PCP Makes a ComebackThe Worst Drug of the 70s Returns

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Frank L. Greenagel Jr.LCSW, LCADC, ACSW, CJC, ICADCMPAP Candidate, CCS Candidatewww.greenagel.com

greenage@rci.rutgers.edufrank@collegetreatmentcenter.comflg2@aol.com

Getting to Know MeLong suffering Viking fan4th generation English teacherQuit coffee for 5 weeks.Vs. Groundhogs

Tell Em What Youre Going to TellEmPCP StoriesDenial Substance Abuse SpectrumFamily Systems TheoryDrugs Mistaken for PCPBath Salts, Molly & DXMThe BrainHistory of PCPPhysical Effects of PCPPsychological Effects of PCPMezzo and Macro level strategies

PCP STORIEShttp://feature.rollingstone.com/feature/the-gangster-in-the-huddle

Denial > BlamingMy parents are always on my caseSchool/work stress me outMy girlfriend is meanThe drugs werent mineThe cops are assholes

The teachers at my school suckI steal because my parents dont give me enough money

Denial > MinimizingIts not like I smoke crackI dont use needlesI dont drink during the weekIm not as bad as ..

Denial > Claiming InvincibilityIll never get caughtIm not stupidI wont overdoseIm a super-star athleteIll never use hard drugs

Denial > Family DenialWhat will neighbors think?My son doesnt have a problemIts not my problemIts her friendsBoys will be boysIts the school

Substance Abuse SpectrumI-----------------I-------------------I---------------------Non-use useabusedependence1 of 43 of 71 yearlife-timeNo 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 problemscaused by or made worse

MisdiagnosesSubstance Abuse, Substance Dependence & Early Recovery often look likeDepressionAnxietyADHDBi-polar disorder

Family Systems Theory

Drugs Mistaken for PCPSynthetic Speed - Bath SaltsMolly DXM

Synthetic Speedsold 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, 2012schedule I druguse WAY down since ban

Synthetic SpeedMethylenedioxypyrovalerone (MDPV)Can be smoked, snorted or injectedAura, Ivory Wave, Vanilla Sky, Ivory Soft, Loco-motion are some common names3 20 mg doseLasts 3-4 hours

Racing thoughts, hallucinations, can induce panic attacksHigh body temperature, high blood pressure, high heart rate, kidney problems

MollySchedule I drug in 1988Less stigma than ecstasy, because it is said that is pure, uncut MDMAthey are only fooling themselves Dr. John Halpern, NYT, 6/23/13Stimulant & hallucinogenSold as Mollys Plant Food Songs by: Lil Wayne, Kanye West, Miley Cyrus, Rick Ross, Sold online$20 to $50 a doseBluelight MDMA drug info & forumCollege, suburban and club drug. Late 2012, moved to the inner cities.

Molly30 minute onset, lasts several hoursEuphoria, psychedelia, stimulation, energy, desireMassive dopamine & serontonin rushShort term effects: insomnia, aches, nausea, stiff jaw, fatigue, anxiety, teeth grinding, dehydration, irritability, gi problemsLong term & more dangerous: depression, hypothermia, seizures, high blood pressureSuicidal TuesdaysAs treatment for soldiers with PTSD?

DXMDextromethorphanCough suppressant1950 patent; race between Swiss and USAOTCMucinex DM, Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, TheraFluCan buy in bulk powder online

DXMSimilar effects to dissociative anaestheticsEuphoria, hallucinationsAt normal doses:body rash , Nausea, Vomiting, DrowsinessDizziness, Constipation, Diarrhea, SedationConfusion, Nervousness, Closed-eye hallucination

DXMAt dosages 3 to 10 times the recommended therapeutic dose:Increased energy, Increased confidenceNausea, Restlessness, InsomniaRacing thoughts and/or speech, perception of increased strength, big pupils, glazed eyes

DXMAt dosages 15 to 75 times the recommended therapeutic dose:Hallucinations, dissociation, vomiting, blurred vision, bloodshot eyes, dilated pupils, sweating, fever, hypertensionshallow respiration, diarrhea, muscle spasmsSedation, euphoria, blackouts, sight lossinability to focus eyes, skin rash

PCPPhencyclidine1950sSchedule II drugdissociative anesthetickeep a patient awake but unresponsive to painStopped being used in humans in 1965veterinary medicine

PCPcrystal, capsule, tablet, powder and liquidEat, smoke, snort or inject (rare)Stimulant properties; Hallucinigen properties; Depressant propertiesStreet 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 - Onsetvery rapid when smoked or injected1-5 minutes when snorted30 minutes when orally ingestedgradual decline of major effects over 4-6 hoursa return to normal may take up to between 1 to 4 days

PCP The HighEuphoria, relaxation, hallucinations, dissociation from mind, body and outside world, effects of drunkenness, cyclical behavior between periods of calm and rage

PCP - Dosagelow 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 - DosageHigh 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 Effectstrachycardia, hypertension, respiratory depression, muscle rigidity, increased reflexes, and seizuresWithdrawal symptoms include diarrhea, chills, tremorshas sedative effects, and interactions with cns depressants can lead to coma or accidental overdose due to potentiating effect

PCP Effects on the BrainPCP inhibits the reuptake of dopamine, norepinephrine and serotonin psychological dependenceShort periods: physical distress, lack of energy, and depression long periods: report memory loss, difficulties with speech & thinking, and depressionup to a year after cessationmood disorders also have been reported

Anti-Drug Ad from Washington DC, 1985

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

PCP - DetectionBoth 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 TreatmentNo antidoteMany 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

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 TrendsThe 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 - Educationgenerational forgettingTarget tweens and teensTobacco and marijuana useHarm reduction25 34 year olds tooSAMHSA report

PCP Community Planpolicymakers access the reports to ensure that adequate substance abuse treatment facilities serve their communitieslaw 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 Planclinical settings to develop useful screening tools for patients in order to detect the use of other substances or the presence of additional mental health concernsemergency 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 NJRay Lesniak HS in Union, NJ cost effective

Reasons To Go To TherapyConcerns About FutureRomantic RelationshipsSexual IdentityGrief/LossAcademic StressInterpersonal StressAdjusting to Life ChangesAlcohol & Drug AbuseMental Health Disorder

Helping People with Substance DisordersAsk about alcohol & drug use (repeatedly)Convey positive attitude about recoveryGet more trainingDont be offended when they lieConsult and/or refer to experts

Macro-Level SuggestionsDrug testing for everyone prescribed RX opiates and stimulantsEducation programs for tweens, teens, parents and teachersPeer education of high school and college studentsTrain future professionals (law, nursing, pharmacy, social work, student affairs & medicine) More Recovery Support Programs.

Macro-Level Suggestions 911 Good Samaritan Bill RX Drug Turn-In Day 2 4 a year RX Drug Drop Box One in each townStronger prescription monitoring programsMore professional access to PMPsMore and cheaper opiate maintenance and withdrawal programsIncrease training of professionals who can prescribe and distribute drugsReform insurance lawsMore TX program in jails & prisons

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