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PCP Makes a Comeback

PCP Makes a Comeback. The “Worst” Drug of the 70’s Returns. Getting to Know You. Who are you? Where do you live and work? How long in your current job? Most difficult aspect of job? Best aspect of job? Goal for this training Take Pre-Test. Frank L. Greenagel Jr.

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PCP Makes a Comeback

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  1. PCP Makes a Comeback The “Worst” Drug of the 70’s Returns

  2. Getting to Know You • Who are you? • Where do you live and work? • How long in your current job? • Most difficult aspect of job? • Best aspect of job? • Goal for this training • Take Pre-Test

  3. Frank L. Greenagel Jr. LCSW, LCADC, ACSW, CJC, ICADC MPAP Candidate, CCS Candidate www.greenagel.com greenage@rci.rutgers.edu frank@collegetreatmentcenter.com flg2@aol.com

  4. Getting to Know Me… • Long suffering Viking fan • 4th generation English teacher • Quit coffee for 5 weeks…. • Vs. Groundhogs

  5. Tell ‘Em What You’re Going to Tell’Em • PCP Stories • Denial • Substance Abuse Spectrum • Family Systems Theory • Drugs Mistaken for PCP • Bath Salts, Molly & DXM • The Brain • History of PCP • Physical Effects of PCP • Psychological Effects of PCP • Mezzo and Macro level strategies

  6. http://feature.rollingstone.com/feature/the-gangster-in-the-huddlehttp://feature.rollingstone.com/feature/the-gangster-in-the-huddle PCP Stories…

  7. My parents are always on my case School/work stress me out My girlfriend is mean The drugs weren’t mine The cops are assholes The teachers at my school suck I steal because my parents don’t give me enough money Denial –> Blaming

  8. Denial –> Minimizing • It’s not like I smoke crack • I don’t use needles • I don’t drink during the week • I’m not as bad as …..

  9. Denial –> Claiming Invincibility • I’ll never get caught • I’m not stupid • I won’t overdose • I’m a super-star athlete • I’ll never use hard drugs

  10. Denial –> Family Denial • What will neighbors think? • My son doesn’t have a problem • It’s not my problem • It’s her friends • Boys will be boys • It’s the school

  11. I-----------------I-------------------I---------------------I-----------------I-------------------I--------------------- Non-use use abuse dependence 1 of 4 3 of 7 1 year life-time No role failure - role failure - role failure - mv/machinery - tolerance - recurring legal issues - withdrawal - confrontation x2 - 30 hrs/wk - previous attempts to quit - more use/time than planned - phys/psych problems caused by or made worse Substance Abuse Spectrum

  12. Misdiagnoses • Substance Abuse, Substance Dependence & Early Recovery often look like • Depression • Anxiety • ADHD • Bi-polar disorder

  13. Family Systems Theory

  14. Drugs Mistaken for PCP Synthetic Speed - Bath Salts Molly DXM

  15. Synthetic Speed • sold as “Bath Salts” • designer stimulant out of Germany • illegal in NJ: 4/28/11 • chemical components banned in NJ: 8/23/11 • Banned by law signed by President Obama in July, 2012 • schedule I drug • use WAY down since ban

  16. Synthetic Speed • Methylenedioxypyrovalerone (MDPV) • Can be smoked, snorted or injected • Aura, Ivory Wave, Vanilla Sky, Ivory Soft, Loco-motion are some common names • 3 – 20 mg dose • Lasts 3-4 hours • Racing thoughts, hallucinations, can induce panic attacks • High body temperature, high blood pressure, high heart rate, kidney problems

  17. Molly • Schedule I drug in 1988 • Less stigma than ecstasy, because it is said that is “pure, uncut MDMA” • “they are only fooling themselves” Dr. John Halpern, NYT, 6/23/13 • Stimulant & hallucinogen • Sold as “Molly’s Plant Food” • Songs by: Lil Wayne, Kanye West, Miley Cyrus, Rick Ross, • Sold online • $20 to $50 a dose • Bluelight  MDMA drug info & forum • College, suburban and club drug. Late 2012, moved to the inner cities….

  18. Molly • 30 minute onset, lasts several hours • Euphoria, psychedelia, stimulation, energy, desire • Massive dopamine & serontonin rush • Short term effects: insomnia, aches, nausea, stiff jaw, fatigue, anxiety, teeth grinding, dehydration, irritability, gi problems • Long term & more dangerous: depression, hypothermia, seizures, high blood pressure • “Suicidal Tuesdays” • As treatment for soldiers with PTSD?

  19. DXM • Dextromethorphan • Cough suppressant • 1950 patent; race between Swiss and USA • OTC • Mucinex DM, Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, TheraFlu • Can buy in bulk powder online

  20. DXM • Similar effects to dissociative anaesthetics • Euphoria, hallucinations • At normal doses: • body rash , Nausea, Vomiting, Drowsiness • Dizziness, Constipation, Diarrhea, Sedation • Confusion, Nervousness, Closed-eye hallucination

  21. DXM • At dosages 3 to 10 times the recommended therapeutic dose: • Increased energy, Increased confidence • Nausea, Restlessness, Insomnia • Racing thoughts and/or speech, perception of increased strength, big pupils, glazed eyes

  22. DXM • At dosages 15 to 75 times the recommended therapeutic dose: • Hallucinations, dissociation, vomiting, blurred vision, bloodshot eyes, dilated pupils, sweating, fever, hypertension • shallow respiration, diarrhea, muscle spasms • Sedation, euphoria, blackouts, sight loss • inability to focus eyes, skin rash

