What is Phencyclidine Use Disorder?
Phencyclidine use disorder is a diagnostic label that appeared for the first time in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, also known as DSM-5. The disorder is given to people who are experiencing problems as a result of using a group of substances called phencyclidines, or substances that are pharmacologically similar to them, such as ketamine.
Phencyclidines are commonly known as PCP or Angel Dust. Although less popular in recent decades, PCP seems to be making a comeback. Marijuana cigarettes laced with PCP, known as “fry,” have been identified as a modern form of PCP, which is considered harmful, due to their rapidly addictive characteristics and effects which include increased risk of violence and hallucinations.
To receive a diagnosis of a phencyclidine use disorder, the person must have been taking one of this group of drugs, and as a result, experienced at least two of the following problems within a 12-month period:
- Taking more phencyclidine or a similarly acting drug than was intended.
- Trying unsuccessfully to cut back or control the use of phencyclidine or a similarly acting drug.
- Spending a great deal of time obtaining, using, and recovering from the effects of phencyclidine or a similarly acting drug.
- Experiencing cravings to take more phencyclidine or a similarly acting drug.
- Failing to carry out normal role expectations at school, work or home, such as repeated absences from school or work, or neglecting the care of home and family.
- Continuing to use phencyclidine or a similarly acting drug, even in the face of ongoing social or interpersonal problems as a result.
- Dropping out of other important activities, whether social, occupational, or recreational.
- Taking phencyclidine or a similarly acting drug in situations that are dangerous to self or others.
- Using phencyclidine or a similarly acting drug with the knowledge that it is causing or physical or psychological problems, or making existing physical or psychological problems worse.
- Tolerance for phencyclidine or a similarly acting drug.
While addiction is often the first concern when we think of substance use disorders, many other dangers outweigh addiction. Withdrawal does not usually occur, and while tolerance and habitual use can certainly be an issue for users of phencyclidine and similarly acting drugs, such as ketamine, the risks of physical harm and severe mental illness are higher than for many other drugs.
The drug is at best dissociative, producing feelings of being separated from the body, which can lead users to wander without proper attention to hazards such as traffic and heights. In more serious cases, it can lead to a phenomenon known as a k-hole, experiencing difficulty moving, putting the user in a physically vulnerable state, or even inducing a coma. On the mental health side, the hallucinogenic effects of the drug can continue for days or weeks, putting the individual into a psychotic state.
Dissociative drugs are also sometimes used to facilitate sexual abuse because the victim may be unable to move and may not even be aware that they are being abused. However, the psychological aftermath of sexual abuse and rape are just as traumatic, and can still lead to criminal convictions for the perpetrators and long-term psychological problems for the victims.
As date rape is a real risk of drug-taking, especially among vulnerable young women, never take drugs under the encouragement of someone who may be a potential date rapist, no matter how charming they may appear. Be cautious about accepting drinks that you have not prepared or observed being prepared by a professional bartender. There have been many cases of date rape after a dissociative drug has been used to spike a drink given to an unsuspecting victim.
If you believe you have been raped under the influence of a drug, even if your memory of the incident is not clear, it is important to report it to the police as soon as possible. This is not only doing justice to yourself but also to other potential victims who may be abused by serial date rapists, who go unreported.
Effects on Your Brain
Phencyclidine is a mind-altering drug. This means it acts on your brain (central nervous system) and changes your mood, behavior, and the way you relate to the world around you. Scientists think it blocks the normal actions of certain brain chemicals.
PCP is in a class of drugs called hallucinogens. These are substances that cause hallucinations. These are things that you see, hear, or feel while awake that appear to be real, but instead have been created by the mind.
PCP is also known as a dissociative drug. It causes you to feel separated from your body and surroundings. Using Phencyclidine may make you feel:
- You are floating and disconnected from reality.
- Joy (euphoria, or “rush”) and less inhibition, similar to being drunk on alcohol.
- Your sense of thinking is extremely clear, and that you have superhuman strength and aren’t afraid of anything.
How fast you feel the effects of PCP depends on how you use it:
- Shooting up. Through a vein, PCP’s effects start within 2 to 5 minutes.
- Smoked. The effects begin within 2 to 5 minutes, peaking at 15 to 30 minutes.
- Swallowed. In pill form or mixed with food or drinks, PCP’s effects usually start within 30 minutes. The effects tend to peak in about 2 to 5 hours.
Signs of Phencyclidine Use Disorder
Angel dust can greatly impact the brain’s chemical responses. Levels of chemicals or neurotransmitters like dopamine and serotonin can be affected. These chemicals play a role in mood, behavior, and overall mental health, all of which can be inhibited by abusing drugs like PCP.
