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Phencyclidine (PCP) Abuse: an Appraisal

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Phencyclidine (PCP) Abuse: an Appraisal PCPPhencyclidine Abuse: An Appraisal U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration Phencyclidine (PCP) Abuse: An Appraisal Editors: Robert C. Petersen, Ph.D. Richard C. Stillman, M.D. NIDA Research Monograph 21 August 1978 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse 5600 Fishers Lane Rockville, Maryland 20857 NIDA Research Monographs are prepared by the research divisions of the National Institute on Drug Abuse and published by its Office of Science. The primary objective of the series is to provide critical reviews of research problem areas and techniques, the content of state-of-the-art conferences, and integra- tive research reviews Its dual publication emphasis is rapid and targeted dissem- ination to the scientific and professional community. Editorial Advisors Martin W Adler, Ph.D. Temple University, School of Medicine Philadelphia, Pennsylvania Sydney Archer, Ph.D. Rensselaer Polytechnic Institute Troy, New York Richard E. Belleville, Ph.D. NB Associates, Health Sciences Rockville, Maryland Gilbert J. Botvin, Ph.D. Cornell University Medical College New York, New York Joseph V. Brady, Ph.D. The Johns Hopkins University School of Medicine Baltimore, Maryland Theodore J. Cicero, Ph.D. Washington University School of Medicine St. Louis, Missouri Sidney Cohen, M.D. Los Angeles, California Reese T. Jones, M.D. Langley Porter Neuropsychiatric Institute San Francisco, California Denise Kandel, Ph.D. College of Physicians and Surgeons of Columbia University New York, New York Herbert Kleber, M.D. Yale University School of Medicine New Haven, Connecticut NIDA Research Monograph Series William Pollin, M.D. DIRECTOR, NIDA Jack Durell, M.D. ASSOCIATE DIRECTOR FOR SCIENCE, NIDA EDITOR-IN-CHIEF Eleanor W. Waldrop MANAGING EDITOR Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857 Phencyclidine (PCP) Abuse: An Appraisal ACKNOWLEDGMENT This monograph is based upon papers presented at a conference which took place on February 27-28, 1978, at the Asilomar Confer- ence Center, Pacific Grove, California. The conference was conducted and reported by PLOG Research, Inc. , Reseda, California under NIDA contract 271-77-3413. The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this material is prohibited without specific permission of the copyright holders. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the Institute or the authors Citation of the source is appreciated. The U.S. Government does not endorse or favor any specific commercial product or commodity . Trade or proprietary names appearing in this publication arc used only because they are considered essential in the context of the studies reported herein. Library of Congress catalog card number 78-600095 DHHS publication number (ADM) 85-728 Printed 1978 Reprinted 1983, 1985 NIDA Research Monographs are indexed in the Index Medicus. They are selectively included in the coverage of American Statistics Index, BioSciences Information Service, Chemical Abstracts, Current Contents , Psychological Abstracts , and Psychopharmacology Abstracts iv Foreword Phencyclidine (PCP), or “angel dust” as it is more commonly known to drug users, posed until recently a relatively modest problem. While some illicit use occurred as early as the mid ‘6Os, the drug’s initially poor street reputation seemed to make it decidedly unlikely that it would ever become popular as a drug of choice. More recent events have made it abundantly clear that our initial optimism was poorly founded. A change in mode of use from oral ingestion to smoking or snorting, which may enable the user to better control aversive consequences of use, together with the ease with which PCP can be synthesized, have markedly changed the phencyclidine abuse picture. In one year (from 1976 to 1977) the number who had used phencyclidine as measured by NIDA’s National Drug Use Surveys nearly doubled in the 12 to 17 year age group. Among young adults between 18 and 25, the number of PCP users increased nearly fifty percent in that same year. Although the level of use detected was still modest, there is good reason to believe that the standardized indicators of the extent of PCP use and of its adverse consequences represent significant under- estimates of the seriousness of the problem. Clinical reports have also indicated that phencyclidine use can precipitate violent acting out and seriously self-destructive behavior as well as psychotic thinking and behavior. Because of the relatively recent emergence of phencyclidine abuse as a