It was several hours after taking a large dose of the psychedelic drug LSD that things took a turn for the worse for Nadia. She and her friends were lost in a park and had to ask for directions to get back to the main road. The only people there to ask were police officers, and she suddenly became hyper-aware that she had taken an illegal substance. Nadia started feeling anxious that she would get in trouble and got paranoid — worrying, for example, that somehow her cats got into the LSD and would be poisoned.
She wanted the trip to end, so she turned to her antipsychotic prescription, which she takes daily. She had read online that it could reverse the effects of a so-called “bad trip” and had some on hand prepared for this very reason.
“It made the experience much better since it gave me the option to stop the bad trip,” Nadia, who is using a pseudonym to protect her privacy, told Salon. “It makes me feel safe taking LSD in general knowing that I can kill the trip in case it turns bad.”
Psychedelic experiences can be both physically and emotionally intense, sometimes lasting for hours or even lingering for days, depending on the substance. As Hunter S. Thompson famously quipped (paraphrased) when you buy the ticket, you take the ride. And these experiences can feel very similar to a journey, with crests and waves of emotion and altered perception that can make an 8-hour psilocybin mushroom snack feel like an adventure. But what if you want to — need to — get off the ride? Well, there are drugs for that, too.
Some evidence suggests people have been using sedatives or tranquilizers as early as the 1970s to try to halt tripping. As both the therapeutic and recreational use of psychedelics exploded in what some call the "psychedelic renaissance," it would make sense that bad trips, have also become more common. Not every bad trip is necessarily negative, so some have resorted to calling them "challenging" experiences, understanding that frightening or uncomfortable trips can sometimes resolve themselves or offer "deep existential and life-altering insights," as one 2021 survey of Norwegian trippers put it.
As a result, using “trip killers” like benzodiazepines or antipsychotics (under trade names like Xanax, Olanzapine and others) to stop a bad trip is more often unofficially recommended on social media sites like Reddit, according to a study published last month in the Emergency Medicine Journal. Yet very few of the hundreds of posts recommending these medications on social media found in the study discussed their potential for harm, according to study author Gregory Yates, of the Manchester Royal Infirmary.
“These harms are dose-dependent, but everyone reacts to drugs differently, and there was a wide range of doses recommended by Reddit users in our study,” Yates told Salon in an email.
When a bad trip occurs, it can cause feelings of panic, losing one’s sanity, or physical illness like heart palpitations that can persist for weeks or even months after the psychedelics wear off, said Matthew Johnson, a Johns Hopkins Medicine professor studying psychedelics.
“There can be lasting harm where someone has a bad trip and then has lasting dissociative symptoms, lasting anxiety symptoms, or even lasting trauma,” Johnson told Salon in a phone interview. But he emphasized, “We’re not seeing that clinically, probably because of all the safeguards, the preparation and follow-up care.”
Professionals administering psychedelics in research or clinical settings have safeguards in place to reduce the risk of a bad trip and are trained to guide users through challenging experiences. Psychedelics are still illegal in most places, though that is changing, and it’s not recommended to try them outside of clinical trials or affiliated centers where these protocols are in place because they carry risks.
Yet, partially because of the promise they’ve shown as a medicine to treat anxiety, depression, eating disorders, post-traumatic stress disorder (PTSD), chronic pain and a host of other conditions, folks desperate for relief have continued to use them outside of these facilities on their own.
So-called "trip killers" have largely not been studied in the context of being used with psychedelics, so best practices are still unknown in this context. While there is some evidence to suggest atypical antipsychotics would chemically reverse the effects of a trip by binding to 5HT2A receptors, benzodiazepines would be used to treat the underlying symptoms of anxiety and dread accompanying a challenging trip. Some other drugs like ketanserin, which also works on the 5HT2A receptors but is not available in the U.S., are being tested for their potential trip reversal effects.
However, these are prescription drugs that should only be administered by a prescriber. Using them independently also carries risks, including not taking the right dosage or missing contraindications that might come up in a physician consultation. And if these drugs are not obtained through a prescription, it implies they were obtained illicitly and could be contaminated with other substances.
“Nowadays, you think it’s a straight-up clonazepam [Klonopin] or Xanax, but it’s a pressed pill that could contain a fentanyl derivative,” Johnson said. “If you just got it from some dude at a festival and they say, ‘take this, that will calm you down,’ there’s a chance that is a lethal dose of a fentanyl derivative.”
Trusting unofficial recommendations online could also be dangerous because they may lack nuance or specification. While certain atypical antipsychotics have been shown to mellow the effects of a strong trip, some evidence shows typical antipsychotics like haloperidol can actually enhance its effects. Meanwhile, benzodiazepines can be deadly if consumed with alcohol or opioids.
“People may take a few drinks to calm down and then they start loading up on benzos, and then they may stop breathing,” Johnson said. “That’s something that definitely wouldn’t happen if [the trip] was being medically supervised.”
Benzodiazepines, and particularly Xanax, can also lead to dependence if used chronically. However, their addiction potential is fairly low, especially if they are used in the situation of a bad trip, said Dr. Mark Willenbring, an addiction psychiatrist at the Expanse clinic in St. Paul, Minnesota. Psychedelics, in general, are not considered addictive and are even being tested to treat addiction. Plus, the negative feelings of a bad trip will likely make users shy away from trying them again any time soon, Willenbring explained.
“If somebody's having a bad trip, the likelihood they're going to repeat [taking a trip killer] is going to be lower,” Willenbring told Salon in a phone interview.
In some emergency medicine settings, benzodiazepines or atypical antipsychotics are included in protocols to treat people who come in with agitation and distress caused by a bad trip. However, this would be a last resort rarely used because reassurance, time and compassionate understanding — that is, providing a safe space to process the trip — usually do the trick, said Dr. Sandeep Nayak, an assistant professor at the Johns Hopkins University School of Medicine who studies psychedelics.
“The sort of bad trip experiences that might prompt somebody to use a trip killer out in the wild happen all the time in the clinical trials,” Nayak told Salon in a phone interview. “It's not like they're always pleasant, but in the clinical trial environment, they're guided to sort of engage with the experience even if it's difficult, and that very often will help them go through it and process it.”
