Flakka, the latest dangerous designer drug, has rapidly spread across the United States and beyond.
This synthetic cathinone has powerful stimulant effects leading to delirium, aggression, dangerous health issues, and even death.
What is Flakka and Why Is It So Troubling?
Flakka, commonly referred to as gravel or bath salts, is the street name for the synthetic cathinone α-PVP (alpha-pyrrolidinovalerophenone).
It emerged in the early 2010s as a new designer drug meant to mimic the effects of amphetamines while skirting drug laws.
Key facts about flakka:
- A potent central nervous system stimulant that can cause euphoria along with delirium, agitation, aggression, psychosis, dangerous health effects, and death
- Classified as a Schedule 1 drug, meaning it has no accepted medical use and a high potential for abuse
- Can be eaten, snorted, injected, or vaped using e-cigarettes
- Effects kick in rapidly and can last several hours
- Highly addictive and can lead to compulsive redosing behavior
- Toxic reactions include extreme agitation, aggression, psychosis, elevated body temperature, seizures, kidney damage, and cardiac arrest
Source: Int J Mol Sci
Flakka’s Rise as The Next Deadly Designer Drug
Synthetic cathinones like flakka emerged in the early 2010s as “legal highs” meant to mimic illegal stimulants like methamphetamine and MDMA.
They were initially sold openly as “bath salts,” “plant food,” or “jewelry cleaner” to skirt regulations.
Flakka is chemically similar to an earlier synthetic cathinone called MDPV, which caused scattered cases of delirium and agitation before being banned.
After MDPV was outlawed around 2011, foreign chemists synthesized slightly tweaked cathinone analogues like α-PVP to fill demand for these stimulants.
Flakka flooded the underground drug market, touted as a cheap, powerful high.
By 2014, Florida was experiencing a major flakka outbreak, with hundreds of cases of bizarre behavior, violence, and overdose.
It quickly earned a reputation as the next deadly designer drug.
How Flakka Works in the Brain: Neuropsychiatric Effects
Flakka is considered a synthetic cathinone because of its chemical structure.
Natural cathinones like cathine and cathinone are stimulant chemicals found in the khat plant, used for centuries in Africa and the Middle East for its euphoric effects.
Synthetic cathinones are designed to act like natural cathinones and amphetamines by boosting levels of the neurotransmitters dopamine and norepinephrine in the brain.
Specifically, flakka:
- Inhibits reuptake of dopamine and norepinephrine, leaving more active in the brain
- Binds to dopamine and norepinephrine transporters, preventing reabsorption
- May also act directly on dopamine receptors
This flood of dopamine and norepinephrine is responsible for flakka’s potent stimulant, euphoric effects.
It also leads to dangerous overstimulation that can produce delirium, psychosis, and life-threatening complications.
The Rise of a Deadly New Designer Drug: Flakka in Florida
Before 2009, there were virtually no reports of illicit use of cathinones like flakka.
By 2010, calls to poison control centers about “bath salts” skyrocketed.
Flakka emerged around 2013 as MDPV was banned, and caused major issues in Florida.
A few key events in flakka’s timeline:
- Early 20th century – Cathinones first synthesized but largely forgotten for decades
- 2009 – 158 calls to poison control about cathinones, mostly about mephedrone
- 2010 – Over 600 bath salts calls to US poison control centers
- 2012 – DEA bans MDPV, a common early bath salt drug
- 2013 – Flakka appears as a replacement to MDPV
- 2014 – Florida sees major spike in flakka cases, over 300 cases in 3 months
- 2014 to 2016 – DEA bans flakka and 10 related cathinones
- 2015 – 105 flakka-related deaths in Europe
Flakka Use and Addiction
Flakka is considered highly addictive due to its tendency to produce compulsive re-dosing.
Users seek to prolong its potent high, but tolerance quickly builds.
Higher and higher doses are required to get the same effect.
People who use flakka typically ingest, snort, inject or vape the drug.
Doses range from as little as 3 mg injected to 250 mg swallowed.
Desired effects set in rapidly but only last a couple hours before fading.
This short duration leads people to repeatedly re-dose every couple hours.
Binges can go on for days, with some reporting using up to 1 gram per day.
This spiraling pattern of use increases the risks.
Addiction occurs with regular use as the brain grows dependent on flakka’s dopamine boost.
Withdrawal brings anhedonia, depression, anxiety, fatigue, and drug cravings.
Addiction treatment typically involves behavioral therapy combined with medications to ease withdrawal symptoms.
Dangers and Side Effects of Flakka (Alpha-PVP)
Flakka poses serious dangers given its potency and toxicity.
