What are PCP and Hallucinogen Use Disorders?
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Although phencyclidine and other hallucinogens make up two separate substance use categories, they are frequently studied and discussed together and are often all grouped together under the term “hallucinogens”. In fact, across the two disorders, there are at least four distinct genres of substances (phencyclidines, phenylalkylamines, indoleamines, and ergolines), not to mention several outliers. The common thread across all these substances is that they alter users’ perceptions of reality in several ways.
PCP
Using phencyclidine (‘PCP’, ‘angel dust’) causes aggression and erratic behavior. Users have reduced judgment, and they are frequently confrontational and dangerous. They tend to appear visibly agitated and tense. They also have an altered gait, speech pattern changes, and decreased sensitivity to pain. Chronic phencyclidine or ketamine (‘special K’) use can lead to persistent psychotic states lasting days or weeks beyond the last dose of the drug. These appear very similar to an exacerbation of Schizophrenia. Patients have hallucinations, delusional and disorganized thoughts, separation from reality, agitation, reduced speech, emotional changes, impaired motivation, and social withdrawal. Long term phencyclidine use can also cause speech and cognitive difficulties, depression, anxiety, and suicidality.
MDMA
MDMA (3,4-methylenedioxymethamphetamine, ‘ecstasy’ or ‘molly’) originally developed a reputation as a “club drug”, first seeing frequent use at raves (large, overnight dance parties). It acts not only as a stimulant, but also makes users more empathic and emotionally open. Users experience increased energy, sexual arousal, euphoria, altered senses, and, most classically, increased sensitivity and intimacy with others. MDMA’s other immediate effects are similar to those of amphetamines (to which MDMA is closely related), such as restlessness, muscle tension, dry mouth, teeth grinding, increased heart rate and blood pressure, and high body temperature. Higher doses lead to hallucinations, agitation, anxiety, temporary psychosis, and disorganized and bizarre behavior. A ‘hangover’ period follows in the next 24-48 hours characterized by depression, decreased energy, and lack of concentration.
Chronic MDMA use damages serotonin-releasing cells in the brain, reducing both their numbers and their activity. Brain wave activity in these patients appears similar to that of dementia patients. Patients suffer significant cognitive problems (impaired memory, organization, and problem-solving), and the severity is directly proportional to the amount of MDMA that was used. Patients also deal with long lasting mood and behavioral changes, such as treatment-resistant depression, panic disorder, and impulsivity. They can also experience flashbacks characterized by paranoia, hallucinations, and psychosis.
Hallucinogens
Hallucinogens other than phencyclidine and MDMA manipulate serotonin levels to create auditory, visual, and tactile hallucinations. User’s senses intensify, and they experience changes in perception of the passage of time. The different compounds can bring about emotional reactions, agitation, relaxation, and even metaphysical experiences. The effects of LSD (lysergic acid diethylamide, ‘acid’), psilocybin (‘magic mushrooms’, ‘shrooms’), and peyote cactus take up to 1.5 hours to begin and can last up to 12 hours. Those of Salvia divinorum and DMT (dimethyltryptamine) start within minutes and last up to an hour.
Long term users of these drugs (though most evidence concerns LSD specifically) can develop two different disorders: chronic psychosis and Hallucinogen Persisting Perception Disorder (HPPD). Chronic psychosis mimics schizophrenia and includes paranoia, hallucinations, disorganized thought patterns, and mood issues. HPPD occurs long after the last drug use and consists of episodes (formerly referred to as ‘flashbacks’) of perceptual changes and hallucinations similar to those experienced when the drug is taken.