Three clinical cases-reports in France with 3-MeO-PCP in 2018. The “Angel Dust”, baby it is here!

PCP, a dissociative anaesthetic first synthesized in 1956 and later discontinued due to adverse effects, has reappeared on the street drug market. Three cases of 3-MeO-PCP consumption are reported: a 36-year-old male presenting with agitation, confusion, and hypertonia; a 32-year-old male with abdominal pain and suspected cannabis hyperemesis; and a routine urine test in a methadone user. All cases occurred within a week in the same town, suggesting local PCP trafficking. Benzodiazepines successfully reduced symptoms. French health authorities were alerted due to life-threatening risks.

Study at a glance

Abstract

Introduction PCP was synthesized in 1956 by Maddox and was established as a potent general anaesthetic, but it was early discontinued due to more frequent adverse drug reactions than expected. Later, PCP became a popular street drug. We report 3 cases of people who consumed PCP: 1 typical clinical case and also 2 others cases with PCP on drug urine testing. Case reports Case 1: a 36-year-old male was found agitated on the street, crying that PCP was the best drug in the world. On ED, he presented alternatively confusion, aggressiveness, logorrhoea, hypertonia of 4 members, myosis, hypersalivation and then was calm. TA was 151/90 mmHg, heart rate 100 bpm, glycemia 5 mmol/L, temperature 37.3 °C. CPK was 273 UI/L with unremarkable liver enzymes and creatinine. He was given 5 mg of midazolam. Alcohol level was 0.185 dg/L, urine testing with Drug-Screen® (Nal Von Minden), positive for buprenorphine and tramadol. CG-MS found 3-MeO-PCP. Case 2: a 32-year-old male presented to ED for abdominal pains with a past history of strong cannabis user. Painkillers were inactive with high doses of morphine, paracetamol and nefopam. Explorations were negative and Cannabis Hyperemesis was suspected. TA was 137/87 mmHg, heart rate 83 bpm, glycemia 8.1 mmol/L, temperature 36 °C and white blood cell was 20.8 giga/L. Urines testing with Drug-Screen® were positive for opiates, THC-COOH, tramadol. 3-MeO-PCP was curiously identified. Case 3: a urine routine test on drug methadone user was done. Trace of 3-MeO-PCP was detected by GC-MS. No clinical sign was reported. All cases have been seen in a week in the same town, leading to a PCP traffic on street drug users. Discussion PCP, an old arylcyclohexanexylamine is a potent dissociative anaesthetic drug due to be antagonist of the N methyl D Aspartate receptor (NMDAR) displaying dissociative anaesthetic effects as ketamine and MK 801. PCP was labelled in 1957 as Sernyl®, severe adverse effects have led to its early discontinuation and replacement by ketamine in 1962 [1] . PCP nonmedical use was famous years later for its un-human-strength effects appearing as supernatural and was scheduled II in 1978, with continued authorized veterinary use. Disappeared from the street market and back in 2012, PCP use has led to publications relating cases with fatalities in 2017 in Sweden, Italy, France and Belgium with an early warning system message for Europe in 2017 [2] . PCP use has been diagnosed in 2018 in France, on drug users presenting unusual clinical signs (bizarre behaviour, catatonia and agitation). Benzodiazepines were successfully used for reducing symptoms. PCP was told to have being bought on the black market. In our cases, CG-MS has found 3-MeO-PCP with m/z 274—86,121 on their urine samples, with other drugs. On drug-screen, tramadol was falsely positive due to crossed reaction with PCP. Due to those new cases and life threatening risk, French Health Authorities were sending an alert message. Those cases were seen on one-month duration, leading to hypothesise as delivery of small amount of PCP or consumption of small amount or by advised customers. Conclusion PCP, the “supernatural” street drug is back and must be reported to health authorities to help closing illegal dark market.