His mother threatened to sue me. She did not want her son to go to St. Elizabeths. However, this was the second time in two weeks that he attempted to set the house on fire and assault his family. Now all he would do was remain quiet or sit up in bed while staring into space. He had a history of using PCP.
More than any other substance of abuse, PCP adversely and irreversibly affects our youth. The drug has created a new type of public menace and a new population of mentally disturbed persons, in part because PCP is easy and cheap to make and buy.
There are an estimated 8 million PCP abusers in the nation, many of whom reside in the District. PCP abusers account for more than 50 percent of admissions to psychiatric emergency rooms in New York, Los Angeles, Boston and the District.
The difference between PCP and other drugs starts with its history. PCP (phencyclidine) was originally developed as a surgical anesthetic. However, after preliminary trials, it was observed that patients recovering from surgery displayed bizarre, psychotic behavior. Subsequently, the drug was banned.
PCP is a man-made substance now produced in clandestine laboratories with no control over the ingredients. On the street, it's called "loveboat," "angel dust," "elephant tranquilizer" or "goon."
It greatly reduces or eliminates awareness of physical pain and recent memory, and it increases strength.
It is common to hear of patients who break out of handcuffs or leather restraints, suffering broken bones and serious cuts in the process but oblivious to the pain. Furthermore, these persons generally do not remember the events that caused the injuries.
I remember one patient crying and talking incoherently while in leather restraints. The nurse confirmed that his restraints were secure. The next moment, I saw the patient's right arm coming at my face. It knocked me back about 20 feet.
PCP is usually smoked with marijuana; it also is smoked with tobacco, mixed and snorted with cocaine, swallowed with alcohol in its liquid form or injected with heroin. Under those conditions, it is difficult to predict whether the drug will act as a stimulant, depressant or hallucinogen.
A one-time use of the drug may trigger an underlying psychiatric problem, or cause irreversible destructive/self-destructive behavior (for example, jumping off a building or gouging out eyes).
Symptoms of chronic use resemble those of a brain-injured or learning-disabled person. Speech is slow and slurred, and certain words are difficult to pronounce. The abilities to concentrate, organize and think in abstraction become impaired. These symptoms endure for an indefinite period of time after use of the drug is discontinued.
The symptoms take on added significance when we consider that the average PCP user in the District is a 17-year-old male who is poor, black and often mentally disturbed. He often abuses a variety of drugs.
Rather than being metabolized or excreted like cocaine, heroin or marijuana, PCP is absorbed in body and brain fat tissue, where it accumulates. These fat deposits serve as sources of continued PCP toxicity. Symptoms range from psychotic episodes, which unpredictably recur, to the more sedate symptoms of brain injury.
Psychological rather than physical detoxification is a more appropriate term for what PCP abusers need, because there is psychological rather than physical dependence associated with PCP abuse, and discontinued use does not assure that psychotic symptoms will end or not recur.
Psychiatrically, we find that depression is prominent among younger PCP abusers. As a result, suicide is common. Agitation, aggression and very often self-destructive psychosis are characteristic.
The effect of the drug is not necessarily obvious or consistent even during the acute phase of reaction. The patient may seem to be very calm and in control and then very suddenly become psychotically violent.
This is often very misleading to doctors and enforcement authorities and has been the basis for many unfortunate injuries to patients, doctors and police.
A doctor recently requested that handcuffs be taken off a patient who had injured himself as a result of being on PCP. He seemed to be calm, and the officer unlocked the handcuffs. A few seconds later he attacked the doctor and, with the handcuffs, beat the officer who was trying to restrain him. It took eight men to subdue him.
The patient suffered broken ribs but did not feel any pain and did not remember what happened. The officer required surgery.
More medical care is required with PCP abuse because use of the drug results in respiratory and cardiovascular dysfunctions, seizures and convulsions. There are many accidents and self-inflicted injuries. Often PCP patients believe they are Superman and can fly off buildings or that they can breath under water.
What can be done? These steps could get us on the way to controlling the manufacture of PCP, helping those who abuse the drug and preventing further abuse:
Local and national legislation needs to be passed to control the sale of essential ingredients of PCP by chemical warehouses and companies.
The mental health service delivery system needs to provide more comprehensive and effective services to PCP abusers.
A greater emphasis needs to be placed on preventive education, starting in elementary school. Government and community cooperation is necessary to bring the use of PCP to an end.