PCP Makes a ComebackPCP Makes a ComebackThe “Worst” Drug of the 70’s The “Worst” Drug of the 70’s

Returns Returns

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

Frank L. Greenagel Jr.Frank L. Greenagel Jr.LCSW, LCADC, ACSW, CJC, ICADCLCSW, LCADC, ACSW, CJC, ICADCMPAP Candidate, CCS CandidateMPAP Candidate, CCS Candidate

www.greenagel.com

greenage@rci.rutgers.edufrank@collegetreatmentcenter.com

flg2@aol.com

Getting to Know Me…Getting to Know Me…

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

Tell ‘Em What You’re Going to Tell’EmTell ‘Em What You’re Going to Tell’Em• 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

PCP STORIES…

http://feature.rollingstone.com/feature/the-gangster-in-the-huddle

Denial –> BlamingDenial –> Blaming• My parents are always on my case• School/work stress me out• My girlfriend is mean• The drugs weren’t mine• The cops are assholes

• The teachers at my school suck• I steal because my parents don’t give me enough money

Denial –> MinimizingDenial –> Minimizing• It’s not like I smoke crack• I don’t use needles• I don’t drink during the week• I’m not as bad as …..

Denial –> Claiming InvincibilityDenial –> Claiming Invincibility• I’ll never get caught• I’m not stupid• I won’t overdose• I’m a super-star athlete• I’ll never use hard drugs

Denial –> Family DenialDenial –> Family Denial• What will neighbors think?• My son doesn’t have a problem• It’s not my problem• It’s her friends• Boys will be boys• It’s the school

Substance Abuse SpectrumSubstance Abuse SpectrumI-----------------I-------------------I---------------------Non-use use abuse dependence

1 of 4 3 of 71 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 problemscaused by or made worse

MisdiagnosesMisdiagnoses• Substance Abuse, Substance Dependence &

Early Recovery often look like– Depression– Anxiety– ADHD– Bi-polar disorder

Family Systems TheoryFamily Systems Theory

Drugs Mistaken for PCPDrugs Mistaken for PCP• Synthetic Speed - Bath Salts• Molly • DXM

Synthetic SpeedSynthetic 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

Synthetic SpeedSynthetic 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

MollyMolly• 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 “Molly’s 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….

MollyMolly• 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?

DXMDXM

• 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

DXMDXM• Similar effects to dissociative anaesthetics• Euphoria, hallucinations• At normal doses:• body rash , Nausea, Vomiting, Drowsiness• Dizziness, Constipation, Diarrhea, Sedation• Confusion, Nervousness, Closed-eye

hallucination

DXMDXM

• 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

DXMDXM• 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

PCPPCP

• Phencyclidine• 1950’s• Schedule II drug• dissociative anesthetic

– keep a patient awake but unresponsive to pain

• Stopped being used in humans in 1965• veterinary medicine

PCPPCP

• 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

PCP - OnsetPCP - 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

PCP – The HighPCP – The High

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

PCP - DosagePCP - 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

PCP - DosagePCP - 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

PCP – Physical EffectsPCP – 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

PCP – Effects on the BrainPCP – 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

Anti-Drug Ad from Washington DC, 1985

PCP - DetectionPCP - 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.

PCP - DetectionPCP - 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

PCP – TreatmentPCP – Treatment

• No antidote• Many PCP users are brought to emergency

rooms because of PCP’s 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 TrendsPCP – Usage Trends

PCP – Usage TrendsPCP – Usage Trends

PCP – Usage TrendsPCP – Usage Trends

PCP – Usage TrendsPCP – Usage Trends

PCP – Usage TrendsPCP – Usage Trends

PCP – Usage TrendsPCP – Usage Trends

PCP – Usage TrendsPCP – 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 TrendsPCP – 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.

PCP - EducationPCP - Education

• generational forgetting• Target tweens and teens

– Tobacco and marijuana use– Harm reduction

• 25 – 34 year olds too• SAMHSA report

PCP – Community PlanPCP – 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

PCP – Community PlanPCP – 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.

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 NJ•Ray Lesniak HS in Union, NJ• cost effective

Reasons To Go To TherapyReasons 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

Helping People with Helping People with Substance DisordersSubstance Disorders

• Ask about alcohol & drug use (repeatedly)• Convey positive attitude about recovery• Get more training• Don’t be offended when they lie• Consult and/or refer to experts

Macro-Level SuggestionsMacro-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.

Macro-Level SuggestionsMacro-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 PMP’s• 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

My English Teacher Thing…My English Teacher Thing…(1 slide to go…)(1 slide to go…)

• Narrative of the Life of Frederick Douglass • A Long Way Down • An American’s Resurrection • New Jack• Drown & The Brief Wondrous Life of Oscar

Wao