PCP “Angel Dust”
- Common Names: Embalming fluid, Hog, Rocket Fuel, Sherms, (Mixed with marijuana: Zoom)
- Forms: white or colored powder, tablet, or capsule; clear liquid
- Ways Taken: Injected, snorted, swallowed, smoked (powder added to mint, parsley, oregano, or marijuana)
PCP or Phencyclidine and ketamine are both considered club/party drugs that work on the glutamate system as antagonists of NMDA in the calcium channels. It’s a mouthful but so are the dissociated and hallucinations. PCP has more unpredictable severe reactions, which is why it’s no longer used in anesthetics in humans.
Short Term Effects: delusions, hallucinations, paranoia, problems thinking, a sense of distance from one’s environment, anxiety.
- Low Doses: slight increase in breathing rate; increased blood pressure and heart rate; shallow breathing; face redness and sweating; numbness of the hands or feet; problems with movement.
- High Doses/Overdose: nausea; vomiting; flicking up and down of the eyes; drooling; loss of balance; dizziness; violence; seizures, coma, and death. Stahl included extremely high temperature and muscle breakdown (rhabdomyolysis)
PCP is in the realm of hallucinogens like LSD, shrooms, marijuana but what makes PCP stands apart is the agitation, violent behavior, irrationality (very sensitivity to sounds/synthesis). Treatment is primarily supportive, ABC’s, check labs/organs, reducing social interactions, treat with BZD if excited or agitated, nothing is FDA approved. Some of my previous books report administering ascorbic acid/Vitamin C but the CARLAT and Stahl doesn’t mention these and it’s actually discouraged due to the risk of rhabdomyolysis.
General Clinical Observations
- PCP (Phencyclidine) is not commonly encountered nowadays, though it was more popular in the 1980s.
- Users often don’t know exactly what they’ve taken unless a drug screen is performed.
- PCP effects differ significantly from other club drugs (e.g., LSD, mescaline, marijuana) and tend to cause severe agitation and potential violence.
A Simple Case Study:
A young adult suspected of using PCP presented to the ED after a rave
- Priority includes ensuring staff safety due to the patient’s extreme agitation and violent strength.
- Symptoms raised concerns about a possible brain bleed, but sedation options were limited because this would complicate diagnostics like a CT scan and protecting the airway.
- Despite multiple sedative attempts (e.g., B52 injections, restraints), the patient remained uncontrollably strong.
- Ketamine was ultimately used, rendering the patient unconscious (requiring bagging for breathing) but allowed the CT scan to be performed.
- The patient later woke up calm, pleasant, and had no memory of the incident, leading to discharge without further complications.
Contrasts with Other Drugs:
- Unlike PCP, other “party drugs” like LSD and marijuana typically involve managing psychological or emotional issues rather than the physical violence like with PCP.
- PCP users often require hospitalization and may take hours or days to stabilize and reorientate the person to reality, if not having an admission to the ICU.
In Conclusion in Outpatient Settings:
- PCP use is sometimes reported as a “blur of time” by patients, making detailed histories unreliable or can include additional substances.
- Emphasis is placed on stability and maintaining airway and safety.
CARLAT actually described it the best, “… is like taking a sedative, an amphetamine, and a hallucinogen all at once, people feel drunk, accelerated, and dissociated…and is an anesthetic…users also tend to be pain-insensitive” and compared them to The Terminator movie lol. CARLAT and Stahl don’t have anything in particular for treatment but mainly address supporting the mood and stability.
- Long-Term Effects: memory loss, problems with speech and thinking, loss of appetite, anxiety.
-Drug Abuse
