Flakka

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What is Flakka? What are the signs and symptoms of Flakka abuse?

A synthetic street drug called "Flakka" was in the news in late 2014 and 2015. Hospitals, doctors, police, and fire rescue crews in Florida saw patients with symptoms and signs that included

Reported cases included an agitated man running naked through traffic, a delusional drug addict who attempted to perform a sex act on a tree and then resisted arrest, and a paranoid man trying to break into a police station to seek safety. These bizarre, dangerous, and violent behaviors are directly due to the side effects of the street drug Flakka.

Flakka can be smoked, vaped with an e-cigarette, snorted, injected, or swallowed. When heated up, it gives off a foul-smelling smoke characterized as smelling like dirty socks.

Paranoia is a symptom of Flakka abuse.

What Are Bath Salts Made Of?

How Do People Abuse Bath Salts?

Bath salts are a type of "designer" drug of abuse. The reason these drugs are commonly called bath salts is because they tend to be in the form of white powder or crystals. However, these substances are not at all the same as the bath salts in which people bathe. Many of the bath salt drugs include mephedrone, methylone, and methylenedioxypyrovalerone (MDPV or MDPK) and are synthetic cathinones, which are found in plants commonly called khat. These drugs and are chemically similar to stimulant chemicals like cocaine or amphetamines. MDPV or MDPK also have chemical similarities to hallucinogens like Ecstasy.

As of 2011, bath salts were the sixth most commonly used drugs, after tobacco, alcohol, marijuana, cocaine, and Ecstasy. Bath salts users tend to be male slightly more often than female and younger than the users of other drugs, and most use it at least weekly. Most bath salts users snort or otherwise inhale the drug, causing a more intense high and higher risk of addiction and complications.

Flakka vs. bath salts

Word on the street is that Flakka (also called gravel or flocka) is a combination of heroin and crack cocaine, or heroin and methamphetamines, but in reality, Flakka is just a newer-generation version of a type of synthetic drug called bath salts (MDPV).

Bath salts, in general, are psychoactive synthetic drugs (designer drugs) made in large quantities in foreign drug labs. These drugs are all related to a broader group of chemical compounds known as synthetic cathinones, chemically similar to a substance found in the khat plant, which is known for its amphetamine-like stimulant effects. Some brand names of synthetic cathinones include Bliss, Vanilla Sky, Lunar Wave, Cloud Nine, and White Lightning. Flakka is the street name for the synthetic cathinone called alpha-pyrrolidinopentiophenone (Alpha-PVP).

Each time one type of bath salt is made illegal, the drug labs change the chemical structure slightly and a new drug that is technically not illegal is created. In the case of Flakka, the new chemical is called alpha-pyrrolidinopentiophenone or alpha-PVP. Drug users take Flakka to get a feeling of euphoria, a heightened sense of awareness, stimulation, and energy.

Flakka was also very inexpensive, costing as little as $5 for a dose. This caused people most at risk, poor desperate drug addicts and homeless people, to use it instead of more expensive drugs like cocaine or methamphetamines.

What are the side effects of Flakka?

Flakka is a dangerous drug that has many bad side effects, mostly including changes in behavior or mood. Even slight overdoses of Flakka can cause

  • elevated heart rate,
  • extreme agitation,
  • jerking muscle movements,
  • delirious thoughts,
  • hyperstimulation,
  • hallucinations, and
  • often profound paranoia.

In some of the documented delusions, individuals' experiences are of a typical paranoia, where the drug users feel they are being chased by a large group of people trying to kill them. These patients are a threat to themselves, the people around them, and the first responders (police, EMS) who are there to help them. It is common to hear reports that it takes multiple people to restrain and sedate these patients. Rescue crews and emergency department staff need to give sedatives to these patients to calm them and make them safe.

What are the complications of Flakka use?

Some complications of Flakka drug abuse can happen while the drug user is acutely agitated, if they were to harm themselves or others; however, medically, the severe consequences of the agitation caused by the drug appear later. Patients who are agitated can go into a state called "excited delirium," which is a medical emergency. In the excited delirium state, restrained patients struggle to free themselves, scream, flail, and can even have seizures. This struggling causes a high core body temperature called hyperthermia. The combination of a high body temperature and the extreme muscle overactivity can cause other metabolic problems to happen in the body. Muscle tissue begins to break down, releasing proteins and other cellular products into the bloodstream, in a process called rhabdomyolysis. The extreme struggling can also cause dehydration. The end result of the cellular products and proteins released during rhabdomyolysis and dehydration can impair the filtering function of the kidneys, leading to renal failure and death. In addition, such agitation may trigger Taser use or other methods that have the potential to harm the individual when law enforcement personnel have to intervene.

Researchers have not thoroughly clinically studied the long-term effects of Flakka, but renal failure can occur that is irreversible.

Individuals with Flakka overdose were isolated to a few geographic regions of the country. The epicenter of the Flakka epidemic was Broward County, Florida, which includes the city of Fort Lauderdale.

Since 2016, Flakka has been reported very sporadically. Law enforcement and community activists were instrumental in limiting the damage done by the drug's dangerous effects. Most reports of Flakka after 2016 turned out to be other similar chemicals in the bath salt family.

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Medically Reviewed on 12/27/2018
References
REFERENCES:

"'Bath Salts' Intoxication." N Engl J Med 365 Sept. 8, 2011: 967-968. <http://www.nejm.org/doi/full/10.1056/NEJMc1107097>.

Kaizaki, A., S. Tanaka, and S. Numazawa. "New recreational drug 1-phenyl-2-(1-pyrrolidinyl)-1-pentanone (alpha-PVP) activates central nervous system via dopaminergic neuron." J Toxicol Sci 39.1 Feb. 2014: 1-6. <http://www.ncbi.nlm.nih.gov/pubmed/24418703>.

"The Science of Alpha-PVP ('Gravel'), a Second-Generation Bath Salt." The Poison Review. Mar. 14, 2014. <http://www.thepoisonreview.com/2014/03/14/the-science-of-alpha-pvp-gravel-a-second-generation-bath-salt/>.

United States. National Institute on Drug Abuse. "Synthetic Cathinones ('Bath Salts')." February 2018. <https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts>.

"Violent, Impaired and/or Excited Delirium (ExDS) Patient." Greater Broward EMS Medical Director's Association. <http://www.gbemda.org/adult-2/2-5-adult-neurologic-emergencies/2-5-2-violent-andor-impaired-patient>.
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