In the past, most surveys of drug use have included PCP within a category of "other hallucinogens," making trend detection difficult. Further, the patient admitted for emergency treatment of PCP-induced bizarre behavior is likely to be diagnosed as schizophrenic, rather than as a drug reaction. Patients admitted with injuries from automobile accidents, fires, and drownings in which PCP was a cause may not be so identified. Thus, any marked increase in use and in use-related drug emergencies is not fully reflected in national statistics. There is good evidence, ranging from reports of law enforcement agencies on disruption of illegal laboratory production to self-reports by users, to suggest increased use in recent months. In the National Institute on Drug Abuse (NIDA) 1977 National Survey, 6 percent, or an estimated 1,440,000 youth between 12 and 17 years of age, acknowledged having used PCP at some time in their lives, a doubling of use since 1976. Among young adults 18-25, the age category in which drug use peaks, 14 percent, or an estimated 4,210,000 young adults, reported having ever used PCP, an increase of 46 percent in the number of young adult users since 1976. By the end of 1977 an estimated 52 million people between 12 and 25 had experimented with PCP (Chart 1). Nearly one-third of 2,700 adolescents under age 19 enrolled in drug abuse treatment programs studied recently reported having used PCP and used it more often than inhalants, sedatives, and cocaine. Females in the survey were as likely to have used PCP as males. White (42 percent) were far more likely to have used it than either black (9 percent) or Hispanic (9 percent) clients. PCP use among youths referred for treatment is commonly an integral part of a larger multidrug use pattern. (Services Research Report: Phencyclidine Use Among Youths in Drug Abuse Treatment, Jan. 1978). The most recently available Drug Abuse Warning Network (DAWN) data reveals an increase over the last two years in the number of people having problems resulting from the use of PCP (Charts 2, 3 and 4). However, PCP accounted for 2 percent of the drug mentions in emergency rooms for the reporting period October-December 1977 (Chart 5). A greater percentage of persons reported in emergency rooms or medical examiner's offices with problems attributed to diazepam (Valium)-11.8 percent, flurazepam (Dalmane)-2.5 percent, alcohol in combination with another drug-11.5 percent, heroin-4.9 percent, and aspirin4 percent. Nearly all the emergency room cases were persons under age 30; 73 percent of those were male and 58 percent were white (Chart 6). In order to provide sensitive and current data about drug use patterns, the Institute has developed a growth index program using data provided through the DAWN network. Under this system Institute officials are made aware whenever any one of 300 monitored drugs approaches certain predetermined "danger" limits. Charts 7 and 8, containing data based on a 3-month moving average, give an indication of more recent national trends for PCP use. Although these charts cannot be compared to the earlier charts as a different group of hospitals provided data, it is significant to note the peaks in PCP use reported in the periods January and February 1977, June 1977, November 1977, and February 1978. In response to the NIDA PCP Task Force and in order to obtain preliminary data from NIDA's Client Oriented Data Acquisition Process (CODAP) system, a special study of a 10 percent random sample of all federally funded drug abuse treatment clinics reporting to CODAP was begun in June 1977. One hundred twenty-one clinics located in 36 states, the District of Columbia, and Puerto Rico were studied over the 4-month period March to June 1978. Of the 3,323 client admissions to treatment during that period, PCP represented 2.2 percent of all primary drug problems, 1.1 percent of secondary drug problems, and 1.3 percent of tertiary drug problems (Charts 9 and 10). Four-fifths of the PCP admissions in the sample were for whites (Chart 11). Seven out of 10 admissions were for male clients. White males accounted for 55.6 percent of PCP admissions, while white females accounted for 24.2 percent. Two-fifths of the clients using PCP had no use of the drug during the month prior to their admission (Chart 12). However, 13.2 percent reported use of PCP at least once per day. 46.3 percent took PCP orally, 37.3 percent smoked their PCP, and 10.7 percent inhaled it. Two thirds of the PCP users in the sample first began using PCP after 1974; 13.5 percent first used PCP in 1975, 14.6 percent in 1976, 28.7 percent in 1977, and 9.6 percent in 1978 (Chart 13). Effective January 1979, PCP will be added to all CODAP forms as a separate drug category so that all treatment service units will be able to report PCP use. EFFECTS OF PHENCYCLIDINE The known effects of PCP are so