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2 months ago
76 The Journal of American Medical Association (JAMA) published a study on January 31, 2024 that found hundreds of psychedelic drug users turning to the social media platform Reddit looking for ways to end a “bad trip.” After decades of stigma around using psychedelic drugs like LSD, psilocybin and even non-classic psychedelic drugs like ketamine, popularity is surging as new users are introduced to the compounds.
Trip killers
Unfortunately, while most psychedelic drug experiences are pleasurable, there can be some that are downright scary and described as a “bad trip.” This has resulted in many users designating someone as a “trip sitter.” This is typically a person who doesn’t engage in using the drug but is on hand if things go wrong. However, it isn’t always possible to find a volunteer to sit out a trip and so the growth of interest in trip killers is growing. The idea behind a trip killer is to ingest another compound to quickly end the effects of a bad experience.
JAMA reported that the study’s lead author, Gregory Yates, MBBS, MA, a trainee emergency physician at the Manchester Royal Infirmary in the UK, said he first learned about trip-killers from a patient who claimed to have used an antihistamine to reverse a trip.
“I couldn’t believe that I’d never heard of this thing called ‘trip-killing,’” Yates recalled in an interview with JAMA. “But people are definitely doing it, and this patient was doing it with a very specific antidote—suggesting an impressive knowledge of pharmacology.”
The problem with researching such an issue is that little research exists. Yates found one study published on ketanserin reversing acute responses to lysergic acid diethylamide (LSD) in research and psychotherapeutic settings. So he decided to go on the hunt and went to Reddit to see what he could find.
Reddit findings
The JAMA article stated that the research team identified 128 threads, or conversations, containing at least one post recommending a trip-killer. It wrote that these threads, which were written in English and created between 2015 and 2023, yielded 709 relevant posts. From these posts, the researchers identified:
• The psychedelics described
• The types of trip-killers recommended
• Suggested trip-killer doses
• Trip-killer safety warnings
The top three drugs that people searched for trip killers were LSD, psilocybin and MDMA in that order. According to Yates, the most frequently recommended trip-killers were benzodiazepines—prescription medications used as anticonvulsants and anxiolytics. “Drugs in this class were mentioned in 46% of all posts. Alprazolam was overwhelmingly the most popular choice, having been referenced in 137 posts, whereas diazepam was suggested in 50 posts. Clonazepam and lorazepam were both named in 24 posts.”
The second most discussed drug class according to the study was antipsychotic medication, which was mentioned in 18% of the posts. “Almost 100 posts proposed quetiapine, followed by 14 posts suggesting olanzapine. 10% of posts advised antidepressants, and the recommendations were chiefly trazodone and mirtazapine, with 77 posts and 14 posts, respectively. Other trip-killers noted in 5% or less of posts included alcohol, antihistamines, opioids, herbal remedies, and prescription sleep medications. Cannabidiol and cannabis were the least referenced trip-killers, both having appeared in only 2% of posts.”
Ketamine warning
The study also found that while ketamine was included in the group, it isn’t a classic psychedelic drug and the remedies could actually worsen the issue of a bad trip. Joshua Woolley, MD, PhD, a staff psychiatrist at the San Francisco Veterans Affairs Medical Center, who wasn’t involved in the study told JAMA that using calming substances like benzodiazepines or opioids can make a ketamine trip even more dangerous.
“If you take a very high dose of classic psychedelics like LSD or psilocybin, you don’t typically stop breathing, and you don’t go to sleep; you might ‘freak out’ or have a really challenging experience,” he said. “But as you go up in the dose of ketamine, you get more and more dissociated and incapacitated,” which he speculated could have contributed to the drowning of actor Matthew Perry this past October.”
Conclusion
Yates said he wasn’t too surprised at the options being discussed on Reddit for trip killers, but he said he was surprised at the range of dosage recommendations. He said some dosage suggestions weren’t bad, while others were so high it could actually harm the individual.
His suggestion if someone was having a bad trip, was to essentially wait it out. He believes a trip sitter is the best solution and if that person isn’t available, then just find a friend or family member for reassurance as the drug wears off. Yates said going to the emergency room sounded awful to him
“An emergency department is bright and noisy with people rushing around everywhere, so if you’re having the worst trip of your life, I cannot imagine a worse environment,” he explained.
