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Phencyclidine (PCP, angel dust, peace pill, hog), developed as an anesthetic agent, first appeared as a street drug deceptively sold as tetrahydrocannabinol (THC) Because it is simple to produce and mimics to some degree the traditional psychedelic drugs, PCP has become a common deceptive substitute for LSD, THC, and mescaline It is available in crystals, capsules, and tablets to be inhaled, injected, swallowed, or smoked (it is commonly sprinkled on marijuana) Absorption after smoking is rapid, with onset of symptoms in several minutes and peak symptoms in 15 30 minutes Mild intoxication produces euphoria accompanied by a feeling of numbness Moderate intoxication (5 10 mg) results in disorientation, detachment from surroundings, distortion
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some women Cognitive impairments are common Health care utilization for a variety of health problems is increased in chronic marijuana smokers Sudden withdrawal produces insomnia, nausea, myalgia, and irritability Psychological effects of chronic marijuana usage are still unclear Urine testing is reliable if samples are carefully collected and tested Detection periods span 4 6 days in acute users and 20 50 days in chronic users
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Stimulant abuse is quite common, either alone or in combination with abuse of other drugs The amphetamines, including Methedrine ( speed ) one variant is a smokable form called ice, which gives an intense and fairly long-lasting high methylphenidate, and phenmetrazine, are under prescription control, but street availability remains high Moderate usage of any of the stimulants produces hyperactivity, a sense of enhanced physical and mental capacity, and sympathomimetic effects The clinical picture of acute stimulant intoxication includes sweating, tachycardia, elevated blood pressure, mydriasis, hyperactivity, and an acute brain syndrome with confusion and disorientation Tolerance develops quickly, and, as the dosage is increased, hypervigilance, paranoid ideation (with delusions of parasitosis), stereotypy, bruxism, tactile hallucinations of insect infestation, and full-blown psychoses occur, often with persecutory ideation and aggressive responses Stimulant withdrawal is characterized by depression with symptoms of hyperphagia and hypersomnia People who have used stimulants chronically (eg, anorexigenics) occasionally become sensitized ( kindling ) to future use of stimulants In these individuals, even small amounts of mild stimulants such as caffeine can cause symptoms of paranoia and auditory hallucinations Cocaine is a stimulant It is a product of the coca plant The derivatives include seeds, leaves, coca paste, cocaine hydrochloride, and the free base of cocaine Cocaine hydrochloride is the salt and the most commonly used form Free base, a purer (and stronger) derivative called crack, is prepared by simple extraction from cocaine hydrochloride There are various modes of use Coca leaf chewing involves toasting the leaves and chewing with alkaline material (eg, the ash of other burned leaves) to enhance buccal absorption One achieves a mild high, with onset in 5 10 minutes and lasting for about an hour Intranasal use is simply snorting cocaine through a straw Absorption is slowed somewhat by vasoconstriction (which may eventually cause tissue necrosis and septal perforation); the onset of action is in 2 3 minutes, with a moderate high (euphoria, excitement, increased energy) lasting about 30 minutes The purity of the cocaine is a major determinant of the high Intravenous use of cocaine hydrochloride or freebase is effective in 30 seconds and produces a short-lasting, fairly intense high of about 15 minutes duration The combined use of cocaine and ethanol results in the metabolic production of cocaethylene by the liver This substance produces more intense and long-lasting cocaine-like effects Smoking freebase (volatilized cocaine because of the lower boiling point) acts in seconds and results in an intense high lasting several minutes The intensity of the reaction is related to the marked lipid solubility of the freebase
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form and produces by far the most severe medical and psychiatric symptoms Cardiovascular collapse, arrhythmias, myocardial infarction, and transient ischemic attacks have been reported Seizures, strokes, migraine symptoms, hyperthermia, and lung damage may occur, and there are several obstetric complications, including spontaneous abortion, abruptio placentae, teratogenic effects, delayed fetal growth, and prematurity Cocaine can cause anxiety, mood swings, and delirium, and chronic use can cause the same problems as other stimulants (see above) Clinicians should be alert to cocaine use in patients presenting with unexplained nasal bleeding, headaches, fatigue, insomnia, anxiety, depression, and chronic hoarseness Sudden withdrawal of the drug is not life-threatening but usually produces craving, sleep disturbances, hyperphagia, lassitude, and severe depression (sometimes with suicidal ideation) lasting days to weeks Treatment is imprecise and difficult Since the high is related to blockage of dopamine reuptake, the dopamine agonist bromocriptine, 15 mg orally three times a day, alleviates some of the symptoms of craving associated with acute cocaine withdrawal Other dopamine agonists such as apomorphine, levodopa, and amantadine are under study for this purpose Carbamazepine may be a useful adjunct in treating symptoms of alcohol withdrawal, and desipramine in moderate doses has been useful in helping maintain abstinence in the early stages of treatment Treatment of psychosis is the same as that of any psychosis: antipsychotic drugs in dosages sufficient to alleviate the symptoms Any medical symptoms (eg, hyperthermia, seizures, hypertension) are treated specifically These approaches should be used in conjunction with a structured program, most often based on the Alcoholics Anonymous model Hospitalization may be required if selfharm or violence toward others is a perceived threat (usually indicated by paranoid delusions)
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