Phencyclidine (PCP) is a hallucinogenic substance that was first created for medical use and has since become an illicitly manufactured drug of abuse. PCP intoxication and overdose can cause serious symptoms, including psychological, behavioral, and physical complications. In overdose, PCP can be particularly dangerous and may cause fatality.
- Phencyclidine (PCP) is a hallucinogenic substance that can result in serious health complications.
- PCP intoxication and overdose can cause dangerous effects, although intoxication is less likely to be life-threatening.
- Urgent medical attention should be sought in the event of PCP overdose.
Phencyclidine (PCP) and how it affects the brain
Phencyclidine, known as PCP, is commonly used as a recreational drug. It was first created as an anesthetic for use in surgical procedures, but was discontinued in the late 1960s due to concerns about post-operative effects, including hallucinations. Following this, it has since been manufactured and sold illicitly. [1]
PCP works as both a stimulant and a depressant of the central nervous system (CNS). It is an antagonist of the NMDA receptor, which can cause sedation, pain relief, cognitive impairments, and psychosis. It also binds to acetylcholine and GABA receptors, further adding to sedating effects, airway constriction, and reduced heart rate. [1][2]
PCP also blocks dopamine and norepinephrine reuptake, leading to increased levels in the brain. This can cause paradoxical effects, such as significant increases in blood pressure and heart rate, agitation, and bronchodilation. The effects of PCP can vary depending on the dose and individual responses to the substance. [1][2]
Signs and symptoms of PCP intoxication
PCP intoxication can impact mood, behavior, and physiological functions. Signs and symptoms of intoxication may vary depending on the dose and could overlap with overdose symptoms.
Some of the signs and symptoms of PCP intoxication in low to moderate doses of up to 5-10 mg include: [2][3]
- Hallucinations
- Extreme agitation, paranoia, or aggression
- Impaired judgment and decision-making abilities
- Dissociation, feeling separate or disconnected from the body and reality
- Euphoria
- Superhuman strength
- Lack of inhibition and fear
- Numbness
- Impaired coordination
- Nystagmus
- Increases in heart rate, breathing, and body temperature
- Reduced ability to feel pain
- Changes in mood, such as dysphoria or anxiety
Higher doses, between 5-25 mg, can cause more severe effects, particularly psychological and behavioral effects, such as violence, suicidal thoughts, and psychotic symptoms, including hallucinations, paranoia, delusions, stupor, or catatonia. This dosage range can lead to toxicity and dangerous complications. [2]
Spotting PCP nystagmus and behavioral red flags
Nystagmus refers to involuntary eye movements, often jerky, horizontal or vertical movements that occur in one or both eyes. This can be related to various conditions, although it is a common symptom of PCP intoxication. [2][4]
Healthcare professionals may be able to recognize PCP intoxication upon emergency admission if the individual presents with nystagmus, particularly if other symptoms are present, such as hypertension, psychotic symptoms, and agitation. [1][2]
PCP toxicity and overdose
PCP toxicity and overdose can occur with higher doses, particularly doses above 25 mg, although doses lower than this may cause overdose symptoms. The severity of PCP toxicity can depend on the dosage as well as the individual, their frequency of use, tolerance, physical response, and administration method. [1][2]
It is also possible for a dosage of between 5 and 25 mg to cause toxicity and overdose. These symptoms can become life-threatening, such as organ dysfunction and failure, hyperthermia, seizures, rhabdomyolysis, and coma. [2]
Doses of 20-25 mg or more are likely to cause severe and life-threatening overdose effects, such as: [1][2][5]
- Loss of consciousness
- Unresponsiveness
- No response to pain
- Hyperthermia
- Kidney failure
- Seizures
- Intracranial hemorrhage
- Cardiac arrest
- Severe respiratory distress
Immediate first response for PCP overdose
Immediate response for PCP overdose involves seeking urgent medical attention, particularly if the individual has lost consciousness, is having difficulty breathing, or is experiencing seizures. [1][6]
Depending on the mental and physical state of the individual, efforts can be taken to ensure the safety of the person and their surroundings. For example, if they are unconscious, they can be placed in the recovery position to open airways. [1][2]
