Marihuana Tax Act of 1937. However, this decision was reversed in the 1969 U.S. Supreme Court case Timothy Leary v. United States (395 U.S. 6) on the grounds that the Act required self-incrimination, thus violating the Fifth Amendment of the U.S. Constitution. Publicity surrounding the case further cemented Leary's growing reputation as a counter cultural guru. Around this time, President Richard Nixon described Leary as "the most dangerous man in America." Repeated FBI raids instigated the end of the Millbrook experiment. Leary refocused his efforts towards countering the tremendous amount of anti-LSD propaganda then being issued by the United States government, popularizing the slogan "Turn on, tune in, drop out." Many experts blame Leary and his activism for the near-total suppression of psychedelic research over the next 35 years.

Owsley Stanley

Historically, LSD was distributed not for profit, but because those who made and distributed it truly believed that the psychedelic experience could be beneficial for humanity. A limited number of chemists, probably fewer than a dozen, are believed to have manufactured nearly all of the illicit LSD available in the United States. The best known of these is undoubtedly Augustus Owsley Stanley III, usually known simply as Owsley or Bear. The former chemistry student set up a private LSD lab in the mid-60s in San Francisco and supplied the LSD consumed at the famous Acid Test parties held by Ken Kesey and his Merry Pranksters, as well as the Human Be-In in San Francisco in January 1967 and the Monterey International Pop Festival in June 1967. He also had close social connections the Grateful Dead, Jefferson Airplane, and Big Brother and The Holding Company, regularly supplying them with LSD and working as their live sound engineer, creating many tapes of these groups in concert. Owsley's LSD activities—immortalized by Steely Dan in their song "Kid Charlemagne"—ended with his arrest at the end of 1967, but some other manufacturers most likely operated continuously for 30 years or more. Announcing Owsley's first bust in 1966, The San Francisco Chronicle's headline "LSD Millionaire Arrested" inspired the rare Grateful Dead song "Alice D. Millionaire".

Owsley associated with other early LSD producers, Tim Scully and Nicholas Sand.

Ken Kesey

Ken Kesey was born in 1935 in La Junta, Colorado to dairy farmers Frederick A. Kesey and Ginevra Smith. In 1946, the family moved to Springfield, Oregon. A champion wrestler in both high school and college, he graduated from Springfield High School in 1953.

Kesey attended the University of Oregon's School of Journalism, where he received a degree in speech and communication in 1957, where he was also a brother of Beta Theta Pi. He was awarded a Woodrow Wilson National Fellowship in 1958 to enroll in the creative writing program at Stanford University, which he did the following year. While at Stanford, he studied under Wallace Stegner and began the manuscript that would become One Flew Over the Cuckoo's Nest.

At Stanford in 1959, Kesey volunteered to take part in a CIA-financed study named Project MKULTRA at the Menlo Park Veterans Hospital. The project studied the effects on the patients of psychoactive drugs, particularly LSD, psilocybin, mescaline, cocaine, AMT, and DMT. Kesey wrote many detailed accounts of his experiences with these drugs, both during the Project MKULTRA study and in the years of private experimentation that followed. Kesey's role as a medical guinea pig inspired him to write the book One Flew Over the Cuckoo's Nest in 1962. The success of the book, as well as the sale of his residence at Stanford, allowed him to move to La Honda, California in the mountains west of Stanford University. He frequently entertained friends and many others with parties he called "Acid Tests" involving music (such as Kesey's favorite band, The Warlocks, later known as the Grateful Dead), black lights, fluorescent paint, strobes and other "psychedelic" effects, and, of course, LSD. These parties were noted in some of Allen Ginsberg's poems and are also described in the books The Electric Kool-Aid Acid Test by Tom Wolfe, Hell's Angels: The Strange and Terrible Saga of the Outlaw Motorcycle Gangs by Hunter S. Thompson, and Freewheelin Frank, Secretary of the Hell's Angels by Frank Reynolds. Ken Kesey was also said to have experimented with LSD with Ringo Starr in 1965 and that he influenced the setup for future performances with The Beatles in the UK.

In the summer of 1964, Kesey's Merry Pranksters customized a bus named "Furthur" and set out on a tour to propagate LSD use.

