05/6/16

Fading Flakka Fad

© ARTHIT BUARAPA | 123rf.com

© ARTHIT BUARAPA | 123rf.com

In the summer of 2015 when flakka was at its zenith in Broward County Florida, police needed four or five officers to subdue one agitated person high on flakka. In The Washington Post, Todd Frankel said people high on flakka were everywhere. “Running into traffic. Zoned-out on curbs. Sometimes naked. Sometimes in the grips of a drug-fueled psychosis.” Emergency departments were overwhelmed. A drug treatment counselor in Florida said: “At the height of the flakka craze, you were almost praying for crack cocaine to come back.”

In the summer of 2015, 12 new cases of flakka-related delirium were admitted daily to South Florida hospitals. Flakka users are resistant to pain and sometimes have superman strength. Tasers were sometimes ineffective. Deputies sometimes had to wrestle users to the ground and punch them to gain control. Talking didn’t work. Reporting for The Fix, Valerie Tejeda said CNN reported there were 63 deaths attributed to using flakka in South Florida between September 2014 and December 2015. Also for The Fix, McCarton Ackerman said some Florida EMS departments were training to use ketamine to sedate flakka users who showed signs of aggression.

Then almost as quickly as flakka came onto the scene, it went away. Returning with Todd Frankel to a gas station that had been a local gathering place to buy and sell flakka, a police lieutenant in Pompano Beach Florida couldn’t find even one person. In a short period of time flakka has disappeared from South Florida. “Experts say drug epidemics almost never burn out like this.”

In March of 2015, the United Way of Broward County organized the Flakka Action Team. The task force consisted of substance abuse counselors, local police officers and others. They developed a plan “to educate the community, to teach the police how to respond and figure out how to stop flakka production.” Anti-flakka posters were put up around the county. Community forums were held. Education presentations were done at schools, jails and homeless shelters.

Traditional drug treatment didn’t work with flakka users. One of the post acute withdrawal effects with chronic users was concentration. “Even filling out paperwork was a challenge.” Some people were light sensitive, so sessions occurred in darkened rooms. Some others struggled with paranoia and insomnia.

Jim Hall, an epidemiologist at Nova Southeastern University in Fort Lauderdale, publicized the Chinese connection with flakka. You could place an online order for flakka from a Chinese manufacturer and have it delivered to your door. A kilo of flakka cost $1,500 and had a street value of $50,000. In mid–October of 2015, the U.S. Treasury imposed sanctions on one alleged synthetic drug producer in China. In November, Florida law enforcement officials and local DEA agents went to China to plead their case directly with the Chinese government.

Afterwards, China announced they had banned 116 different synthetic drugs, including flakka and fentanyl. Confusingly, the announcement said this action had been taken on October 1st. Reported hospital cases of flakka in Broward County went from 306 in October of 2015 to 54 in December. There have been no reported deaths from flakka in 2016 as of the beginning of April 2016. There were only six flakka users admitted to Florida treatment centers in January. In February the Flakka Action Team dropped “flakka” from its name.

Michael Bauman of the National Institute on Drug Abuse (NIDA) said: “History has shown that one of the unintended consequences to banning certain drugs is that it typically leads to an explosion of new replacement drugs.” Whether or not that will occur in response to the 116-drug ban remains to be seen. But there is a next step to be taken, if the recommendations of a Broward County grand jury are activated. They recommended that entire classes of drugs, such as synthetic cathinones or bath salts, which includes flakka, should be banned.

Florida Attorney General Pamela Bondi has proposed the “2016 Florida Designer Drugs Enforcement Act.” The legislation would ban synthetic cathinones, synthetic opioids and synthetic cannabinoids. It could potentially outlaw as many as 1,000 different chemical compounds, according to Jim Hall.

But what’s next? The next “designer-drug battlefield” would seem to be variations of the synthetic opioid fentanyl. Craig Mallak, the Chief Medical examiner for Broward County said: “Flakka is gone … fentanyl is the next big thing.” His office is in the process of developing a database to track the trend of fatalities with fentanyl.

For more information on flakka, read “Flack from Flakka,” “High on Flakka” and “Emerging Public Health Threat.”

02/23/16

Emerging Public Health Threat

© imagination | 123f.com

© imagination | 123f.com

I’m almost positive that a guy I saw was high on Flakka. I’d been to Fort Lauderdale Florida for a training conference on relapse prevention. The conference finished early on Friday, so my friend and I decided to catch lunch down by the beach. We were getting a recommendation for lunch from a woman renting Segways, when a man walked by. He was barefoot, shirtless and wearing sweat pants cut off at the knees. He was also busy arguing with someone who wasn’t there. He walked right by us, caught up in his own world.