problem of widespread proportions, our knowledge remains fragmen- tary. If the dimensions of the problem continue to be in doubt, still more remains to be learned about the implications of use, especially on a chronic basis. This volume represents an attempt to bring together our present knowledge. It is based on a small working conference of researchers and clinicians with extensive PCP experi- ence which was held in late February of this year (1978). We hope that it proves to be a useful compendium of information on the prob- lem as well as a stimulus to further work to answer some of the critical questions with which we are confronted. In addition, because phencyclidine may well prove to be prototypic of a range of easily synthesized psychoactive drugs susceptible to abuse, we hope it will stimulate thinking about better ways both to anticipate newly emerging drug problems and to cope with them. The Editors v Contents Foreword The Editors . v Chapter 1 Phencyclidine: An Overview Robert C. Petersen and Richard C. Stillman . 1 Chapter 2 Neurobiology of Phencyclidine--An Update Edward F. Domino . 18 Chapter 3 Neurochemical Pharmacology of Phencyclidine Kenneth M. Johnson . 44 Chapter 4 The Behavioral Effects of Phencyclidine in Animals Robert L. Ealster and Larry D. Chait . 53 Chapter 5 Phencyclidine Use Among Youth: History, Epidemiology, and Acute and Chronic Intoxication Steven E. Lerner and R. Stanley Burns . 66 Chapter 6 Phencyclidine and Ketamine Intoxication: A Study of Four Populations of Recreational Users Ronald K. Siegel . 119 Chapter 7 Epidemiology of Multiple Drug Use with Special Reference to Phencyclidine J. Fred E. Shick . 148 Chapter 8 Patterns of Phencyclidine Use David B. Graeven . 176 Chapter 9 The Psychiatric Aspects of Chronic Phencyclidine Use: A Study of Chronic PCP Users Michael A. Fauman and Beverly J. Fauman . 183 vi Chapter 10 Phenomenological Aspects of Phencyclidine Abuse Among Ethnic Groups in Hawaii Anthony J. Marsella and Russell D. Hicks . 201 Chapter 11 The Pharmacokinetics of Phencyclidine in Overdosage and Its Treatment Alan K. Cone, Regine Aronow, and Joseph N. Miceli . 210 Chapter 12 Clinical Observations During Phencyclidine Intoxication and Treatment Based on Ion-Trapping Regine Aronow, Joseph N. Miceli, and Alan K. Done . 218 Chapter 13 The Diagnosis and Treatment of the PCP Abuse Syndrome David E. Smith, Donald R. Wesson, Millicent E. Buxton, Richard Seymour, and Honey M. Kramer . 229 Chapter 14 The Phencyclidine Psychosis: Phenomenology and Treatment Paul V. Luisada . 241 Chapter 15 Long Term Treatment of Adolescent PCP Abusers Gerald G. DeAngelis and Elliott Goldstein . 254 Chapter 16 Phencyclidine, Criminal Behavior, and the Defense of Diminished Capacity Ronald K. Siegel . 272 Chapter 17 Control of Drug Self-Administration: The Role of Aversive Consequences Nancy K. Mello . 289 Conference Participants . 309 List of Monographs . 311 vii Chapter 1 Phencyclidine: An Overview Robert C. Petersen, Ph.D., and Richard C. Stillman, M.D. Although phencyclidine was first abused in oral form over a decade ago, it is only in recent years as a smoked or snorted drug that it has become a more serious problem involving significant numbers of users. This overview is intended to review and summarize what is presently known about the drug with special emphasis on the con- tributions of the authors of this volume. By providing a relatively brief integrated view of our current knowledge we hope to convey the limitations of that knowledge and to encourage others to en- large our presently modest understanding of the implications of phencyclidine abuse. THE MATERIAL Phencyclidine,or PCP, one of the group of arylcyclohexylamines, is in pharmaceutically pure form a white powder which readily dissolves in water. In “street” form PCP is often adulterated and quite often misrepresented as a variety of other drugs. It is highly variable in appearance, being sold in liquid, powder, and tablet form, the latter two in many colors. As a powder or liquid, it is often placed on parsley or on other leaf mixtures to be smoked as cigarettes (joints). When misrepresented, PCP is most commonly sold as THC (the principal psychoactive ingredient in marihuana, which in reality is not available on the street). But phencyclidine has also been sold as cannabinol (another marihuana constituent), mescaline, psylocybin, LSD, and even as amphetamine or cocaine. Because of the variability in street names and its frequent misrepresentation, the casual user may be unaware of what he or she has ingested or may be mistaken about its true identity. Some of the street names for phencyclidine
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