I do not pretend that S. 2778, if enacted into law, will necessarily eliminate the epidemic of PCP abuse among our young people. It should, however, make the drug harder to obtain, drive up prices, and reduce demand accordingly. It should halt the proliferation of illegal PCP laboratories that are currently so widespread and so lucrative.

S. 2778 is a step in the right direction, its logic is irrefutable. It attracted 34 co-sponsors in the Senate and was passed by voice vote on July 27th as an amendment to S. 2399, the Psychotropic Substances Act of 1978, currently pending be fore the House.

I know that Congressman Rogers' subcommittee on health and environment has acted favorably on the Psychotropic Substance legislation, and I would hope that the distinguished Subcommittee Chairman might be favorably inclined toward my amendment, either on the floor of the House or in conference.

I would also note that my PCP Control legislation has been endorsed by the International Association of Police Chiefs, the International Narcotics Enforcement Officers Association, and by 14 State narcotic agencies. The Federal Drug Enforcement Administration and the Department of Justice have also embraced the proposal.

In addition to making it more difficult for drug dealers to purchase piperidine, S. 2778 also increases criminal sanctions for unauthorized manufacture, distribution or possession with intent to manufacture or distribute PCP from a maximum first offense penalty of five years in prison and/or a $15,000 fine to 10 years in prison and/or a $25,000 fine. And finally, by providing legal procedures for the purchase of piperidine, this legislation would give drug enforcement officials an added weapon to use in prosecuting illegal PCP producers.

Mr. Chairman, I appreciate your patience in hearing me out on this important subject. I hope S. 2778 makes sense to the members of this distinguished com: mittee and merits your support.

Thank you very much. I would be pleased to take any questions you might have.

PREPARED STATEMENT OF FRANK E. MINYARD, M.D., CORONER, PARISH OF ORLEANS, NEW ORLEANS, LA.

The drug PCP is the most devasting drug on the streets of our country today. The usage of PCP and its involvement in medical, social, and legal circles has not been truly identified because, one, it was not looked for and two, it's very difficult to detect minute amounts of PCP. The DAWN Report (Drug Abuse Warning Network) does not reflect the actual incident of PCP usage in most communities because of these factors. In the New Orleans area my colleagues and I have been conducting tests for evidence of PCP in Coroner's cases of violent deaths and accidents and medical cases that came into Charity Hospital's admitting Room since April 1, 1978. In the ensuing months we took 175 samples for the detection of PCP and came up with 37% positive from patients admitted to our local Charity Hospital. Most of these cases, as you can see, have psychiatric diagnosis. These cases represent all sorts of bizarre activity involving both the patients' relatives and the police. We have had three deaths connected with the usage of PCP in that four month period and there are other deaths that are under investigation at this time.

The significant findings in our studies were a bizarre suicide occurred when a young male under the influence of PCP jumped in front of a bus. Several drownings have occurred in which persons jumped into a swimming pool and never surfaced. An attempted airline highjacking armed robbery, burglaries and violent destructive behavior have been detected in our study. In most of the bizarre and or violent behavior cases the patient suffers memory loss and or distortion of memory and usually cannot remember or realize what has occurred and reports that what occurred seemed like a dream or a detached event.

Gentlemen, I personally believe that PCP is a major medical, social and legal public health concern and, in a sense, is more dangerous than the so-called hard narcotic Heroin. I believe the Heroin problem is lessening in the United States. because of many factors, the Drug Enforcement Administration, local police and harsh sentences. In the New Orleans area a bag of Heroin now cost $30 and is less than 1% pure.

Recommendations: (1) Research monies be appropriated to do not only Clinical research at various centers around the country, but also, the incidence of

PCP in our Criminal Justice System should be thoroughly investigated. I know that crimes are committed under the influence of PCP and I am extremely concerned about traffic safety with PCP. There is no antedote for PCP intoxication. (2) I believe there should be stricter penalties imposed on the illicit use of PCP and strongly recommend a bill that is co-sponsored by Senator Russell B. Long (S. 2778).

PCP ABUSE IN NEW ORLEANS: RESULTS OF A PRELIMINARY STUDY (By Richard E. Garey, Ph. D.,1 Monroe S. Samuels, M.D.,2 Stephen A. Hite, B.S.,2 Robert G. Health, M.D.,1 and Frank E. Minyard, M.D.3)

A potent psychotomimetic agent, phencyclidine (PCP), is currently found in numerous street drug preparations. PCP is also known as "Hog", animal tranquilizer, angel's dust, angel's mist, Peace Pill, but most commonly as THC. It is being sold under these names but seldom as PCP, especially as the warnings grow concerning the adverse behavioral and medical effects of this compound. One of the major reasons for the widespread use of PCP is the relative ease with which it is synthesized and the profit margin involved (i.e., approximately 1,000 percent). PCP can be smoked (inhalation), snorted (insufflation), injected

1 Dept. Psychiatry and Neurology, Tulane Medical School, New Orleans, La.

2 Dept. Pathology, Pharmacology and Medicine, L.S.U. Medical School, New Orleans, La. 3 Coroner, Orleans Parish, New Orleans, La.

