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 rhabdo.
OUTPATIENT with PCP
I don’t have many patients currently dealing with this issue. Most of my older patients expressed how it was popular in the 80s. The issue with the club drugs, people normally don’t know what exactly that they took unless there was a drug screen. So I’m going to discuss a quick case study of an incident in the ED.
I had a young-adult patient in the ED who was suspected of doing PCP. It was a huge rave going on downtown and you just know the profile. The drug screen was not a priority, our safety was… These patients can be unintentionally VIOLENT.
It’s not directed towards anything in particular (it’s how we differentiate it from other drugs) but the agitation can be so extreme, everyone was worried about a brain bleed. However, with multiple B52’s, leather restraints, and some darkroom isolation, he was still so strong that he was rocking the stretcher. FYI with ruling out brain bleeds, you don’t want to sedate or wait till the pupils start changing so we had limited options but clearly, we were desperate.
The ONLY thing that help was Ketamine and he was out cold (we had to bag him), but finally was able to get a CT scan. Towards the end of the shift, he was so calm, pleasant, and was d/c with no issues or memory of anything!
I gave this story because this is a complete contrast with patients on the other “party drugs” such as LSD, mescaline, marijuana where you try to offer psychological and emotional support. With PCP, they possibly need to be hospitalized and can take hours if not days to be stabilized.
PCP might not be popular, but you know some people will just about dabble with everything. When they come to your office it seems like the patient describes it as a blur of time. Therefore, when I get patients that said they did it a couple of days ago, I sort of ignore it (mainly because they don’t remember the effects) and focus on discouraging these activities. It’s never good to take something that causes a lapse of memory or has the potential to be very dangerous, it’s not the same as dissociation with the other drugs where the body can relax.
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