A person who’s addicted to angel dust may exhibit mental and behavioral symptoms like:
- Flashbacks of a “trip” or a time they were high
- Ignoring or neglecting responsibilities
- Changes in friend groups
- Spending a large amount of time and money on PCP
- Lack of or poor hygiene
- Mood swings
- Frequent anxiety
- Loss of sensation or balance
- Stiff muscles
- Memory loss
- Numbness in the extremities
- Low blood pressure
- Irregular heartbeat
PCP can also cause coma, seizures, and damage to the skeletal system. A long-term PCP drug addiction often results in various health problems related to mental illness and decreased muscle health. If you recognize angel dust addictive behavior in yourself or a loved one, do not wait to get help.
Diagnosing Phencyclidine intoxication
According to the scientific piece ‘Phencyclidine Intoxication and Adverse Effects: A Clinical and Pharmacological Review of an Illicit Drug’, published by the National Library of Medicine, phencyclidine intoxication is a diagnosis that must be suspected clinically so that the appropriate tests are ordered for confirmation. The differential diagnosis of the clinical picture created by PCP includes other intoxications like schizophrenia, intracranial pathology, hypoxia, hypoglycemia, hyponatremia, sepsis, meningitis and encephalitis, thyroid storm, and neuroleptic malignant syndrome.
PCP intoxication shares many features with overdoses of cocaine, amphetamines, anticholinergic agents, hallucinogens, and withdrawal from benzodiazepines. Therefore, a qualitative urine toxicologic screen has become a mandatory standard of care for any patient, infant or adult, with the altered mental status of unknown etiology.
The simplest way to confirm suspected PCP intoxication is via qualitative chromatographic or immunologic urine drug screen since 9% of the active drug is excreted directly by the kidneys. The urine is usually positive for 2–4 days after PCP use, but after chronic exposure, the test results can be positive for over a week.
Phencyclidine intoxication treatment
The management of PCP intoxication begins just as any other intoxication would. First, the client’s airway, breathing, circulation, thermoregulation, and neurologic status must be stabilized. The client should then be restrained and sedated if necessary to prevent self-inflicted injury, which is the most common cause of morbidity and mortality in these clients. Benzodiazepines are recommended in patients without psychosis, as antipsychotics can amplify PCP-induced hyperthermia, dystonic as well as anticholinergic reactions, and lower the seizure threshold. However, haloperidol has been described as a useful treatment for PCP-induced psychosis provided the patient is not hyperthermic.
Due to their more favorable side effect profile, atypical antipsychotics like olanzapine or ziprasidone would be a better choice than haloperidol when treating PCP-induced agitation and psychosis. Diphenhydramine 50mg or 1mg/kg can be used to treat PCP-induced (or haloperidol-induced) dystonic symptoms but should be administered after a urine sample is obtained for toxicologic screening, since it may cause the specimen to test falsely positive for PCP.
Treatment for Phencyclidine Use Disorder
The treatment of Phencyclidine Use Disorder relies in part on pharmacological and psychotherapeutic approaches. When an individual presents with the symptoms of delirium, seizures, agitation, or even hypothermia; these are the symptoms that must be addressed medically before any long-term treatment plan can be developed. The toxicity of this drug is extreme, and vital signs must be attended to. Dependent upon how the drug was ingested will also determine the type of medical response required. Consider this presentation a medical emergency and life-threatening.
Once the patient is through the initial phase of detoxification then psychiatric and addiction care is indicated. Depending on the ongoing severity of the symptoms; the patient may require transfer to a psychiatric unit if the psychosis is not as yet under adequate control. He or she should be evaluated for chemical dependency and referred for proper treatment. This type of substance abuse is usually indicative of underlying comorbidity such as mood or movement disorders (Brust, 2010); and the use of tricyclic antidepressants such as desipramine may be recommended for withdrawal when dependence is present.
The various types of common therapeutic responses to other forms of substance abuse may be indicated in this scenario as well. It is suggested that perhaps more than one mode of therapy will be beneficial, and there may be a greater response to different aspects of the various behavioral therapies that address the emotional and psychological needs of the user. These could include Dialectical Behavioral Therapy (DBT) for stress management; Cognitive Behavioral Therapy (CBT) directed at maladaptive thinking patterns; Interpersonal Therapy (IPT) that focuses on interpersonal relations and social roles and supportive 12 step and similar programs designed to combat and overcome addition.
Reclaim Your Life From Phencyclidine Use Disorder
Phencyclidine Use Disorder is a serious disease that should not be taken lightly. We Level Up California can provide you, or someone you love, the tools to recover from addiction and manage withdrawal with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
 Bey, T., & Patel, A. (2007). Phencyclidine intoxication and adverse effects: a clinical and pharmacological review of an illicit drug. The California Journal of emergency medicine, 8(1), 9–14. (https://www.ncbi.nlm.nih.gov)