unpleasant that many have wondered how the drug could possibly prove popular. PCP has a street reputation as a “bad” drug, and many people-after using the drug-will not knowingly use it again. Yet others enjoy it consistently and use it chronically. Among the effects of a moderate amount of PCP, depersonalization is reported most frequently. The user feels a sense of distance and estrangement from his surroundings. Time and body movement are slowed down. Muscular coordination worsens and impulses are dulled; the user may stagger as if drunk. Speech is blocked, sparse, and purposeless. Auditory hallucinations may occur, more frequently at higher doses, and feelings of impending doom or death may appear and disappear. Touch and pain sensations are dulled. Bizarre behavior, such as nudity in public places and barking while crawling on the floor, have been reported. Some of the other effects reported by PCP users are: feelings of strength, power, and invulnerability which sometimes lead to violent acts. The effects of the drug are often described as stronger than marihuana, more comparable to LSD, but basically "in a class by itself." Chronic users of PCP report persistent memory problems and speech difficulties including stuttering and poor speech. Some of these effects may last 6 months to a year following prolonged (for more than 6 months) daily use. Mood disorders also occur: depression, anxiety, and violent behavior. Following a 2-3 day "run," users often need great amounts of sleep and may awaken feeling disoriented and depressed. In later stages of chronic use, paranoid and violent behavior with auditory hallucinations often appear. Chronic users have reported losing 10-35 pounds of body weight during regular use. There is some clinical evidence that individuals who have used PCP may develop a persistent prolonged psychosis resembling schizophrenia despite abstinence from the drug. Because of increasing evidence of effects that phencyclidine can have, an Institute Task Force on PCP was established in early August 1977 to obtain information on the nature and extent of PCP abuse and its distribution, to develop comprehensive information about PCP, and to disseminate this information to the public. The PCP Plan developed by the Task Force includes education/prevention, training, treatment, and research initiatives, as well as support of the rescheduling of PCP and some of its precursors and analogs. The Office of Drug Abuse Policy, National Institute on Drug Abuse, National Institute of Mental Health, Drug Enforcement Administration, and Food and Drug Administration have pooled their expertise to better coordinate multi-agency efforts through a PCP Action Coordinating Committee formed at the initiative of the White House Office of Drug Abuse Policy. In early December 1977, more than 18,000 letters were sent to alert treatment programs, emergency rooms and other service agencies to the PCP problem and its recognition and treatment, as well as the procedure for detection of PCP. In addition, letters were distributed to all medical examiners urging them to be alert to PCP-related deaths, particularly deaths by accident, fire, and drowning, and to inform them of the procedure for detection of PCP in blood, urine, and body tissue. NIDA has published a brief fact sheet in both Spanish and English to respond to public inquiries. This includes information for use by parents, youth, and educators about PCP and its acute and chronic effects, why people use it, and what to do if someone is using PCP. In addition, NIDA has produced a report which provides an overview of the chemistry, pharmacology, and toxicology of the drug, as well as a discussion of the problems associated with its use. We have developed a 30-second Public Service Television Announcement about the risks of PCP, which has been distributed to all TV stations in the United States. In response to many requests from the media and the public, NIDA also published a brief summary of the extent of PCP abuse and of its acute and chronic effects. PCP is discussed in all NIDA public information and education efforts and is included in the materials developed for the 1978 National Drug Abuse Prevention Campaign, aimed at preventing, reducing, or delaying the misuse and abuse of all drugs primarily among young people aged 8 to 20. NIDA's prevention efforts are focused in four areas: information, education, alternatives, and intervention. They are not drug specific but deal with promoting positive healthy growth and development. In late February 1978, more than two dozen researchers and clinicians from various parts of the United States participated in a conference on PCP sponsored by the Division of Research, in order to review the present state of knowledge about PCP and to focus on areas requiring additional research. A NIDA research monograph on PCP containing the papers delivered at the conference will be published later this summer. The findings presented at the meeting included the following: 1. The use of PCP is increasing. Smoking and snorting are the most common modes of use, intravenous use is less frequent. 