What Is the Synthetic Drug Flakka?

Per the National Institute on Drug Abuse (NIDA), flakka (alpha-pyrrolidinopentiophenone [alpha-PVP]) is a synthetic cathinone drug. It has gained popularity across the US, and particularly in Florida, as a designer drug alternative to the synthetic cathinone drugs known as “bath salts.” Bath salts and flakka are designer drugs that are synthetically made in private laboratories with the sole purpose of producing specific types of psychoactive effects in individuals who take them. These drugs are similar to the substances found in the khat plant that is grown in East Africa and used for its stimulant properties. People in the Middle East use khat for its stimulant effects.

All of the active substances in flakka and bath salts are classified as Schedule I controlled substances by the DEA, indicating that they have no known medicinal uses and are drugs that have extremely high potentials for abuse and the development of physical dependence.

NIDA reports that there are a significant number of reports of individuals who have died as a result of using flakka. Some individuals who abuse the drug have been known to suffer fatal heart attacks and develop suicidal behaviors as a result of the severe psychological and cognitive alterations that the drug produces.

Effects of Flakka Use

Many of these designer drugs were originally manufactured in countries like China and more recently in local labs in Florida and other states. The drugs have extremely potent stimulant properties that mimic other potentially dangerous drugs, such as methamphetamine or ecstasy (MDMA).

Individuals who use these synthetic cathinones are putting themselves at risk for a number of potentially serious issues. Flakka-related drugs are typically in the form of a white or pinkish crystal that can be eaten, ground up and snorted or injected, or vaporized in an e-cigarette. Obviously, snorting, injecting, or smoking the drug results in a far more efficient means of getting the drug into one’s system than taking it orally.

Flakka use results in the blockage of the reuptake of the neurotransmitters norepinephrine and dopamine in the brain; other neurotransmitters are most likely affected as well. This results in the initial feelings of increased energy, euphoria, invulnerability, and a lack of behavioral inhibitions. Research has indicated that using synthetic cathinones is also associated with:

• High blood pressure
• Increased or irregular heartbeat
• Vasoconstriction
• Increased potential to develop a heart attack
• hyperthermia
• Increased sweating and the potential for dehydration
• Respiratory distress
• Renal failure
• Muscle spasms
• Muscle tremors
• Increased risk to develop seizures
• Brain swelling
• Increased risk to develop stroke

In addition to the above effects, some specific psychological effects are associated with the use of synthetic cathinones that include:

• Panic attacks or lower levels of anxiety
• Agitation and aggression
• Self-destructive behaviors, such as “cutting”
• Insomnia
• Appetite loss
• Becoming suicidal
• Development of psychosis (hallucinations and/or delusions)
• Delirium

Delirium refers to a medical condition that is a result of some specific imbalance in bodily functions. Delirium consists of issues with confusion and potential hyperactivity, hypoactivity, paranoia, hallucinations, or severe depression and apathy. NIDA reports that the delirium that occurs as a result of flakka abuse is an excited delirium. This is a severe state where the individual is confused, disoriented, hyperstimulated, and hyperactive, and may be experiencing hallucinations or delusions. These individuals are often extremely dangerous to themselves due to their tendency to act irrationally. They often become violent, aggressive, and need to be physically restrained. In some cases, extended periods of delirium can result in significant brain damage.

Potential brain damage as a result of using synthetic cathinones can occur from a number of different complications. Compromise of the cardiovascular system, severe respiratory suppression, swelling in the brain, and seizures can all have lasting effects and result in severe brain damage. Potential harm due to poor judgment or as a result of psychotic behaviors may also occur. There are numerous stories of people under the influence of synthetic cathinones who have engaged in serious risk-taking behaviors and harmed themselves.

Abuse of Flakka

Animal models of the effects of synthetic cathinone abuse have demonstrated that animals will repeatedly self-administer the substance in a similar manner as drugs like heroin, cocaine, etc. These types of research results show that the drugs result in significant cravings and that these cravings are related to changes in the neurobiology of the abuser.

Observational research on humans also suggests that abuse of these drugs results in the development of a number of symptoms associated with substance use disorders, such as severe cravings, a loss of control over using the drug, and the development of physical dependence. The same research has suggested that the withdrawal process from synthetic cathinones is associated with:

• Depression that is often the result of a severe crash
• Issues with anxiety
• Issues with sleep
• Sweating, increased heartbeat, and tremors
• The development of suspiciousness or paranoia
• The development of psychosis

Anyone undergoing withdrawal from flakka will experience strong desires or cravings to use the drug. There are currently no medications that are specifically designed to treat withdrawal symptoms associated with flakka abuse. One would suspect that benzodiazepines would be helpful in treating anxiety and any potential seizures, and other drugs used in the treatment of the withdrawal process would be targeted at specific symptoms.

Treatment for a substance use disorder as a result of flakka abuse would follow the standard blueprint of initial withdrawal management assistance, the implementation of substance use disorder therapy, social support groups, the use of other therapeutic interventions like family therapy, and other treatment supports as warranted in the individual situation.

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Declining Popularity

The sudden appearance of these designer drugs in states like Florida resulted in national attention to the effects of these drugs on individuals who use them. The American Association of Poison Control Centers has documented an increase in the number of calls to emergency departments in the US related to abuse of synthetic cathinones from 2009 to 2012 and then a steady decline from 2013 to 2016. It is generally believed that the efforts of national and local government agencies, crackdowns on overseas manufacturers, and local efforts at education and enforcement have led to declining use of these drugs. Florida, a state where the use of flakka received significant media attention, has experienced a dramatic decline in the number of cases associated with flakka abuse.

Despite the apparent decline in the popularity of flakka, the drug remains a potential serious danger due to its serious effects on the cardiovascular system and central nervous system. In addition, because the drug is often made in private laboratories and distributed locally, it is important that communities continue to be vigilant regarding its manufacture and use.

Treatment for Flakka Abuse

Individuals seeking treatment for flakka abuse would be well advised to consult with an addiction medicine physician in order to develop a plan of managing potential withdrawal symptoms. The use of a formal physician-assisted withdrawal management program is highly recommended due to the potential that an individual who has abused the drug for a significant period of time has developed physical dependence on it. Physicians supervising these cases will typically administer benzodiazepines and other medications as needed to control withdrawal symptoms. As the individual progresses, the dosage of benzodiazepines will be slowly tapered down to allow the individual to be weaned off the drug and to get through the withdrawal process successfully.

The cornerstone of any recovery program is substance use disorder therapy. Simply discontinuing use of the drug, navigating the withdrawal process, and then moving forward without a formal treatment plan is not a productive way to approach recovery from a substance use disorder. Substance use disorder therapy helps the individual understand the driving forces behind their issues, learn new coping skills, and develop strategies for long-term relapse prevention.

In addition, individuals in recovery should attempt to gather as much support from others as possible. Obviously, support from family members and friends is crucial, but attendance at support groups, like 12-Step groups, can be particularly useful. Twelve-Step groups offer the individual a formalized plan of recovery that is compatible with substance use disorder therapy as well as the option for long-term involvement in a structured recovery program.

Finally, individuals in recovery need to ensure that any other mental health issues are addressed along with their substance abuse. It has long been recognized that these co-occurring issues must be treated alongside the person’s substance abuse problem in order for recovery to be successful. Simply ignoring or putting off treatment for issues, such as major depression, an anxiety disorder, a personality disorder, etc., and attempting to only focus on the substance abuse is an incomplete approach to treatment and doomed to fail. The most successful approach to treatment addresses the individual as a whole person, effectively focusing on all co-occurring disorders.