PCP Makes a Comeback
The “Worst” Drug of the 70’s
Returns
Getting to Know You
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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.
LCSW, LCADC, ACSW, CJC, ICADC
MPAP Candidate, CCS Candidate
www.greenagel.com
greenage@rci.rutgers.edu
frank@collegetreatmentcenter.com
flg2@aol.com
Getting to Know Me…
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Long suffering Viking fan
4th generation English teacher
Quit coffee for 5 weeks….
Vs. Groundhogs
Tell ‘Em What You’re Going to Tell’Em
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PCP Stories
Denial
Substance Abuse Spectrum
Family Systems Theory
Drugs Mistaken for PCP
– Bath Salts, Molly & DXM
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The Brain
History of PCP
Physical Effects of PCP
Psychological Effects of PCP
Mezzo and Macro level strategies
PCP STORIES…
http://feature.rollingstone.com/feature/the-gangster-in-thehuddle
Denial –> Blaming
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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 –> Minimizing
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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 …..
Denial –> Claiming Invincibility
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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
Denial –> Family Denial
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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
Substance Abuse Spectrum
I-----------------I-------------------I---------------------
Non-use
use
No role failure
abuse
1 of 4
1 year
- role failure
- mv/machinery
- recurring legal issues
- confrontation x2
dependence
3 of 7
life-time
- role failure
- tolerance
- withdrawal
- 30 hrs/wk
- previous attempts to quit
- more use/time than
planned
- phys/psych problems
caused by or made worse
Misdiagnoses
• Substance Abuse, Substance Dependence &
Early Recovery often look like
– Depression
– Anxiety
– ADHD
– Bi-polar disorder
Family Systems Theory
Drugs Mistaken for PCP
• Synthetic Speed - Bath Salts
• Molly
• DXM
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
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
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
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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….
Molly
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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?
DXM
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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
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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
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
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
PCP
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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
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
PCP - Onset
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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
PCP – The High
• Euphoria, relaxation, hallucinations,
dissociation from mind, body and outside
world, effects of drunkenness, cyclical
behavior between periods of calm and rage
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
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
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
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
Anti-Drug Ad from Washington DC,
1985
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.
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
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
PCP – Usage Trends
PCP – Usage Trends
PCP – Usage Trends
PCP – Usage Trends
PCP – Usage Trends
PCP – Usage Trends
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
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.
PCP - Education
• generational forgetting
• Target tweens and teens
– Tobacco and marijuana use
– Harm reduction
• 25 – 34 year olds too
• SAMHSA report
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
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.
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
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
Reasons To Go To Therapy
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Concerns About Future
Romantic Relationships
Sexual Identity
Grief/Loss
Academic Stress
Interpersonal Stress
Adjusting to Life Changes
Alcohol & Drug Abuse
Mental Health Disorder
Helping People with
Substance Disorders
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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
Macro-Level Suggestions
• Drug testing for everyone prescribed RX opiates and
stimulants
• Education programs for tweens, teens, parents and
teachers
• Peer education of high school and college students
• Train future professionals (law, nursing, pharmacy,
social work, student affairs & medicine)
• More Recovery Support Programs.
Macro-Level Suggestions
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911 Good Samaritan Bill
RX Drug Turn-In Day
2 – 4 a year
RX Drug Drop Box
One in each town
Stronger prescription monitoring programs
More professional access to PMP’s
More and cheaper opiate maintenance and
withdrawal programs
• Increase training of professionals who can prescribe
and distribute drugs
• Reform insurance laws
• More TX program in jails & prisons
My English Teacher Thing…
(1 slide to go…)
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Narrative of the Life of Frederick Douglass
A Long Way Down
An American’s Resurrection
New Jack
Drown & The Brief Wondrous Life of Oscar
Wao