Many of the metabolites can form sulfates or, more frequently, glucuronides, or other conjugates as Phase II metabolites. Eleven metabolites of α-PVP were detected in rats, as well as in drug abusers’ urine samples. 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. Agitated patients 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. The combination of a high body temperature and extreme muscle overactivity can cause other metabolic problems to happen in the body.

This assessment is based on the drug’s potent effects, its ability to alter brain chemistry, and comparisons with other synthetic drugs like bath salts. Flakka is a highly potent drug that can be snorted, injected, eaten, smoked, or vaporized in e-cigarettes. When heated up, it gives off a foul-smelling smoke characterized as smelling like dirty socks. Flakka is a synthetic cathinone with effects and a chemical makeup similar to bath salts and CNS stimulants. The adverse side effects of the drug include volatile psychosis, leading it to be dubbed “the zombie drug”.

• Bath salts, in general, are psychoactive synthetic drugs (designer drugs) made in large quantities in foreign drug labs.
• A urine drug screen was positive for benzodiazepines, and the patient reported occasional use of benzodiazepines.
• Stimulant-induced neurochemical changes may occur at different times for different brain regions or neurotransmitter systems.
• Amygdala, hippocampus, hypothalamus, prefrontal cortex (PFC), striatum, and thalamus were extracted, and tissue was analyzed with electrochemical detection and liquid chromatography mass spectrometry.

“Baths salts” is a term used to refer to synthetic cathinones as a whole, some of which may cause far more intense hyperstimulation than others. While psychoactive substances like alcohol, opium, and cannabis have been around for thousands of years, many other drugs appearing on the streets in 2021 are far more recent and far less well understood. A Finnish male patient in his sixties with hepatitis C and osteoarthrosis of both knees was admitted to the emergency department because of acute right-sided hemiparesis that had started a day before the admission. Prior to the onset of hemiparesis, the patient’s friend had injected a dose of α-PVP into the patient’s neck. The intended injection site was the left external jugular vein, since the peripheral veins were damaged due to numerous injections.

• In addition, as a pyrrolidone derivative, α-PVP also impairs basic and maximum cellular respiration, suggesting an abnormal mitochondrial function.
• “Flakka” is the street name for the synthetic cathinone α-pyrrolidinopentiophenone (α-PVP).
• At discharge, the patient had a mild right-sided hemiparesis but could walk with the aid of forearm crutches he had already been using because of osteoarthrosis.

In March 2014 77, the DEA temporarily included 10 types of synthetic cathinones, such as α-PVP, in the Schedules of Controlled Substances, and they extended this control period in March 2016 78. In the final rules promulgated by DEA in March 2017 79, α-PVP was listed as a Schedule I drug. Law enforcement and community activists were instrumental in limiting the damage done by the drug’s dangerous effects.

Although people use α-PVP for their euphoric potential, symptoms can easily escalate into terrible delusions, paranoid psychosis, extreme agitation, and many other altered mental states. Α-PVP causes a condition called agitated delirium, where there is an excessive influx of sympathetic activation 31. This condition causes changes to the mental state, including bizarre behavior, anxiety, agitation, violence, confusion, myoclonus, and seizures 32,33. Clinical signs of agitated delirium include tachycardia, hypertension, hyperthermia, diaphoresis, and mydriasis 34.

Despite early and well-publicized reports of people high on flakka literally eating others in fits of insanity, there is no evidence that Flakka causes berserk cannibalism. Flakka only arrived on the drug market in the mid-2000s and has since become a significant threat to public health in many areas of Florida, and Broward County in particular. The clinical neurological evaluation at the emergency department showed right-sided hemiparesis, no visual deficits, and no aphasia or dysarthria. Only a small puncture wound without surrounding hematoma was found on the patient’s neck. Because flakka’s potency can spark life-threatening complications (high fever, heart issues), using this drug can lead to emergency room overcrowding. However, dopamine depletion or receptor damage can lead to crashes, depression, or psychosis over time.

Florida, especially Broward County, once experienced a spike in flakka-related emergencies. Reports show this synthetic drug traveling to states like Georgia, Kentucky, Tennessee, and Ohio. While flakka may not be as alpha-pyrrolidinopentiophenone widespread as opioids or methamphetamine, it has made substantial inroads in specific regions, particularly in pockets of the Southeastern United States. By preventing cells from reabsorbing dopamine and norepinephrine, flakka prolongs the “rush” effect.

What are the Long-Term Effects of Flakka?

These names do not reflect the product properties; they are just a cover for the drug council or the local police. Both substances can induce euphoria, heightened sex drive, increased sociability, and hallucinations. When used in excessive amounts, they can lead to severe negative effects, including high blood pressure, elevated heart rate, paranoia, aggression, panic attacks, and psychosis. Both drugs can be consumed in various ways—such as smoking, injecting, or snorting—and carry a significant risk of overdose and death.

New Psychoactive Substance (NPS)

Below, we’ll explain flakka, why it can be so dangerous, and how communities can respond with both precaution and compassion.

“Flakka drug dance”

The results verified that synthetic cathinone MDPV and α-PVP could maintain a high level of response for an extended time and that they were more effective than cocaine or methamphetamine. Bath salt is a name that has been created for a group of drugs that possesses one or more synthetic chemicals related to cathinone, a stimulant similar to amphetamines that is found in the plant khat (Catha edulis). Chemically, bath salts are derivatives of β-phenyl-ethylamine (PEA), including methamphetamine (N-methyl-1-phenylpropan-2-amine) and MDMA (3,4-methylendioxy-N-methylamfetamin, Ecstasy, or Molly).

Treating Flakka Abuse

Although α-PVP is not a risk-free drug, this new synthetic Cathinone is beginning to dominate the drug arena in the US and Europe 35. Synthetic cathinones (e.g., mephedrone) were first synthesized in the 1920s and have chemical properties analogous to cathinones 11. However, the term cathinone only appeared 40 years ago, and the term synthetic cathinone is even more recent 12. However, due to legal gaps, underground chemists started to exploit them in designer drugs 13,14,15.

What are the symptoms of flakka abuse?

“Flakka” is the street name for the synthetic cathinone α-pyrrolidinopentiophenone (α-PVP). Although it was developed by Boehringer Ingelheim as a central nervous system stimulant and pressor agent in the 1960s, it entered in the drug arena at an accelerated rate during the last 4 years causing intoxications, fatal or not. It can be easily manufactured and purchased through the Internet or in retail shops and is usually sold as “bath salts”. The aim of this review is to summarize the current knowledge of this drug concerning its chemistry, synthesis, metabolism, pharmacology, and toxicology.

Overall, while more research is needed to fully understand the extent of Flakka’s addictive properties, current evidence suggests that it poses a serious threat to users’ health and well-being. Use or possession of Flakka is a serious crime and a major health risk as well. The patient was evaluated, and rehabilitation was initiated by an occupational therapist. However, the patient left the hospital on the fifth day of his own will before a complete physiotherapy evaluation. At discharge, the patient had a mild right-sided hemiparesis but could walk with the aid of forearm crutches he had already been using because of osteoarthrosis.

The legal status of flakka remains a moving target as authorities try to keep pace with the evolving synthetic drug market. It is an ongoing challenge, as 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.