The abuse of a dangerous designer drug known as “flakka” is rapidly on the rise in the US.1 Despite growing efforts to ban this substance by drug enforcement agencies, flakka has infiltrated the youth population. It is sold in combination with other recreational drugs (eg, MDMA), and it is generally distributed in sealed bags marked “not for human consumption” or “for research use only.”
The primary ingredient of is pyrrolidinopentiophenone (alpha-PVP), a synthetic cathinone that is chemically related to pyrovalerone. It is the ketone analog of prolintane,2 which inhibits norepinephrine-dopamine reuptake and thus acts as a central nervous system stimulant.3
These man-made products are easily obtained over the Internet at a very low cost. Flakka is reported to be 10 to 20 times more potent than cocaine and methylenedioxypyrovalerone (or MDPV, an ingredient in bath salts).3 It is introduced in the body by smoking, snorting, placing under the tongue, injecting, or vaping (in e-cigarette-type devices).
Users tend to be young, economically disadvantaged adults. The risk of overdose is high, especially because larger amounts can be purchased and consumed at once and in quick succession, either accidently or on purpose. The effects occur within 30 to 45 minutes of administration with a peak rush at 1.5 hours and the total “desirable” experience continuing from 6 to 8 hours. Adverse effects can continue for days.3
The National Institute on Drug Abuse has warned that because flakka enters the bloodstream very quickly, there is a very real risk of overdose.4 The drug is reported to be stronger and more dangerous than other synthetic cathinones, so health care workers, parents, and adolescents need to be aware of the potentially catastrophic outcomes concerning fatalities and intoxications caused by its use.
Many cases—both fatal and non-fatal—have been reported worldwide with acute intoxications of alpha-PVP for which hospitalizations were required.5 There were 6 fatal cases related to this drug which have been reported in Ohio.6
Patients who use flakka present with symptoms such as excited delirium and agitation; violent and aggressive behavior; and paranoia and hallucinations. Self-injurious behaviors and suicidal tendencies have been reported.3 Eventually, hyperthermia can result in dehydration, rhabdomyolysis, and eventual kidney failure.
Like other street drugs, flakka tends to produce “super human strength.” Although drug effects last one to several hours (or days), neurological damage is long lasting, and serious behavioral manifestations have been reported as “Zombie-like.”
Routine drug screens cannot detect flakka. However, liquid chromatography-mass spectrometry (LC-MS/MS) can measure flakka levels with accuracy and confirm overdose in hospitalized patients or provide evidence in medicolegal death investigations.2,3 Illicit use of the substance has been blamed for 18 deaths in a single south Florida county.7
Dr Anjum is a Research Associate and Dr Aggarwal is Associate Professor in the department of psychiatry at Rutgers New Jersey Medical School, Newark, New Jersey. The authors report no conflicts of interest concerning the subject matter of this article.
1. New synthetic drug ‘ﬂakka’ triggers crazed behaviors. Drugs.com. April 16, 2015. http://www.drugs.com/news/new-synthetic-ﬂakka-triggers-crazed-behaviors-56432.html. Accessed August 3, 2016.
2. Wood MR, Bernal I, Lalancette RA. The dangerous new synthetic drug α-PVP as the hydrated chloride salt α-pyrrolidinopentiophenone hydrochloride 0.786-hydrate. Acta Crystallogr C Struct Chem. 2016;72(Pt 1):48-51.
3. Katselou M, Papoutsis I, Nikolaou P, et al. a-PVP (‘‘ﬂakka’’): a new synthetic cathinone invades the drug arena. Forensic Toxicol. 2016;34(1):41-50.
4. “Flakka” (alpha-pvp). National Institute on Drug Abuse. https://www.drugabuse.gov/emerging-trends/flakka-alpha-pvp. Accessed August 3, 2016.
5. World Health Organization. Expert Peer Review No. 1. Expert Committee on Drug Dependence 37th Meeting; November 16-20, 2015; Geneva, Switzerland. http://www.who.int/medicines/access/controlled-substances/5.3_aPVP_PR1.pdf. Accessed August 3, 2016.
6. Marinetti LJ, Antonides HM. Analysis of synthetic cathinones commonly found in bath salts in human performance and postmortem toxicology: method development, drug distribution and interpretation of results. J Anal Toxicol. 2013;37:135-146.
7. Robles F. Police in Florida grapple with a cheap and dangerous new drug. New York Times. May 24, 2015. http://www.nytimes.com/2015/05/25/us/police-in-florida-grapple-with-flakka-a-cheap-and-dangerous-new-drug.html. Accessed August 3, 2016.
8. Drug Enforcement Administration. Schedules of Controlled Substances: Temporary Placement of 10 Synthetic Cathinones Into Schedule I. Regist 79:129 38- 129 93. http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0307_2.htm. Accessed August 3, 2016.
9. Steinberg J. Flakka: The new illegal drug you need to know about. Inc. November 8, 2015. http://www.inc.com/joseph-steinberg/flakka-the-new-illegal-drug-you-need-to-know-about.html. Accessed August 3, 2016.