Sidney Cohen

Sidney Cohen was a Los Angeles-based psychiatrist. His work primarily focused on the effects of psychedelics, primarily LSD. Cohen published 13 books in his life, all of them being based around drugs and substance abuse. He began working on LSD in the 1950s. One of his earlier works is a video of an experiment that shows Cohen interviewing a woman before and after administering her LSD. In the later part of the 1960s he worked as a director for the National Institute of Mental Health in their Division of Narcotic Addiction and Drug Abuse. He has been open about having taken LSD many times himself, but was always opposed to the growing use of LSD amongst members of the counterculture movement. Cohen thought LSD was only safe if used under medical supervision and that the average person was not equipped with the ability to safely handle the drug. Through his work he had become known as one of the leading experts in LSD research.

William Leonard Pickard

William Leonard Pickard earned a scholarship to Princeton University but dropped out after one term, instead preferring to hang out at Greenwich Village jazz clubs in New York City. In 1971, he got a job as a research manager at the University of California, Berkeley in the Department of Bacteriology and Immunology, a job he held until 1974.

In December 1988, a neighbor reported a strange chemical odor coming from an architectural shop at a Mountain View, California industrial park. Federal agents arrived to find 200,000 doses of LSD and William Pickard inside. Pickard was charged with manufacturing LSD and served five years in prison.

By 1994, Pickard had enrolled at the John F. Kennedy School of Government at Harvard University. His studies focused on drug abuse in the former Soviet Union, where he theorized that the booming black market and many unemployed chemists could lead to a flood of the drug market.

In 2000, Pickard was arrested for manufacturing LSD in Kansas and was serving two life sentences at United States Penitentiary, Tucson. On July 27, 2020, Pickard was granted Compassionate Release from federal prison after serving 17 years of his sentence.

Secret government research

See also: Project MKULTRA and Edgewood Arsenal human experiments

 

The U.S. Central Intelligence Agency (CIA) became interested in LSD when they read reports alleging that American prisoners during the Korean War were being brainwashed with the use of some sort of drug or "lie serum". LSD was the original centerpiece of the top secret MKULTRA project, an ambitious undertaking conducted from the 1950s through the 70s designed to explore the possibilities of pharmaceutical mind control. Hundreds of participants, including CIA agents, government employees, military personnel, prostitutes, members of the general public, and mental patients were given LSD, many without their knowledge or consent. The experiments often involved severe psychological torture. To guard against outward reactions, doctors conducted experiments in clinics and laboratories where subjects were monitored by EEG machines and had their words recorded. Some studies investigated whether drugs, stress or specific environmental conditions could be used to break prisoners or to induce confessions.

The CIA also created The Society for the Investigation of Human Ecology, which was a CIA funding front which provided grants to social scientists and medical researchers investigating questions of interest related to the MKULTRA program. Between 1960 and 1963, the CIA gave $856,782 worth of grants to different organizations. The researchers eventually concluded that LSD's effects were too varied and uncontrollable to make it of any practical use as a truth drug, and the project moved on to other substances. It would be decades before the U.S. government admitted the existence of the project and offered apologies to the families of those who were forced to participate in the experiments. During this time period, the use of LSD for psychochemical warfare was under consideration and testing, among other substances. Looking to replicate the effects of nerve gas created by the Germans during World War II without the toxicity, LSD was sought for use under the pretense that it could induce hysteria and psychoses, or at least an inability to fight without wholesale destruction of the enemy and their properties. Thousands of tests on willing research subjects took place at the Edgewood Arsenal in Maryland, with the ultimate conclusion being that LSD was too unpredictable and uncontrollable for any tactical use.

Recreational use

See also: Psychedelic music, Psychedelic rock, and Psychedelic art

From 1960 to 1980

Estimated annual numbers of first-time LSD use in the United States among persons aged 12 or older: 1967–2008

LSD began to be used recreationally in certain (primarily medical) circles. Mainly academics and medical professionals, who became acquainted with LSD in their work, began using it themselves and sharing it with friends and associates. Among the first to do so was British psychiatrist Humphry Osmond.