2. There is evidence that where the drug is continuously available, it has gained a preferred drug status with small clusters of individuals who use it on a chronic daily basis for periods of 6 months to 6 years. 3. Some youth are now using PCP in social settings in a way similar to marihuana and many have the misconception that PCP is "a little stronger than marihuana." 4. A number of young children have been accidentally poisoned with PCP. 5. With high-dose chronic administration, tolerance can develop to some of the effects of PCP; however, present evidence does not indicate that PCP is addictive. 6. Studies of the effects of PCP on the brain have suggested that various specific neurotransmitters may be involved in some way in mediating the drug's effects. 7. In one study of chronic users in Chicago, 88 percent believed the drug to be dangerous, but, nevertheless, continued to use it. For some, the fact that use is risky may add to the thrill. As a result of the conference, NIDA has identified areas in which research on PCP is needed and has released an announcement of areas of special interest in order to encourage investigators to submit research grant proposals on PCP and PCP-like drug abuse. The Institute has also published a report on PCP which includes information on extent of abuse, acute and chronic effects, diagnosis and treatment of adverse reactions. In addition to these activities, two PCP treatment manuals, to be used by emergency room personnel and health professionals who deal with persons intoxicated with PCP, are currently being developed and will be utilized in various training strategies. PCP information has also been included in all of the Institute's training materials. In addition to those efforts, an ethnographic study of PCP users in four U.S. cities-Seattle, Chicago, Philadelphia, and Miami-has just recently been completed. This study focused on the natural context of PCP use, characteristics of the users, and the effects of the drug. Finally, the treatment systems in five cities located in different areas of the country are being surveyed to determine the extent to which PCP users have sought drug abuse treatment services. NIDA, together with DEA and FDA, is reviewing analogs to PCP (compounds with similar effect) and will make appropriate recommendations for scheduling. FDA has recommended to the Assistant Secretary for Health that ethylamine (PCE) and pyrrolidine (PHP or PcPy) analogs be placed in Schedule I. NIDA has several efforts under way in which additional PCP analogs will be tested for their abuse potential; several have been synthesized by NIDA. The NIDA Addiction Research Center in Lexington, Kentucky, is currently assessing the abuse potential of a few of these analogs in dogs and has initiated behavioral studies in rats and monkeys. Under contract jointly monitored by DEA and NIDA, Dr. Keith Killim of the University of California at Davis, will look at these compounds using EEG patterns and self-administration behavior in monkeys as experimental models. Finally, NIDA and DEA, with scientific assistance from FDA, will develop a contract program to assess the abuse potential of PCP and its analogs. The PCP phenomenon provides us with an example of what can happen with chemical substances that can be easily synthesized. The fact that PCP is highly potent as well as readily available, inexpensive, and easily manufactured, has contributed to its increasing abuse. NIDA has initiated activity to provide the public with information on the nature and extent of the PCP problem. We welcome your efforts to focus attention on the harm that may be caused by this drug. I would be pleased to answer any questions the Committee might have at this time. CHART 1 jmem NIDA Capsules DRUG ABUSE STATISTICS 1977 Issued by the Press Office of the National Institute on Drug Abuse Following are estimates of the numbers of people in the United States over 12 years of age who have tried or are current users of the drugs listed below. These figures are based on a complex scientific survey of 4,594 people. Sponsored by the National Institute on Drug Abuse, the survey concentrated only on non-medical or recreational use of these drugs. Drugs used under a physician's care are not included. * not included in the survey amounts of less than .5% are not listed TERMS: Ever Used = use one or more times in a person's life Current User = use at least once in the 30 days prior to survey SOURCE: NATIONAL SURVEY ON DRUG ABUSE: 1977, available from the National Clearinghouse for Drug Information, 5600 Fishers Lane, Rockville, MD 20857 C78-7 March 17, 1978 |