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Phencyclidine (a complex clip of the chemical name phenylcyclohexylpiperidine, commonly initialised as PCP), also known as angel dust and other street names, is a recreational, dissociative drug formerly used as an anaesthetic agent, exhibiting hallucinogenic and neurotoxic effects. Developed in 1926, it was first patented in 1952 by the Parke-Davis pharmaceutical company and marketed under the brand name Sernyl. In chemical structure, PCP is an arylcyclohexylamine derivative, and, in pharmacology, it is a member of the family of dissociative anesthetics. PCP works primarily as an NMDA receptor antagonist, which blocks the activity of the NMDA receptor. Other NMDA receptor antagonists include ketamine, tiletamine, and dextromethorphan. Although the primary psychoactive effects of the drug lasts for a few hours, the total elimination rate from the body typically extends 8 days or longer.

Biochemistry and pharmacology

Biochemical action

The N-methyl-D-Aspartate receptor, a type of ionotropic receptor, is found on the dendrites of neurons and receives signals in the form of neurotransmitters. It is a major excitatory receptor in the brain. Normal physiological function requires that the activated receptor fluxes positive through the channel part of the receptor. PCP enters the ion channel from the outside of the neuron and binds, reversibly, to a site in the channel pore, blocking the flux of positive ions into the cell. PCP therefore inhibits depolarization of neurons and interferes with cognitive and other functions of the nervous system.

In a similar manner, PCP and analogues also inhibit nicotinic acetylcholine receptor channels (nAChR). Some analogues have greater potency at nAChR than at NMDAR. In some brain regions, these effects act synergistically to inhibit excitatory activity.

PCP is retained in fatty tissue and is broken down by the human metabolism into PCHP, PPC and PCAA.

The most troubling clinical effects are likely produced by the indirect action of phencyclidine on the presynaptic dopamine receptor (DA-2). This has been suggested to account for most of the psychotic features. The relative immunity to pain is likely produced by indirect interaction with the endogenous endorphin and enkephalin system in rats.

Structural analogs

More than 30 different analogues of PCP were reported as being used on the street during the 1970s and 1980s, mainly in the USA. The best known of these are PCPy (rolicyclidine, 1-(1-phenylcyclohexyl)pyrrolidine); PCE (eticyclidine, N-ethyl-1-phenylcyclohexylamine); and TCP (tenocyclidine, 1-(1-(2-Thienyl)cyclohexyl)piperidine). These compounds were never widely-used and did not seem to be as well-accepted by users as PCP itself, however they were all added onto Schedule I of the Controlled Substance Act because of their putative similar effects.

The generalized structural motif required for PCP-like activity is derived from structure-activity relationship studies of PCP analogues, and summarized below. All of these analogues would have somewhat similar effects to PCP itself, although, with a range of potencies and varying mixtures of anesthetic, dissociative and stimulant effects depending on the particular substituents used. In some countries such as the USA, Australia, and New Zealand, all of these compounds would be considered controlled substance analogue of PCP, and are hence illegal drugs, even though many of them have never been made or tested.

Brain effects

Like other NMDA receptor antagonists, it is postulated that phencyclidine can cause a certain kind of brain damage called Olney's lesions. Studies conducted on rats showed that high doses of the NMDA receptor antagonist MK-801 caused irreversible vacuoles to form in certain regions of the rats' brains, and experts say that it is possible that similar brain damage can occur in humans. All studies of Olney's Lesions have only been performed on animals and may not apply to humans. The research into the relationship between rat brain metabolism and the creation of Olney's Lesions has been discredited and may not apply to humans, as has been shown with ketamine.

Phencyclidine has also been shown to cause schizophrenia-like changes in the rat brain, which are detectable both in living rats and upon necropsy examination of brain tissue. It also induces symptoms in humans that are virtually indistinguishable from schizophrenia.

History and medicinal use

PCP was first synthesized in 1926, and later tested after World War II as a surgical anesthetic. Because of its adverse side effects, such as hallucinations, mania, delirium, and disorientation, it was shelved until the 1950s. In 1953, it was patented by Parke-Davis and named Sernyl (referring to serenity), but was withdrawn from the market two years later because of side-effects. It was renamed Sernylan in 1967, and marketed as a veterinary anesthetic, but again discontinued. Its side effects and long half-life in the human body made it unsuitable for medical applications.

When smoked, some of it is broken down by heat into 1-phenyl-1-cyclohexene (PC) and piperidine.



Recreational use

Illicit PCP seized by the DEA in several forms.


PCP comes in both powder and liquid forms (PCP base is dissolved most often in ether), but typically it is sprayed onto leafy material such as cannabis, mint, oregano, parsley, or ginger leaves, then smoked.

PCP is a Schedule II substance in the United States, a List II drug of the Opium Law in the Netherlandsmarker and a Class A substance in the United Kingdom.

Method of absorption

The term "embalming fluid" is often used to refer to the liquid PCP in which a cigarette is dipped, to be ingested through smoking, commonly known as "boat" or "water." Smoking PCP is known as "getting wet." A tobacco or cannabis cigarette dipped in PCP is called by the street names "sherm stick," "sherm," "fry stick," "amp," "toe tag", "dippa", "happy stick," and "wet stick." There is much confusion over the practice of dipping cigarettes in "embalming fluid" leading some to think that real embalming fluid may actually be used. Smoking actual formaldehyde will cause intoxication, but may cause serious health consequences beyond those of consuming PCP, due to the toxicity of formaldehyde and other embalming chemicals. The slang term "embalming fluid" likely originated from PCP's somatic "numbing" effect and the feeling of physical dissociation from the body. This is one of the fastest growing means of using PCP, especially in the western United States where its is sold for about $10 to $25 per cigarette.