Psychedelic subculture goes mainstream

LSD historian Jay Stevens, author of the 1987 book Storming Heaven: LSD and the American Dream, has said that in the early days of its recreational use, LSD users (who were at that time mostly academics and medical professionals) fell into two broadly delineated groups. The first group, which was essentially conservative and exemplified by Aldous Huxley, felt that LSD was too powerful and too dangerous to allow its immediate and widespread introduction, and that its use ought to be restricted to the 'elite' members of society—artists, writers, scientists—who could mediate its gradual distribution throughout society. The second and more radical group, typified by Richard Alpert and Timothy Leary, felt that LSD had the power to revolutionize society and that it should be spread as widely as possible and be available to all.

During the 1960s, this second 'group' of casual LSD users evolved and expanded into a subculture that extolled the mystical and religious symbolism often engendered by the drug's powerful effects, and advocated its use as a method of raising consciousness. The personalities associated with the subculture included spiritual gurus such as Dr. Timothy Leary and psychedelic rock musicians such as the Grateful Dead, Jimi Hendrix, Pink Floyd, Jefferson Airplane and the Beatles, and soon attracted a great deal of publicity, generating further interest in LSD.

The popularization of LSD outside of the medical world was hastened when individuals such as author Ken Kesey participated in drug trials and liked what they saw. Tom Wolfe wrote a widely read account of the early days of LSD's entrance into the non-academic world in his book The Electric Kool Aid Acid Test, which documented the cross-country, acid-fueled voyage of Kesey and the Merry Pranksters on the psychedelic bus "Furthur" and the Pranksters' later 'Acid Test' LSD parties.

In 1965, Sandoz laboratories stopped its still legal shipments of LSD to the United States for research and psychiatric use, after a request from the U.S. government concerned about its use. By April 1966, LSD use had become so widespread that Time magazine warned about its dangers.

In December 1966, the exploitation film Hallucination Generation was released. This was followed by the films The Trip in 1967 and Psych-Out in 1968.

Musicians and LSD

On March 27, 1965, Beatles members John Lennon and George Harrison (and their wives) were dosed with LSD without their permission by their dentist, Dr. John Riley. John Lennon mentioned the incident in his famous 1970 Rolling Stone interview, but the name of the dentist was revealed only in 2006. On August 24, 1965, Lennon, Harrison and Ringo Starr took their second trip on LSD. Actor Peter Fonda repeatedly said "I know what it's like to be dead" to John Lennon during an LSD trip. John Lennon wrote "Lucy in the Sky with Diamonds", a fanciful song which many assumed referred to LSD, although he always denied the connection as coincidence. The songs "She Said She Said" and "Tomorrow Never Knows" from the Beatles' Revolver album explicitly reference LSD trips, and many lines of "Tomorrow Never Knows" were borrowed from Timothy Leary's book The Psychedelic Experience. Around the same time, bands such as Pink Floyd, Jefferson Airplane, and The Grateful Dead helped give birth to a genre known as "psychedelic rock" or acid rock. In 1965, The Pretty Things released an album called Get the Picture? which included a track titled "L.S.D."

LSD became a headline item in early 1967, and the Beatles admitted to having been under the influence of LSD. Earlier in the year, British tabloid News of the World ran a sensational three-week series on 'drug parties' hosted by rock group The Moody Blues and attended by leading stars including Donovan, The Who's Pete Townshend and Cream drummer Ginger Baker. Largely as a result of collusion between News of the World journalists and the London Drug Squad, many pop stars including Donovan and Rolling Stones members Mick Jagger and Keith Richards were arrested for drug possession, although none of the arrests involved LSD.

The FBI suggested in now declassified documents that the Grateful Dead were responsible for introducing LSD to the U.S. The Grateful Dead were the "house band" at Ken Kesey and the Merry Pranksters' Acid Tests. These free-form parties introduced many people on the West Coast to LSD for the first time, as documented in Tom Wolfe's The Electric Kool-Aid Acid Test and Phil Lesh's Searching for the Sound. Acid historian Jesse Jarnow describes how Grateful Dead concerts served as the United States' primary distribution network for LSD in the second half of the twentieth century.

In 1992, Mike Dirnt of Green Day wrote the famous "Longview" bass line while under the influence of LSD. In an interview, Green Day lead singer and guitarist Billie Joe Armstrong recalled that he arrived at their house and saw Mike sitting on the floor with highly dilated pupils, holding his bass guitar. Mike looked up at Billie and exclaimed, "Listen to this!"