  23. PCP • Phencyclidine • 1950’s • Schedule II drug • dissociative anesthetic • keep a patient awake but unresponsive to pain • Stopped being used in humans in 1965 • veterinary medicine

  24. PCP • crystal, capsule, tablet, powder and liquid • Eat, smoke, snort or inject (rare) • Stimulant properties; Hallucinigen properties; Depressant properties • Street names: Mess, Angel Dust, TH, Peace Pill, Crazy Eddie, Hog, Rocket Fuel, Wet, Embalming Fluid, Killer Weed, Killer Grass, Animal Tranquilizer, Dips, Dust, Elephant, Tranq, Water

  25. PCP - Onset • very rapid when smoked or injected • 1-5 minutes when snorted • 30 minutes when orally ingested • gradual decline of major effects over 4-6 hours • a return to normal may take up to between 1 to 4 days

  26. PCP – The High • Euphoria, relaxation, hallucinations, dissociation from mind, body and outside world, effects of drunkenness, cyclical behavior between periods of calm and rage

  27. PCP - Dosage • low to moderate doses: 3-5 mgs, 5-10 mgs; can cause shallow breathing, flushing, profuse sweating, generalized numbness of the extremities and poor muscular coordination

  28. PCP - Dosage • High doses: 10+ mgs; hallucinations, seizures, coma, and death (though death more often results from accidental injury or suicide during PCP intoxication) • Nausea, vomiting, blurred vision, flicking up and down of the eyes, drooling, loss of balance, and dizziness. • delusions, paranoia, disordered thinking, and a sensation of distance; garbled speech

  29. PCP – Physical Effects • trachycardia, hypertension, respiratory depression, muscle rigidity, increased reflexes, and seizures • Withdrawal symptoms include diarrhea, chills, tremors • has sedative effects, and interactions with cns depressants can lead to coma or accidental overdose due to potentiating effect

  30. PCP – Effects on the Brain • PCP inhibits the reuptake of dopamine, norepinephrine and serotonin • psychological dependence • Short periods: physical distress, lack of energy, and depression • long periods: report memory loss, difficulties with speech & thinking, and depression • up to a year after cessation • mood disorders also have been reported

  31. Anti-Drug Ad from Washington DC, 1985

  32. PCP - Detection • Hilarity, hallucinations, excitable, wild-eyed, dilated pupils, very strong physically, insensitive to pain, completely confused, flushed, sweat profusely • Elimination of PCP in 72 hours urine ranges from 4 to 30% • Approximately 97% of a dose is excreted in 10 days • Hair follicle cut off is 6 months given the testing procedures.

  33. PCP - Detection • Both urine drug screens and hair follicle tests are notoriously bad at indicating long term or chronic use. Neither give reliable indications of the frequency or level of consumption

  34. PCP – Treatment • No antidote • Many PCP users are brought to emergency rooms because of PCP’s unpleasant psychological effects or because of overdoses. In a hospital or detention setting, they often become violent or suicidal, and are very dangerous to themselves and to others. They should be kept in a calm setting and should not be left alone

  35. PCP – Usage Trends

  36. PCP – Usage Trends

  37. PCP – Usage Trends

  38. PCP – Usage Trends

  39. PCP – Usage Trends

  40. PCP – Usage Trends

  41. PCP – Usage Trends • PCP-related emergency room visits rose 400 percent between 2005 and 2011, and actually doubled from 2009 to 2011, from 36,719 to 75,538

  42. PCP – Usage Trends • The most significant increase by age was demonstrated among adults aged 25 to 34, with a 518 percent increase from 3,643 visits to 14,175. In 2011 males comprised 69 percent of the 75,538 ER room visits and 45 percent of the visits were by adults between the ages of 25 to 34. PCP was combined with other drugs 72 percent of the time: with one other substance in 37 percent of ER visits, two other substances in 18 percent and 3 or more substances another 18 percent.

  43. PCP - Education • generational forgetting • Target tweens and teens • Tobacco and marijuana use • Harm reduction • 25 – 34 year olds too • SAMHSA report

  44. PCP – Community Plan • policymakers access the reports to ensure that adequate substance abuse treatment facilities serve their communities • law enforcement personnel can use the data to determine where their efforts need to be focused and learn which substances may be most dangerous in their area of service

  45. PCP – Community Plan • clinical settings to develop useful screening tools for patients in order to detect the use of other substances or the presence of additional mental health concerns • emergency department personnel increase training to recognize the signs and symptoms of PCP use and the recommendations for treatment.

  46. Quality Programming for Middle & High Schools get rid of DARE & Scared Straight teach students, teachers & parents about denial strong RX drug, THC and PCP drug education peer education is very impactful be very wary of who you select to be a peer leader reduce stigma associated with therapy

  47. Recovery High Schools 30+ in America 85% of students returning to high school from tx relapse within 30 days HOPE Academy in Indianapolis teachers, staff & administrators all understand addiction & recovery New Day Charter HS rejected in NJ Ray Lesniak HS in Union, NJ cost effective

  48. Reasons To Go To Therapy • Concerns About Future • Romantic Relationships • Sexual Identity • Grief/Loss • Academic Stress • Interpersonal Stress • Adjusting to Life Changes • Alcohol & Drug Abuse • Mental Health Disorder

  49. Helping People with Substance Disorders • Ask about alcohol & drug use (repeatedly) • Convey positive attitude about recovery • Get more training • Don’t be offended when they lie • Consult and/or refer to experts

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