PCP (phencyclidine) is classified as a dissociative hallucinogenic substance that produces marked perceptual alterations. Hallucinogenic drugs affect an individual’s perceptions in a different manner than other drugs affect perception of the environment. Hallucinogenic drugs produce experiences that are not consistent with reality, such as hallucinations (seeing, hearing, feeling, smelling, or even tasting things that are not really there), synesthesias (having mixed perceptual experiences, such as believing that one can see sound or hear colors), and the development of delusional behaviors. The dissociative aspect of PCP also represents an alteration in perception, such that one begins to feel that they are not real, that they are leaving their body, or that things around them are not real.
PCP use peaked in the 1970s and 1980s, according to the DEA. Even so, PCP is still a significant drug of abuse and classified as a Schedule II controlled substance, designating that its distribution is tightly controlled due to its potential to be abused and the extreme effects the drug produces. The drug can be snorted, injected, or smoked in cigarettes or cannabis products.
Anyone who suspects that someone has overdosed on PCP should immediately contact emergency medical services by calling 911. If a person has no medical training, they should not attempt to get the individual any fluids or medications. One should attempt to control the individual by limiting any environmental stimulation, talking to them, and behaving in a calm and controlled manner until help can arrive. Eliminating environmental stimulation may include trying to block bright lights, minimizing noise, not touching the person, and moving slowly and deliberately. Do not approach someone who is extremely agitated; instead, keep your distance and monitor them until help arrives.
Once an individual is relatively well restrained, they can be given intravenous fluids and may be given activated charcoal, especially if it is suspected that the individual took the drug orally. Activated charcoal has been demonstrated to absorb PCP and lessen issues with potential renal failure in cases of PCP overdose. Individuals who have extremely high body temperatures may need to be cooled via the use of liquids and ventilation.
The clinicians will monitor the individual’s vital signs and treat any other symptoms. Seizure activity can be treated with benzodiazepines. If the individual’s behavior is overtly psychotic, antipsychotic medications may be used in some cases. IV fluids can help to flush the drug from the system. Medical personnel can also deal with complications, such as rhabdomyolysis, which is a condition that occurs when muscle tissue begins to break down and proteins are released in the blood.
This condition can be very serious and may have potentially fatal consequences.
Some individuals may continue to display psychotic behaviors for a significant length of time following an overdose of PCP. These individuals may need long-term treatment for this behavior. Individuals who continue to display psychotic behaviors after a PCP overdose and had no prior history of psychosis may have damaged certain areas of the brain that are involved in perception and reasoning. Other organs, such as the heart, liver, and kidneys, can also suffer irreversible damage as a result of reduced blood flow and oxygen.
Follow-up care typically includes referring the individual for substance use disorder treatment, continued outpatient therapy, the use of benzodiazepines to avoid seizures, and the continued use of antipsychotic medications as needed. Because an individual who has overdosed on PCP is at extreme risk for even more severe and potentially permanent effects if they continue to use the drug, it is extremely important that every effort be made to involve them in a formal substance use disorder treatment program. This includes helping the individual avoid use of other drugs of abuse as the damage that may have occurred as a result of a PCP overdose may leave them very vulnerable to future damage from other substances.