However, if the individual is agitated or aggressive, the priority may be to ensure the safety of those nearby. People trying to support the individual may need to remain at a distance, avoiding attempts to provide medical care or restraint for their own safety. If possible, try to monitor the individual from a distance until medical professionals arrive. [6]
Emergency treatment for PCP overdose
Initial care may involve stabilizing airways and breathing, body temperature, heart rate, and other vital signs. [1][6] Typically, the individual will be evaluated to determine PCP toxicity, the presence of other substances, and the severity of overdose symptoms. It may also be necessary to check for any evidence of accidental or self-injury, as this may occur with PCP intoxication. Evaluation is likely to include tests to check: [1][2][6]
- Level of PCP in the blood
- Electrolyte panel
- Blood glucose
- Creatine kinase
- Other substance use
- Heart function
- Cognitive and brain function
- Liver function
- Kidney function
- Injury
Supportive care and monitoring may be sufficient to manage PCP overdose, although other emergency procedures may be required to ensure safety and recovery. There is no medication or treatment to reverse or prevent PCP toxicity and overdose, but ventilation and activated charcoal may be utilized to help stabilize the patient. [6]
Individuals with severe agitation, psychosis, or aggression may require sedation and restraint. This could include medications such as benzodiazepines. Benzodiazepines can also be used to help reduce hyperthermia, seizures, and tachycardia. [2]
Observation and monitoring may be required for several hours or days in those with mild symptoms. However, more severe symptoms as a result of large dosages can take several weeks to improve, requiring close and consistent monitoring and support. [1][2] It is also common for people to experience significant changes in mental state following toxicity, which may also require careful monitoring to prevent self-injury. [2]
Long-term effects of PCP use
Using PCP for a long time can lead to the development of tolerance, dependence, and addiction. It can also increase the risk of physical and mental health complications. For example, long-term PCP use can lead to: [2][3][5]
- Severe cognitive impairments, such as memory loss and problems with thinking.
- Speech issues, such as slurring of words or stuttering.
- Significant weight loss.
- Persistent symptoms of psychosis, including paranoia and delusions.
- Depression and anxiety.
- Increased risk of self-harming or suicidal thoughts and behaviors.
- Increased risk of HIV, hepatitis, or other diseases (if injected and sharing needles).
PCP addiction and dependence
Regular and long-term PCP use can lead to addiction, dependence, and tolerance. This can result in more frequent and higher-dose use and withdrawal symptoms if use is stopped. Withdrawal symptoms can include severe anxiety, agitation, hallucinations, significant changes in body temperature, weight loss, muscle breakdown, or seizures. This may require medical intervention. [3]
Addiction can include physical dependence and also often involves psychological and behavioral changes associated with use, inability to control use, impairments in social, professional, or personal functioning, and harmful consequences in various aspects of well-being.
Harm reduction and safety
People using PCP can implement harm reduction strategies to increase their safety until they are ready to seek treatment. This might include:
- Using smaller doses.
- Avoiding injections or using needle exchanges to ensure the use of clean needles.
- Using PCP in safe consumption sites, where professionals can monitor physical and psychological safety.
- Understanding the signs of overdose and how to seek professional help.
- Avoiding the use of PCP with other substances.
PCP addiction treatment and recovery
People who experience PCP addiction can benefit from professional interventions to reduce and stop use. A primary care provider can advise on or refer to specialist services that offer addiction treatment, and various rehab options can be viewed in the Recovered Directory.
Treatments can include psychological and behavioral therapies to recognize and alter harmful thoughts and behaviors associated with PCP use. People may also benefit from inpatient or outpatient detoxification and rehabilitation services, where they are provided with professional monitoring and treatment to support withdrawal and recovery. [3]
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