Phencyclidine

Management of intoxication

Management of PCP intoxication mostly consists of supportive care – controlling breathing, circulation, and body temperature – and, in the early stages, treating psychiatric symptoms. Benzodiazepines, such as lorazepam, are the drugs of choice to control agitation and seizures (when present). Typical antipsychotics such as phenothiazines and haloperidol have been used to control psychotic symptoms, but may produce many undesirable side effects – such as dystonia – and their use is therefore no longer preferred; phenothiazines are particularly risky, as they may lower the seizure threshold, worsen hyperthermia, and boost the anticholinergic effects of PCP. If an antipsychotic is given, intramuscular haloperidol has been recommended.

Forced acid diuresis (with ammonium chloride or, more safely, ascorbic acid) may increase the clearance of PCP from the body, and was somewhat controversially recommended in the past as a decontamination measure. However, it is now known that only around 10% of a dose of PCP is removed by the kidneys, which would make increased urinary clearance of little consequence; furthermore, urinary acidification is dangerous, as it may induce acidosis and worsen rhabdomyolysis (muscle breakdown), a not-unusual manifestation of PCP toxicity.

Pharmacology

Pharmacodynamics

PCP is well known for its primary action on the NMDA receptor, an ionotropic glutamate receptor. As such, PCP is a non-competitive NMDA receptor antagonist. The role of NMDAR antagonism in the effect of PCP, ketamine, and related dissociative agents was first published in the early 1980s by David Lodge and colleagues. Other NMDA receptor antagonists include ketamine, tiletamine, dextromethorphan, nitrous oxide, and dizocilpine (MK-801).

Research also indicates that PCP inhibits nicotinic acetylcholine receptors (nAChRs) among other mechanisms. Analogues of PCP exhibit varying potency at nACh receptors and NMDA receptors. Findings demonstrate that presynaptic nAChRs and NMDA receptor interactions influence the postsynaptic maturation of glutamatergic synapses and consequently impact synaptic development and plasticity in the brain. These effects can lead to inhibition of excitatory glutamate activity in certain brain regions such as the hippocampus and cerebellum thus potentially leading to memory loss as one of the effects of prolonged use. Acute effects on the cerebellum manifest as changes in blood pressure, breathing rate, pulse rate, and loss of muscular coordination during intoxication.

PCP, like ketamine, also acts as a potent dopamine D₂^High receptor partial agonist in rat brain homogenate and has affinity for the human cloned D₂^High receptor. This activity may be associated with some of the other more psychotic features of PCP intoxication, which is evidenced by the successful use of D₂ receptor antagonists (such as haloperidol) in the treatment of PCP psychosis.

In addition to its well-explored interactions with NMDA receptors, PCP has also been shown to inhibit dopamine reuptake, and thereby leads to increased extracellular levels of dopamine and hence increased dopaminergic neurotransmission. However, PCP has little affinity for the human monoamine transporters, including the dopamine transporter (DAT). Instead, its inhibition of monoamine reuptake may be mediated by interactions with allosteric sites on the monoamine transporters. PCP is notably a high-affinity ligand of the PCP site 2 (K_i = 154 nM), a not-well-characterized site associated with monoamine reuptake inhibition.

Studies on rats indicate that PCP interacts indirectly with opioid receptors (endorphin and enkephalin) to produce analgesia.

A binding study assessed PCP at 56 sites including neurotransmitter receptors and transporters and found that PCP had K_i values of >10,000 nM at all sites except the dizocilpine (MK-801) site of the NMDA receptor (K_i = 59 nM), the σ₂ receptor (PC12) (K_i = 136 nM), and the serotonin transporter (K_i = 2,234 nM). The study notably found K_i values of >10,000 nM for the D₂ receptor, the opioid receptors, the σ₁ receptor, and the dopamine and norepinephrine transporters. These results suggest that PCP is a highly selective ligand of the NMDAR and σ₂ receptor. However, PCP may also interact with allosteric sites on the monoamine transporters to produce inhibition of monoamine reuptake.

Mechanism of action

Phencyclidine is a noncompetitive NMDA receptor antagonist that blocks the activity of the NMDA receptor to cause anaesthesia and analgesia without causing cardiorespiratory depression. NMDA is an excitatory receptor in the brain, when activated normally the receptor acts as an ion channel and there is an influx of positive ions through the channel to cause nerve cell depolarisation. Phencyclidine inhibits the NMDA receptor by binding to the specific PCP binding site located within the ion channel. The PCP binding site is near the magnesium blocking site, which may explain the similar inhibitory effects. Binding at the PCP site is mediated by two non-covalent interactions within the receptor: hydrogen bonding and hydrophobic interaction. Binding is also controlled by the gating mechanism of the ion channel. Because the PCP site is located within the ion channel, a coagonist such as glycine must bind and open the channel for PCP to enter, bind to the PCP site, and block the channel.

