PCP Makes a Comeback

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PCP Makes a Comeback

• The Worst Drug of the 70s Returns

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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

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• Frank L. Greenagel Jr.
• LCSW, LCADC, ACSW, CJC, ICADC
• MPAP Candidate, CCS Candidate
• www.greenagel.com
• greenage_at_rci.rutgers.edu
• frank_at_collegetreatmentcenter.com
• flg2_at_aol.com

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Getting to Know Me

• Long suffering Viking fan
• 4th generation English teacher
• Quit coffee for 5 weeks.
• Vs. Groundhogs

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Tell Em What Youre Going to TellEm

• 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

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PCP Stories

• http//feature.rollingstone.com/feature/the-gangst
  er-in-the-huddle

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Denial gt Blaming

• My parents are always on my case
• School/work stress me out
• My girlfriend is mean
• The drugs werent mine
• The cops are assholes
• The teachers at my school suck
• I steal because my parents dont give me enough
  money

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Denial gt Minimizing

• Its not like I smoke crack
• I dont use needles
• I dont drink during the week
• Im not as bad as ..

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Denial gt Claiming Invincibility

• Ill never get caught
• Im not stupid
• I wont overdose
• Im a super-star
• athlete
• Ill never use
• hard drugs

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Denial gt Family Denial

• What will neighbors think?
• My son doesnt have a problem
• Its not my problem
• Its her friends
• Boys will be boys
• Its the school

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Substance Abuse Spectrum

• 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

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Misdiagnoses

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

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Family Systems Theory
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Drugs Mistaken for PCP

• Synthetic Speed - Bath Salts
• Molly
• DXM

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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

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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

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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 Mollys 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.

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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?

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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

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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

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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

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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

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PCP

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

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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

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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

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PCP The High

• Euphoria, relaxation, hallucinations,
  dissociation from mind, body and outside world,
  effects of drunkenness, cyclical behavior between
  periods of calm and rage

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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

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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

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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

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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

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Anti-Drug Ad from Washington DC, 1985
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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.

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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

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PCP Treatment

• No antidote
• Many PCP users are brought to emergency rooms
  because of PCPs 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

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PCP Usage Trends
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PCP Usage Trends
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PCP Usage Trends
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PCP Usage Trends
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PCP Usage Trends
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PCP Usage Trends
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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

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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.

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PCP - Education

• generational forgetting
• Target tweens and teens
• Tobacco and marijuana use
• Harm reduction
• 25 34 year olds too
• SAMHSA report

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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

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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.

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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

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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

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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

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Helping People with Substance Disorders

• Ask about alcohol drug use (repeatedly)
• Convey positive attitude about recovery
• Get more training
• Dont be offended when they lie
• Consult and/or refer to experts

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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.

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Macro-Level Suggestions

• 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 PMPs
• 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

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My English Teacher Thing(1 slide to go)

• Narrative of the Life of Frederick Douglass
• A Long Way Down
• An Americans Resurrection
• New Jack
• Drown The Brief Wondrous Life of Oscar Wao