In its pure (base) form, PCP is a yellow oil (usually dissolved in petroleum or diethyl ether or tetrahydrofuran). Upon treatment with hydrogen chloride gas, or HCL saturated isopropyl alcohol, this oil precipitates into white - tan crystals or powder (PCP hydrochloride) In this form, PCP can be insufflated, depending upon the purity. However, most PCP on the illicit market contains a number of contaminants as a result of makeshift manufacturing, causing the color to range from tan to brown, and the consistency to range from powder to a gummy mass. These contaminants can range from unreacted piperidine and other precursors, to carcinogens like benzene and cyanide - like compounds such as PCC (piperidinocyclohexyl carbonitrile).

Effects

Phencyclidine use was found in a number of murder cases.

Behavioural effects can vary by dosage. Small doses produce a numbness in the extremities and intoxication, characterized by staggering, unsteady gait, slurred speech, bloodshot eyes, and loss of balance. Moderate doses (5–10 mg intranasal, or 0.01-0.02 mg/kg intramuscular or intravenous) will produce analgesia and anesthesia. High doses may lead to convulsions.

Psychological effects include severe changes in body image, loss of ego boundaries, and depersonalization. Hallucinations and euphoria are reported infrequently.

The drug has been known to alter mood states in an unpredictable fashion, causing some individuals to become detached, and others to become animated. Intoxicated individuals may act in an unpredictable fashion, driven by their delusions and hallucinations.

Included in the portfolio of behavioral disturbances are acts of self-injury including suicide, and attacks on others or destruction of property. The analgesic properties of the drug can cause users to feel less pain, and persist in violent or injurious acts as a result. Recreational doses of the drug can also induce a psychotic state that resembles schizophrenic episodes which can last for months at a time with toxic doses. Users generally report an "out-of-body" experience where they feel detached from reality, or one's consciousness seems somewhat disconnected from consensus reality.

Symptoms are summarized by the mnemonic device RED DANES: rage, erythema (redness of skin), dilated pupils, delusions, amnesia, nystagmus (oscillation of the eyeball when moving laterally), excitation, and skin dryness.

Controversy

The American rapper Big Lurch was accused of murdering an acquaintance and eating her lungs while on PCP.

In April 2009, 34-year-old Angel Vidal Mendoza Sr. bit out his 4-year-old son's eye, and severely damaged the other, while on PCP, before attempting to chop off his own legs with an axe.

During the mid 1990's, A West Virginian woman had been charged of taking off her dog's limbs with a homemade contraption similar to that of a guillotine. Witnesses then described a public display of the woman pulling out large chunks of her hair and forcefully stuffing the loose follicles into her husbands airway(who was under the influence of PCP) restricting his breathing to a point where he felt the need to grab a fork off the table and stab his wife to death. The man was not charged for the death of his wife.

Management of intoxication

Management of phencyclidine intoxication mostly consists of supportive care — controlling breathing, circulation, and body temperature — and, in the early stages, treating psychiatric symptoms. Benzodiazepines, such as lorazepam, are the drugs of choice to control agitation and seizures (when present). Typical antipsychotics such as phenothiazines and haloperidol have been used to control psychotic symptoms, but may produce many undesirable side effects — such as dystonia — and their use is therefore no longer preferred; phenothiazines are particularly risky, as they may lower the seizure threshold, worsen hyperthermia, and boost the anticholinergic effects of PCP. If an antipsychotic is given, intramuscular haloperidol has been recommended.

Forced acid diuresis (with ammonium chloride or, more safely, ascorbic acid) may increase clearance of PCP from the body, and was somewhat controversially recommended in the past as a decontamination measure. However, it is now known that only around 10% of a dose of PCP is removed by the kidneys, which would make increased urinary clearance of little consequence; furthermore, urinary acidification is dangerous, as it may induce acidosis and worsen rhabdomyolysis (muscle breakdown), which is not an unusual manifestation of PCP toxicity.

See also



References

  1. [www.cesar.umd.edu/cesar/drugs/pcp.pdf Development of PCP]
  2. Kapur, S. and P. Seeman. " NMDA receptor antagonists ketamine and PCP have direct effects on the dopamine D2 and serotonin 5-HT2receptors¾implications for models of schizophrenia" Molecular Psychiatry. 7(8): 837–844 (2002)
  3. PCP synthesis and effects: table of contents
  4. Itzhak Y, Kalir A, Weissman BA, Cohen S. New analgesic drugs derived from phencyclidine. Journal of Medicinal Chemistry. 1981; 24(5):496–499
  5. Chaudieu I, Vignon J, Chicheportiche M, Kamenka JM, Trouiller G, Chicheportiche R. Role of the aromatic group in the inhibition of phencyclidine binding and dopamine uptake by PCP analogs. Pharmacology Biochemistry and Behaviour. 1989 Mar;32(3):699–705.
  6. Jansen, Karl. Ketamine: Dreams and Realities. MAPS, 2004. ISBN 0966001974
  7. Erowid DXM Vault : Response to "The Bad News Isn't In": Please Pass The Crow, by William E. White
  8. Diaz, Jaime. How Drugs Influence Behavior. Englewood Cliffs: Prentice Hall, 1996.
  9. AJ Giannini. Drugs of Abuse--Second Edition. Los Angeles, Practice Management Information Corp.,1997,pg. 126. ISBN 1-57066-053-0.
  10. http://criminal-info.com/criminalrecords/roylee.asp
  11. Retrieved on November 3, 2008.
  12. Retrieved on November 3, 2008 through Google Book Search.
  13. Giannini AJ. Price WA. PCP: Management of acute intoxication. Medical Times. 1985;113(9):43-49


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