IM or IV, or eaten (ingestion). The preferred method seems to be smoking PCP on mint leaf or marihuana cigarettes. Recent findings have demonstrated that ▲ 9 THC, the principal psychoactive ingredient of marihuana, potentiates the effects of PCP. The ever-increasing use of PCP has reached epidemic proportions in the U.S. In New Orleans, for example, approximately 55 cases of PCP intoxication have come to the attention of medical and/or law enforcement officers since January 1, 1978. Since only a small percentage of psychotic episodes, bizarre or violent behavior, suicides, or accidental deaths are screened specifically for PCP, we feel that the ones which have been detected are only the tip of the iceberg and that with increasing use more and more cases will be seen by both medical and enforcement personnel as a result of their awareness of this problem increases and screening for PCP is initiated in a greater number of these incidents.

BACKGROUND

PCP was first introduced in the early 50's as an IV anesthetic (Sernyl) for use in humans. However, because of its psychoactive properties, its use was discontinued in the 60's. A relative of PCP, Ketamine, is still in use but again its use is limited because of its psychoactive properties. The legitimate use of PCP today is restricted to animal tranquilization of anesthesia and is marketed under the brand name Sernalyn.

PCP at anesthetic doses has little effect on cardiac function or respiration. Its major effect is as a dissociative anesthetic. It theoretically functions by interfering with the normal transmission of chemical signals between nerve cells or nerve cells and other organs. It primarily affects the "higher” or “integration" centers in the brain and results in the reduction of some inputs (i.e., pain) but increasing the sensitivity to others (i.e., light, sound). For example, persons treated with PCP and placed in sensory isolation did not develop psychological disturbances, although distorted perception, prolonged reaction time and depression of the proprioceptive senses occurred. This suggests that the exteroceptive inputs are needed to produce the psychotic symptoms, a fact that is supported by the fact that attempts to "talk down" PCP patients often intensify the symptoms.

A comparison of the effects of ▲ 9 THC and PCP on depth electrode activity in monkeys demonstrates the more potent effects of PCP on electrical activity in various deep nuclei of the brain. The centers involved with emotional expression, for example, septal (pleasure) hippocampus and amygdala (aggression), lateral geniculate (vision), medial geniculate (sound), fastigial nucleus (motor movement) are dramatically effected by PCP as demonstrated by changes in electrical activity in these areas. In addition, brain nuclei containing specific neurotransmiter substances, i.e., substantia nigra (dopamine) and locus coeruleus (norepinephrine) also show profound EEG changes following administration of PCP. 9 THC also has an effect on many of these same areas, but certainly not to the extent that PCP does.

Abnormal electrical activity can be measured in humans suffering from schizo phrenia in the same areas as those induced by PCP and marihuana. Chronic marihuana smoking has been shown to cause permanent changes in some electrical activity in monkeys. Chronic effects of PCP ingestion has not as of yet been investigated but judging from clinical observation prolonged or chronic changes would be expected.

Clinical symptomatology can be divided into two classes: (1) Medical and (2) Psychiatric. Medically, nystagmus, a slight elevation of pulse and blood pressure, reduced sensitivity to pain and temperature, slurred speech, ataxia and increased deep tendon reflexes may be present. At doses exceeding or approaching anesthetic levels, respiratory depression, coma, decreased muscle tone and seizures leading to status epilepticus have been observed.

Except in severe overdose cases, however, the majority, 38/45 in our study, present as psychiatric problems. This is usually but not always characterized by (1) initial violent psychotic behavior with paranoid ideation. This phase has been observed to last from several hours to 7 to 10 days. A second phase characterized by (2) restless and combatative behavior lasting for 5 to 7 days. (3) Personality reintegration and restoration of normal thought processes and associations which may take up to several months in more severe cases. In six cases (6/48) prolonged hospitalization for at least 3 months has failed to restore the patient to predrug status. Whether or not an irreversible change in brain function (i.e., chemistry) has occurred in these cases is not yet clear.

The first phase involving bizarre and/or violent behavior is certainly the most crucial phase and since this usually occurs on the streets or in the home it is impossible to treat immediately and is, therefore, responsible for the intervention of law enforcement or coroner's officials in the majority of these cases. The remainder are usually brought in by the family or friends. We have also noted that the violent or bizarre behavior may fluctuate in that a patient may suddenly calm down for a period of hours then again become extremely agitated and violent. For example, a patient who had assaulted a priest was brought into the hospital by police claiming he was Jesus Christ. Subsequently he calmed down and was transferred to the psychiatry clinic, became agitated, escaped and was shot in a bar fight several hours later.

