Dr Michelle Muscat

Angel dust or phencyclidine (PCP)1-3 is a crystalline powder which can have a high potential for toxicity.4 This arylcyclohexylamine is usually smoked but can also be taken by other routes such as the intranasal route or injected since it can be dissolved in a solvent. Marijuana can also be laced with PCP.

In the 1950s this drug was marketed as an anaesthetic pharmaceutical but this was later discontinued due to its adverse effect profile. PCP may induce hallucinations, erratic and violent behavior, dissociative states and paranoia. Other psychiatric manifestations have been reported5 including psychosis and suicidal urges. Other effects include gait disturbance, incoherent slurred speech, balance disturbances, with severe intoxication potentially even leading to convulsions.6 Instances of self-mutilation, cannibalism, rape and drowning in a bath have been reported to have occurred under the influence. It is neurotoxic and high dosages can give rise to rhabdomyolysis. There is the propensity for drug tolerance and withdrawal. Using dogs as animal models has shown that PCP can cause spasm of the cerebral arteries.7 Use of angel dust may also have adverse effects on the fetus.

PCP effects are mostly mediated through N-methyl-D-aspartate (NMDA) receptor blockade.8,9 Research on rodent models have indicated that PCP, being a nicotinic acetylcholine receptor inhibitor,10 exerts its effect on dopamine receptor binding.11,12 Other associations include monoamine dysfunction13,14 and dopaminergic dysregulation.15,16

Strategies are sought to deter drug users through education, awareness and drug testing amongst others.17-20 Further strategies are pursued to prevent abuse. In Malta, organizations and agencies such as Sedqa, Oasi Foundation, Caritas and Narcotics Anonymous provide support for drug-related issues.

As Vourakis and Bennett conclude, angel dust was definitely not heaven sent!21

References

  1. Iglesias Lepine ML, Pallas Vilaronga O, Lopez Casanovas MJ, et al. [Phencyclidine, PCP or “angel dust”: a forgotten drug]. Medicina clinica 2004; 122(7):276.
  2. O’Shea B. Phencyclidine, ketamine, and khat phencyclidine (PCP, DOA, ‘angel dust’, ‘crystal’, ‘hog’). Ir Med J 2000; 93(6):185.
  1. Dipalma JR. Phencyclidine: angel dust. Am Fam Physician1979;20(1):120-2.
  2. Petsonk CA, McAlister AL. “Angel dust:” an overview of abuse patterns and prevention strategies. J Sch Health 1979; 49(10):565-8.5. Pitts FN, Jr. Angel dust and psychiatry. J Clin Psychiatry 1981; 42(5):184.
  3. Robinson Bt, Yates A. Angel dust: medical and psychiatric aspects of phencyclidine intoxication. Arizona medicine 1984;41(12):808-11.
  4. Altura BT, Quirion R, Pert CB, et al. Phencyclidine (“angel dust”) analogs and sigma opiate benzomorphans cause cerebral arterial spasm. Proceedings of the National Academy of Sciences of the United States of America. 1983; 80(3):865-9.
  5. Hoiseth G, Hjelmeland K, Bachs L. Fensyklidin – englestøv [Phencyclidine – angel dust]. Tidsskr Nor Lægeforen 2005; 125(20):2775-6.
  6. Paul IA. Angel dust and other antagonists. Neurobiology of the NMDA Receptor: from Chemistry to Clinic, sponsored by the Society for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA, October 27-28, 1989. New Biol 1990;2(2):139-41.
  7. Eaton MJ, Labarca C, Eterovic VA. M2 mutations of the nicotinic acetylcholine receptor increase the potency of the non-competitive inhibitor phencyclidine. J Pharmacol Exp Ther 2000; 61(1):44-51.
  8. Fryer JD, Lukas RJ. Noncompetitive functional inhibition at diverse, human nicotinic acetylcholine receptor subtypes by bupropion, phencyclidine, and ibogaine. J Pharmacol Exp Ther 1999; 288(1):88-92.
  9. Dalton VS, Zavitsanou K. Rapid changes in d1 and d2 dopamine receptor binding in striatal subregions after a single dose of phencyclidine. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology 2011; 9(2):67-72.
  10. Elsworth JD, Groman SM, Jentsch JD, et al. Asenapine effects on cognitive and monoamine dysfunction elicited by subchronic phencyclidine administration. Neuropharmacology 2012; 62(3):1442-52.
  11. Jentsch JD, Elsworth JD, Redmond DE, et al. Phencyclidine increases forebrain monoamine metabolism in rats and monkeys: modulation by the isomers of HA966. J Neurosci 1997; 17(5):1769-75.
  12. Sershen H, Balla A, Aspromonte JM, et al. Characterization of interactions between phencyclidine and amphetamine in rodent prefrontal cortex and striatum: implications in NMDA/glycine-site-mediated dopaminergic dysregulation and dopamine transporter function. Neurochem Int 2008; 52(1-2):119-29.
  13. Javitt DC, Balla A, Burch S, et al. Reversal ofphencyclidine-induced dopaminergic dysregulation by N-methyl-D-aspartatereceptor/glycine-site agonists. Neuropsychopharmacology 2004; 29(2):300-7.PubMed PMID: 14560321.
  14. Hindersson P, Breindahl T. [Is testing for “angel dust” meaningful?]. Ugeskr Laege 2011; 173(19):1379.
  1. Kaul B, Davidow B. Radioimmunoassay screening test for detection of phencyclidine (PCP, “angel dust”) abuse among teenagers. Clin Toxicol 1980; 16(1):7-15.
  2. Chimalakonda KC, Hailey C, Black R, et al. Development and validation of an LC-MS/MS method for determination of phencyclidine in human serum and its application to human drug abuse cases. Anal Methods 2010; 2(9):1249-54.
  3. Isaacs SO, Martin P, Washington JA, Jr. Phencyclidine (PCP) abuse. A close-up look at a growing problem. Oral Surg Oral Med Oral Pathol 1986; 61(2):126-9.
  4. Vourakis C, Bennett G. Angel dust: not heaven sent. AJN 1979; 79(4):649-53.