Desired effects include:
- Euphoria, elation, sense of wellbeing
- Increased alertness and concentration
- Increased sociability and sex drive
- Heightened senses
Unwanted side effects include:
- Insomnia, anxiety, restlessness
- Increased heart rate, blood pressure
- Loss of appetite
- Involuntary bodily movements
- Strange behavior
- Paranoia, hallucinations
Toxic reactions include:
- Agitation, aggression, violent behavior
- Psychosis, delirium
- Panic attacks
- Seizures
- Kidney damage and failure
- Heart attacks
- Strokes
- Hyperthermia
- Breakdown of muscle tissue (rhabdomyolysis)
Flakka-related deaths typically involve heart attacks, strokes, kidney failure, hyperthermia, or suicide while delirious.
Long-term use may also lead to lasting mental illness in susceptible individuals.
Why Flakka Leads to Delirium and Psychosis
A major danger posed by flakka is its tendency to produce delirium, psychosis, paranoia, agitation, self-injury, and dangerous aggression even in previously healthy individuals.
Cathinones like flakka are thought to carry a high risk of psychosis due to their unique pharmacology:
- Powerful stimulation of dopamine, producing euphoria
- Blocking reuptake of norepinephrine, increasing fight-or-flight response
- Little effect on serotonin, which stabilize mood
Together this leads to a “trifecta” of unchecked dopamine and norepinephrine surge combined with depleted serotonin.
This chemical soup can result in delusions, delirium, and uncontrolled aggression.
The Dangers of Flakka Withdrawal Symptoms
As with any addictive drug, attempting to quit flakka after regular use will result in withdrawal symptoms.
This difficult period may involve:
- Drug cravings
- Depression
- Anxiety
- Fatigue
- Inability to experience pleasure or motivation
- Insomnia
- Aches and pains
- Nausea
Withdrawal symptoms tend to peak around 48-72 hours after last use and can last for weeks.
Post-acute withdrawal syndrome can persist for months, involving mood issues and cravings.
Withdrawal brings the risk of self-harm, suicide, and relapse if not managed properly.
Medical detox under the care of addiction professionals can ease withdrawal symptoms, monitor health, and set the stage for effective addiction treatment.
Long-Term Effects of Flakka Use: Damage to the Body & Brain
While research on the long-term impact of flakka is still emerging, regular use poses risks of:
- Severe weight loss and malnutrition
- Permanent heart or kidney damage
- Increased risk of stroke or heart attack
- Worsening psychiatric problems like depression and psychosis
- Damage to dopamine and serotonin systems
- Neurocognitive deficits including impaired memory, attention, and decision-making
For those with a family or personal history of mental illness, flakka may trigger lasting psychiatric symptoms.
Some users develop anxiety, depression, or psychosis that persists months after quitting.
Treatment for Flakka Addiction and Abuse
treatment options for overcoming flakka addiction include:
- Medical detox – Monitored 24/7 care through withdrawal period
- Inpatient rehab – 30-90 day residential program with therapy, groups, education
- Outpatient rehab – Part-time programming while living at home
- Behavioral therapy – CBT, DBT, contingency management, etc.
- Support groups – 12-step programs, SMART recovery, etc.
- Medications – Certain drugs can help control cravings and stabilize mood
A comprehensive treatment plan will likely involve professional treatment along with community-based recovery supports.
Long-term outpatient therapy and participation in sober support groups are key to maintaining sobriety after initial treatment.
The Future of Flakka and Synthetic Drugs
While the height of the flakka epidemic has passed, it remains a threat.
Traffickers continue finding innovative ways to evade drug laws and feed demand.
As long as people seek out dangerous synthetic highs, chemists will synthesize new substances.
The popularity of e-cigarette devices has also opened up new routes of administration for novel street drugs.
Unregulated vape liquids provide an easy way to ingest unknown chemicals.
The best ways to counter emerging synthetic drugs like flakka include:
- Expanding education on their dangers and warning signs
- Increasing illicit drug screening capabilities
- Agile regulatory approaches to contain new substances before widespread adoption
- Access to addiction treatment and mental health services
- Harm reduction outreach programs
- Partnerships with law enforcement to identify trafficking patterns
While synthetic drug chemists will likely stay one step ahead, a nimble, collaborative public health approach across sectors can help mitigate their harms through strategic early warning systems, regulations, treatment, and education.
References
- Study: Flakka: New Dangerous Synthetic Cathinone on the Drug Scene
- Authors: Jiri Patocka et al. (2020)