Neurotoxicity

Some studies found that, like other NMDA receptor antagonists, PCP can cause a kind of brain damage called Olney's lesions in rats. Studies conducted on rats showed that high doses of the NMDA receptor antagonist dizocilpine caused reversible vacuoles to form in certain regions of the rats' brains. All studies of Olney's lesions have only been performed on non-human animals and may not apply to humans. One unpublished study by Frank Sharp reportedly showed no damage by the NMDA antagonist ketamine, a structurally similar drug, far beyond recreational doses, but due to the study never having been published, its validity is controversial.

PCP has also been shown to cause schizophrenia-like changes in N-acetylaspartate and N-acetylaspartylglutamate levels in the rat brain, which are detectable both in living rats and upon necropsy examination of brain tissue. It also induces symptoms in humans that mimic schizophrenia. PCP not only produced symptoms similar to schizophrenia, it also yielded electroencephalogram changes in the thalamocortical pathway (increased delta decreased alpha) and in the hippocampus (increase theta bursts) that were similar to those in schizophrenia. PCP-induced augmentation of dopamine release may link the NMDA and dopamine hypotheses of schizophrenia.

Pharmacokinetics

PCP is both water- and lipid-soluble and is therefore distributed throughout the body quickly. PCP is metabolized into PCHP, PPC and PCAA. The drug is metabolized 90% by oxidative hydroxylation in the liver during the first pass. Metabolites are glucuronidated and excreted in the urine. Nine percent of ingested PCP is excreted in its unchanged form.

When smoked, some of the compound is broken down by heat into 1-phenylcyclohexene (PC) and piperidine.

The time taken before the effects of PCP manifest is dependent on the route of administration. The onset of action for inhalation occurs in 2–5 minutes, whereas the effects may take 15 to 60 minutes when ingested orally.

Chemistry

PCP is an arylcyclohexylamine.

Analogues

Fewer than 30 different analogs of PCP were reported as being used as a street drug during the 1970s and 1980s, mainly in the United States. Only a few of these compounds were widely used, including rolicyclidine (PCPy), eticyclidine (PCE), and tenocyclidine (TCP). Less common analogs include 3-HO-PCP, 3-MeO-PCMo, and 3-MeO-PCP.

The generalized structural motif required for PCP-like activity is derived from structure-activity relationship studies of PCP derivatives. All of these derivatives are likely to share some of their psychoactive effects with PCP itself, although a range of potencies and varying mixtures of anesthetic, dissociative, and stimulant effects are known, depending on the particular drug and its substituents. In the United States, all of these compounds would be considered controlled substance analogs of PCP under the Federal Analog Act and are hence illegal drugs if sold for human consumption.

History

Phencyclidine was initially discovered in 1926 by Arthur Kötz and his student Paul Merkel as a product of a Grignard reaction of 1-piperidinocyclohexancarbonitrile.

It was again synthesized in 1956 by chemist H Victor Maddox and brought to market as an anesthetic medication by pharmaceutical company Parke-Davis, now a subsidiary of Pfizer. Its use in humans was disallowed in the US in 1965 due to the high rates of side effects, while its use in animals was disallowed in 1978. Moreover, ketamine was discovered and was better tolerated as an anesthetic.

PCP is classified as a schedule II drug in the US. Derivatives of PCP have been sold for recreational and non-medical use.

Society and culture

Regulation

PCP is a Schedule II substance in the US. The Administrative Controlled Substances Code Number (ACSCN) for PCP is 7471. Its manufacturing quota for 2014 was 19 grams (0.67 oz). It is a Schedule I drug by the Controlled Drugs and Substances act in Canada, a List I drug of the Opium Law in the Netherlands, and a Class A substance in the UK.

Frequency of use

PCP began to emerge as a recreational drug in major cities in the US in the 1960s. In 1978, People magazine and Mike Wallace of the TV news program 60 Minutes called PCP the country's "number one drug problem". Although recreational use of the drug had always been relatively low, it began declining significantly in the 1980s. In surveys, the number of high school students admitting to trying PCP at least once fell from 13% in 1979 to less than 3% in 1990.

Cultural depictions

Jean-Michel Basquiat depicted two angel dust users in his 1982 painting Dustheads.

Tsukasa Hojo's 1985 manga City Hunter features a drug, Angel Dust, presumably a reference to PCP's street name. The related 2023 animated film, City Hunter: Angel Dust, more directly moved the franchise's angel dust into the realm of fantasy, as it is portrayed as a science fiction nanomachine serum developed by a biotech company to create super-soldiers with a tendency to drive them berserk, side-stepping the real-life PCP.