Another problem that has arisen in some cases is that PCP toxicity is mistaken for acute alcohol intoxication and the patients were placed in a "drunk tank" or jail cell where they became violent or lapsed into a medical emergency. In the cases of vehicular homicide the drivers were thought to be drunk and arrested for driving while intoxicated (DWI) but passed the intoximeter test (breathanalyzer). It was later discovered that they had taken PCP (IV) just prior to the incident.

A bizarre suicide occurred when a young male under the influence of PCP jumped in front of a bus. Several drownings have been reported in which persons jumped into a swimming pool and never surfaced. An attempted airline hijacking, armed robberies, burglaries and violent destructive behavior have been detected in our study. In most of the bizarre and/or violent behavior cases, the patient suffers memory loss and/or distortion of memory and usually cannot remember or realize what has occurred and reports that what occurred seemed like a dream or a detached event.

DETECTION

The detection of PCP in body fluids is best performed on urine samples, although it can be detected in blood and gastric content. TLC and GLC will detect levels down to 0.5 μg/ml. In approximately 60% of the cases these procedures were not sensitive enough and yielded false negative results. Later analysis, however, demonstrated the specimens to be positive by combination GC-MS analysis using specific ion monitoring techniques where sensitivity was approximately 5 μg/ml or a 100 fold increase over GLC or TLC. PCP has been detected in some cases 7 days after ingestion but usually becomes undetectable in 2 to 3 days even with GC/MS techniques. This, of course, depends on the dose which was taken by the patient and presupposes that an average street dose of 5 mg was taken. Higher doses will, of course, yield positive results for a larger period. It has been possible to detect one urinary metabolite of PCP (4-hydroxy-PCP) by GC-MS in several psychiatric cases in which no toxicity was ordered for several days after admission and in which the patient admitted to smoking a marihuana joint containing PCP.

The rather long life of PCP in the body is due to several of its chemical properties: (1) solubility in lipids and (2) being a weak base it readily ionizes in strong acid milieu of the stomach but as it passes to the more alkaline region of the bowel will deionize and is reabsorbed, thus prolonging its half-life.

No characteristic anatomical changes are seen in postmortem examination of PCP-related deaths. Confirmation is strictly by specific identification of PCP in gastric content blood or urine.

TREATMENT

Gastric lavage or emetics are usually ineffective because PCP is so rapidly absorbed. Acidification of urine by ammonium chloride followed by continuous gastric drainage may be of value. Valium (IM) may reduce agitation but may also retard clearance of PCP. Since PCP has anticholinergic properties, phenothiazines which also have anticholinergic properties should not be used because of the chance of precipitating an atropine crisis. Haldol is widely used but the undesirable side effects produced by this drug and the possibility of exacerbating dystonic reactions make this treatment a stopgap measure at best. There is no specific antidote for PCP intoxication.

SUMMARY

Any patient who exhibits bizarre and/or violent behavior may be under the influence of PCP. If possible this should be confirmed by laboratory analysis and the patient observed until laboratory results are obtained. Incarceration or short term hospitalization is not in the best interest of the patient, his attendants or the community because of the possibility of exacerbations of psychotic symptoms or emergence of a medical crisis. All such patients should be monitored until conclusive laboratory data are available and appropriate treatment initiated, or until the patient is psychiatrically stable for at least 24 hours. Similar reasoning should apply to persons who are arrested for DWI and who physically appear to be intoxicated yet have negative tests for blood alcohol. If possible a urine screen for PCP should be done before releasing the subject and returning control of a vehicle to such a person. Another point to be made because of the paranoid ideation produced by PCP is that such persons can be made worse by any type of situation or person he perceives as a threat. For example, one extremely violent patient could only be handled by nurse, attendants or physician in street clothing. The appearance of any type of uniform-police, white coats, etc., would immediately set off a violent episode in this patient. A quiet reassuring atmosphere with minimum intervention appears to be beneficial in these

cases.

Additionally, any cases of suicide, violent death, or fatal drug overdose should be screened for PCP by the coroner's office. This certainly will not help the patient but will assist in explaining the circumstances surrounding the demise and may be of legal use in cases where police action, self-defense of DWI charges are involved. With the current plethora of law suits such information may be useful by either defense or prosecution or in some cases both parties.

From the results of the study that we are conducting in New Orleans and of those reported from elsewhere in the United States, the promiscuous use of PCP is a major medical as well as a social hazard, and in a sense is more dangerous than the so-called "hard narcotics." One can argue, of course, that the hard narcotics are not only more dangerous in the physical sense, but are addicting as well, and, therefore, are much more hazardous than PCP. It should be pointed out, however, that narcotic addicts are, in general, more experienced in the use of drugs than are the users of PCP and, therefore, less likely to experience bad trips or overdoses than a naive drug user of the other street preparations. Regardless of the theoretical arguments concerning the relative merits of any street drug, PCP must be considered as a potentially lethal drug when used in the street form and the user would be aware of the possible consequences of its use; from the number of reports in the medical literature, this is not the case.