Flakka More Dangerous Than Bath Salts

Officials Report Extreme Reactions to Synthetic Drug

Flakka. DEA

Public health officials are concerned about the growing number of reported negative and extreme psychological reactions to a new designer drug called Flakka, which is a souped up version of the synthetic drugs known as bath salts.

Flakka is the result of drug manufacturers trying to get around a 2012 federal law that banned various forms of bath salts, also known as fake cocaine. The drug's makers altered the chemicals of the banned varieties to get around the law.

The result is Flakka, sold in some sections of the country as "gravel," which has reportedly caused users to have heart palpitations and exhibit aggressive, violent and paranoid behavior.

Experts say the new amphetamine-like drug, which is a version of synthetic cathinones, is stronger and more addictive than previous versions. It's like bath salts on, well, drugs. The drug is sometime referred to as "$5 Insanity" on the street.

Flakka Use Growing Rapidly

According to the Drug Enforcement Administration (DEA), the use of Flakka is growing rapidly, especially in Florida, Ohio and Texas. The number of cases of Flakka abuse went from zero in 2010 to 85 cases in 2012, to more than 670 cases in 2014.

In Florida, state crime lab testing for flakka went from 38 in 2013 to 228 in 2014. In Broward County, the sheriff's lab tested for flakka 200 times in 2014, but had 275 flakka submissions in the first three months of 2015.

Synthetic cathinones cases, which include bath salts and Flakka increased from 14,239 to 16,500 from 2012 to 2013.

What Is Flakka?

Flakka is a compound known as alpha-PVP, which is synthetically produced from a derivative of the drug cathinone, an amphetamine-like drug that comes from the khat plant.

It is being marketed in the United States in a crystalline rock form, which experts say can be swallowed, snorted, injected, or vaped in an e-cigarette.

Because it can be used in e-cigarette form, it can be used and easily concealed in plain view.

Effects of the drug, which is highly physically and psychologically addictive, can be from 3-4 hours to as long as several days.

How Flakka Affects the Brain

Because the drug is so new, there are no published studies about Flakka's short-term and long-term effects. The information which is available is from case reports from physicians and healthcare providers who have been treating its users in emergency departments.

Experts say Flakka acts as a re-uptake inhibitor of dopamine and norepinephrine, both of which are involved in nerve transmission. In normal circumstances these brain chemicals are taken back up by cells after they are released, but Flakka blocks this reuptake mechanism.

When dopamine and norepinephrine are blocked by Flakka from reuptake, it concentrates and prolongs their effects, creating a state known as "excited delirium."

The Short-Term Effects of Flakka

During a state of excited delirium, the body's temperature can spike to 105 to 106 degrees, which can lead to kidney damage and other problems.

The physiologic effects of Flakka reported by healthcare providers include:

"It actually starts to rewire the brain chemistry. They have no control over their thoughts. They can't control their actions," said Don Maines, a drug treatment counselor with the Broward Sheriff's Office. "It seems to be universal that they think someone is chasing them. It's just a dangerous, dangerous drug."

Alpha-PVP Is Now Banned

In early 2014, the DEA banned alpha-PVP, the main ingredient of Flakka, and labeled it a Schedule 1 drug, but the move mostly went unnoticed in the media. It wasn't until a couple of incidents of bizarre behavior by Flakka users were reported in the news that the national media began to take notice.

In one incident, it took five Miami police officers to restrain a man who ran through the streets screaming loudly and wearing nothing but his sneakers. In the second incident, someone took a video of a man running naked in Fort Lauderdale who said he was being chased by people who were stealing his clothes.

As a result of these stories, media outlets began to seek more information from health officials who have been dealing with the Flakka phenomenon.

Cheap and Powerful

Jim Hall, an epidemiologist at Nova Southeastern University in Fort Lauderdale, told reporters that Flakka produces an instant sense of euphoria for the user as well as an increase in physical strength.

"It's cheap like crack cocaine," Hall said. "This is as close as we've come to a crack cocaine problem since 1995 in terms of the severe reactions, low prices, and that it's available to young kids, and even homeless populations are now impacted."

Abdul El-Sayed, assistant epidemiology professor at Columbia University, said one of the dangers of Flakka is that users never know how strong the dose of the drug will be, which can make overdose possible.

Dosages Can Vary Widely

"It's being marketed to folks with amphetamine addiction, and they market it as the latest and greatest," El-Sayed told reporters, "but the reality of addiction is that the main hallmark is tolerance. A lot of these folks are really tolerant already. It's not pure, so there's no standard for how much people can take. People are basically playing with their lives by taking this."

Hall said the ability of the drug to block the reuptake transporters of dopamine makes the Flakka more addictive.

"More of it remains active, flooding the brain with excess dopamine, resulting in intense pleasure and its related anticipation that users come to crave. This results in compulsive use and a stronger addiction," Hall said. "Designing the molecule of a drug that blocks the exit door for dopamine in the brain makes it a more addictive substance."

Serious Public Health Problem

Hall said that 15% to 20% of patients currently being treated in South Florida for substance abuse were admitted for Flakka abuse.

Officials agreed that Flakka is a serious and growing public health problem.

"The immediate question that comes to mind is, 'This is a really crazy drug, and how can we make sure we're safe from people who use this drug?'" El-Sayed said. "But the question we should be asking as a society is, 'Why are people turning to drugs like this, and why is there this increasing need for stronger drugs?' So we should be looking at this not as a law enforcement problem but as a public health problem."

News Sources:

Forbes "Flakka: The New Designer Drug You Need To Know About." Pharm & Healthcare April 4, 2015

FOX News "Doctors express concern over synthetic drug that can induce ‘excited delirium’." Health Care April 10, 2015

FOX News "Naked, 'superhuman' paranoids begging police to save them from imaginary mobs? That's flakka!." April 30, 2015

New York Daily News "Paranoia-induced Florida crime wave fueled by 'flakka,' a cheap synthetic drug more potent than 'bath salts'." Health April 8, 2015

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