LSD in Australia

LSD was evidently in limited recreational use in Australia in the early 1960s, but is believed to have been initially restricted to those with connections to the scientific and the medical communities. LSD overdose was suggested as a possible cause of the January 2, 1962 deaths of CSIRO scientists Dr. Gilbert Bogle and his lover Dr. Margaret Chandler, but is very unlikely as there are no known cases of a LSD fatal overdose and other more likely causes of death have been suggested. Large quantities of LSD began to appear in Australia around 1968, and soon permeated the music scene and youth culture in general, especially in the capital cities. The major source of supply during this period is believed to have been American servicemen visiting Australia (mainly Sydney) from Vietnam on 'rest and recreation' (R&R) leave, although the growing connections between American and Australian organized crime in the late 1960s may also have facilitated its importation. Recreational LSD use among young people was on a par with that in other countries in Australia by the early 1970s and continued until late in the decade. LSD is not believed to have been manufactured locally in a significant quantity (if at all) and most if not all supplies were sourced from overseas.

Production of LSD

During the 1960s and early 1970s, the drug culture adopted LSD as the psychedelic drug of choice, particularly amongst the hippie community. However, LSD dramatically decreased in popularity in the mid-1970s. This decline was due to negative publicity centred on side-effects of LSD use, its criminalization, and the increasing effectiveness of drug law enforcement efforts, rather than new medical information. The last country to produce LSD legally (until 1975) was Czechoslovakia; during the 1960s, high-quality LSD was imported from the communist country to California, a fact appreciated by Leary in The Politics of Ecstasy.

Victor James Kapur had the first known home grown UK 'acid lab'. Up to then, all LSD had been imported from the U.S. or was remnant produce of Sandoz before it stopped producing LSD. In 1967, Kapur was caught distributing 19 grams of crystalline LSD and subsequently the police raided both of his laboratories. One was in the back room of Kapur's chemist shop and another, larger one, was in a garage he rented from a friend of his brother-in-law.

A second group was busted in 1969. A lab in Kent, and a flat in London were raided simultaneously and quantities of equipment and LSD seized along with the two men who had been making the LSD, Quentin Theobald and Peter Simmons.

The availability of LSD had been drastically reduced by the late 1970s due to a combination of governmental controls and law enforcement. The supply of constituent chemicals including lysergic acid, which was used for production of LSD in the 1960s, and ergotamine tartrate, which was used for production in the 1970s, were placed under tight surveillance and government funding for LSD research was almost eliminated. These efforts were augmented by a series of major busts in England and Europe. One of the most famous was "Operation Julie" in Britain in 1978, named after the first name of the female drug squad officer involved; it broke up one of the largest LSD manufacturing and distribution operations in the world at that time, headed by chemist Richard Kemp. The group targeted by the Julie task force were reputed to have had links to the mysterious The Brotherhood of Eternal Love and to Ronald Stark.

Modern times

LSD made a comeback in the 1980s accompanying the advent of recreational MDMA use, first in the punk and gothic subcultures through dance clubs, then in the 1990s through the acid house scene and rave subculture. LSD use and availability declined sharply following a raid of a large scale LSD lab in 2000 (see LSD in the United States). The lab was run by William Leonard Pickard (who served 17 years of a two lifetime sentence in US federal prison in Tucson, AZ) and Clyde Apperson (now serving 30 years in prison). Gordon Todd Skinner, who owned the property the large scale lab had been operating on, came to the DEA looking to work as an informant. He and his then-girlfriend Krystle Cole were intimately involved in the case, but were not charged in the bust. The lab was allegedly producing a kilogram of LSD every five weeks, and the U.S. government contends that LSD supply dropped by 90% following the bust. In the decade after the bust, LSD availability and use has gradually risen. Since the late 1980s, there has also been a revival of hallucinogen research more broadly, which, in recent years, has included preclinical and clinical studies involving LSD and other compounds such as members of the 2C family compounds and psilocybin. In particular, a study released in 2012 highlighted the extraordinary effectiveness of LSD in treating alcoholism.

In November 2015, Rolling Stone magazine reported on an increasing number of young professionals, particularly in the San Francisco area, who were using "microdosing" (around 10 micrograms) of LSD in an effort to "work through technical problems and become more innovative." In 2018, the book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence by Michael Pollan became a No. 1 New York Times best-seller. In 2020, Oregon became the first U.S. state to decriminalize possession of small amounts of LSD.