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(^76) CHAPTER 4 Substance Abuse
(dizziness) and ataxia (stagger). They also have paresthesias (numbness, tin-
gling) and muscle weakness. The drug also induces drowsiness and sleep.
PCP
PCP is a controlled substance called phencyclidine that causes hallucinations.
Usage can result in assaults, murders, and suicides. PCP was developed in the
late 1950s as a dissociative anesthetic that leaves a patient awake but detached
from surroundings and unresponsive to pain. Once the drug’s hallucinogenic
effect was discovered, PCP was withdrawn from use in humans, but continued
to be used in veterinary medicine. PCP picked up the street name “hog” because
of its use with animals.
PCP metabolizes rapidly in the liver and forms a high concentration in urine
if taken in large quantities. A small dose of PCP has a half-life of between half
an hour and 1 hour. Larger doses can have a half-life of 1 to 4 days.
Patients who are under the influence of PCP are flushed and sweat profusely.
They have nystagmus (rapid eye movements), diplopia (double vision), and pto-
sis (drooping eyelids). These patients also appear sedated and under the influ-
ence of an analgesic. They also exhibit the effects of alcohol intoxication with
ataxia (staggering gait) and generalized numbness of the extremities.
Patients undergo three stages of psychological effect when using PCP. The first
stage is a change in body image and a feeling of de-personalization. This follows
with the second stage when the patient’s hearing and vision become distorted. The
third stage occurs when the patient feels apathy, estrangement, and alienation.
The patient’s thoughts become more disorganized. Attention span is impaired
as is motor skills and overall sense of body boundaries. The drug’s hallucinatory
effects can occur long after the patient’s acute symptoms are gone. These are
unpredictable and can happen months after the drug was taken.
The patient can experience psychotic disturbances which are exhibited by
paranoid behavior, self-destructive actions, random eye movement, and excita-
tion. These are combined with physiological changes such as tachycardia, hyper-
tension, respiratory depression, muscle rigidity, increased reflexes, seizures, and
an unconscious state with open eyes.
There is no known chemical antidote to PCP. The only treatment is to keep
the patient quiet, in a dark room, away from sensory stimuli, and protected from
self-inflicted injury. Don’t attempt to talk the patient down as the patient can per-
ceive any interaction as a personal attack and may become very violent. The
patient is commonly given diazepam (Valium) or haloperidol (Haldol) for their
antianxiety and antipsychotic effects.
PCP is very toxic and nurses should be aware of the severity of the drug’s
effects. These include hypertensive crisis, intracerebral hemorrhage (bleeding