Phencyclidine (PCP), often called “angel dust,” is a powerful synthetic dissociative hallucinogen. Originally developed as an anesthetic, it was discontinued due to severe psychological side effects. PCP alters brain function, causing a profound detachment from reality and distorted perception of sight and sound. Intoxication manifests as extreme agitation, psychosis, and violent behavior, posing a significant risk of injury to the patient or others. Treatment is primarily supportive, focusing on managing these severe symptoms and complications while the body metabolizes the drug.
Acute Medical Stabilization
The immediate priority is the systematic assessment and stabilization of the patient’s core life functions (ABCs: Airway, Breathing, and Circulation). High doses of PCP can cause respiratory depression or altered mental status, potentially requiring intubation and mechanical ventilation to secure a patent airway. Continuous and close monitoring of all vital signs—including heart rate, blood pressure, respiratory rate, and body temperature—is necessary, as these can fluctuate rapidly and dangerously.
Establishing intravenous access is crucial for the rapid administration of fluids and medications to manage emerging complications. Initial stabilization also requires creating a controlled, low-stimulus environment. Minimizing external stimuli like loud noises, bright lights, and excessive physical handling helps reduce agitation and prevents worsening behavioral symptoms. This initial phase focuses strictly on maintaining physiological stability and preventing physical harm to the patient and medical staff.
Managing Behavioral and Psychological Symptoms
Controlling the severe psychomotor agitation, paranoia, and violent behavior is a primary focus of acute care. Because patients often have a diminished perception of pain and feelings of invulnerability, both chemical and safe physical restraints are frequently required to prevent accidental injury and facilitate medical treatment. Chemical sedation is the preferred method, with benzodiazepines serving as the first-line pharmacologic treatment for agitation, muscle spasms, and seizures.
Benzodiazepines, such as lorazepam or diazepam, are typically administered intravenously or intramuscularly, often requiring repeated doses for adequate sedation and behavioral control. They are favored because they calm the patient and help control the severe hypertension and tachycardia associated with PCP toxicity. Older antipsychotics like phenothiazines are generally avoided, even for severe psychosis, because they can lower the seizure threshold and worsen hyperthermia. Non-pharmacological de-escalation is often unsuccessful until chemical sedation takes effect due to the drug’s potent dissociative effects.
Addressing Specific Physical Complications
Extreme physical activity and PCP’s effects on the central nervous system can lead to several serious complications requiring targeted intervention. Severe hyperthermia (excessively high body temperature) is one of the most dangerous, potentially leading to multi-organ failure. Treatment involves aggressive external cooling techniques, such as ice packs or cooling blankets, to rapidly lower the core body temperature.
Antipyretic medications like acetaminophen are ineffective because the temperature elevation results from muscle activity and CNS effects, not a change in the body’s thermoregulatory set point. Severe, persistent hypertension must also be managed, as it places the patient at risk for stroke or heart attack. If benzodiazepines fail to control dangerously high blood pressure, specific intravenous medications like phentolamine or nitroprusside may be necessary.
Rhabdomyolysis Management
The prolonged, intense muscle activity can cause rhabdomyolysis, the breakdown of muscle tissue that releases toxic proteins into the bloodstream. This complication is treated with aggressive intravenous hydration using normal saline to promote a high urine output. This helps flush myoglobin proteins out of the kidneys and prevents acute kidney injury.
Long-Term Recovery and Rehabilitation
Once acute intoxication passes and physical stability is confirmed, the focus shifts to addressing the underlying substance use disorder. Recovery programs move beyond the immediate medical crisis to treat the behavioral and psychological dependence that can develop with chronic PCP use. This comprehensive approach typically includes a combination of both inpatient and outpatient rehabilitation services.
Psychotherapy, particularly Cognitive Behavioral Therapy (CBT), is a primary therapeutic tool in recovery. CBT helps individuals identify drug use triggers and develop healthier, more effective coping mechanisms to prevent relapse. Addressing co-occurring mental health conditions (such as anxiety, depression, or psychosis) is also a necessary component of long-term treatment. Ongoing support, including group therapy and relapse prevention strategies, is implemented to support sustained abstinence and a return to normal function.