The reason I suspected he was high on Flakka, was because Fort Lauderdale is in Broward County Florida, which has been ground zero for Flakka. After I commented that I thought the guy was on Flakka, the woman told us that Clearwater was where most of the Flakka problems were at the time. She added that people high on Flakka usually kept to themselves and weren’t violent or aggressive. Then she added that Flakka caused problems because it opened (or activated) the third eye and users were then able to see into the future. We thanked her for her lunch recommendation and left. The guy on Flakka had moved on as well.

We are entering a brave new world of mind-altering substances with NPS—new psychoactive substances—coming to market faster than governments around the world can ban them. See “The New Frontier of Synthetic Drugs” and the “2014 Global Synthetic Drugs Assessment” for more information on the growing problem with NPS. Synthetic cannabinoids (synthetic marijuana), with names like K2 and Spice, are available everywhere. Sold online or in small retail outlets like convenience stores (I’ve heard there’s one that sells it within a mile of my home), synthetic marijuana is popular among younger drug users. After cannabis, synthetic marijuana was the most frequently reported illicit substance used by teenagers in 2012. No longer is finding a pipe in a teenager’s jeans an automatic indication that they are smoking cannabis, the marijuana of their parents’ generation.

The Synthetic Drug Abuse Prevention Act (SDAPT) was signed into law in 2012, but keeping up with the ever-changing chemical formulas used in the manufacturing process is difficult. “The chemical compositions of synthetic drugs are frequently altered in an attempt to avoid government bans.” SDAPT permanently placed 26 types of synthetic cannabinoids and cathinones into Schedule 1. The total number of NPS identified in 2012 was 158.

A CDC report in 2012 said that multiple states found there was an association between synthetic marijuana and unexplained acute kidney injury that was diagnosed after severe nausea, vomiting and flank or abdominal pain brought them to emergency departments. Additional side effects can include tachycardia (faster than normal heart rate) and hypertension.

Synthetic cannabinoid compounds originally were developed to facilitate study of cannabinoid receptor pharmacology, but in recent years have emerged as drugs of abuse. In 2005, SC products marketed as “Spice” first emerged in European countries, before appearing in the United States in 2009, where they were marketed initially as “K2.” Today, SC products are distributed worldwide under countless trade names and packaged in colorful wrappers designed to appeal to teens, young adults, and first-time drug users. Products often are packaged with disingenuous labels such as “not for human consumption” or “incense,” but health professionals and legal authorities are keenly aware that these products are smoked like marijuana. Despite federal and state regulations to prohibit SC sale and distribution, illicit use continues, and reports of illness are increasing.

A 2015 CDC report indicated that poison control centers had 3,572 calls related to synthetic cannabinoid use, which was a 299% increase over the same January-May period in 2014. The number of calls spiked in mid-April before decreasing to 2014 levels by the end of May. The number of reported calls stayed under 100 all throughout 2014. They rapidly increased to 500 calls by April 16th and did not decrease to near 100 until May 28th. See the figure in the 2015 CDC report.

The most commonly reported adverse health effects were: agitation (35.3%), tachycardia (29.0%), drowsiness or lethargy (26.3%), vomiting (16.4%), and confusion (4.2%). Eighty-three percent of the poison center calls had a medical outcome and 11.3% of those had a major adverse event—signs or symptoms that were life threatening or that could in substantial disability or disfigurement. There were 1,407 (47.5%) with a moderate effect—signs or symptoms were not life threatening, and no threat of disability or disfigurement, but did require some form of treatment. “A total of 1,095 (37.0%) had a minor effect (signs or symptoms that are minimally bothersome and generally resolve rapidly with no residual disability or disfigurement).” Fifteen deaths were reported.

This is a fast growing problem and we can’t afford to see it get out of hand. Synthetic cannabinoids were first reported to be in the US in December of 2008 when a shipment of “Spice” was seized by U.S. Customs and Border Protection in Dayton, Ohio. And now, the CDC is saying: “The increasing number of synthetic cannabinoid variants available, higher toxicity of new variants, and the potentially increased use as indicated by calls to poison centers might suggest that synthetic cannabinoids pose an emerging public health threat.”

09/14/15

High on Flakka

P14296870603635738mFlakka continues to make the news and it seems to be spreading beyond its popularity in South Florida. A Fusion article showed that while 48% of the confirmed cases of flakka in the first half of 2014 were from Southern states, 27% were in the North East and 23% in the Midwest. “In 2015, individuals have been arrested for dealing Flakka in Illinois, Iowa, New York, and Minnesota.”

But the largest epicenter outside of Florida may be southern Ohio around the town of Ironton. In January of 2015, two brothers, residents of Ironton, were arrested and charged with trafficking in alpha-PVP (flakka). Detective Joe Ross said they were having a lot of complaints from citizens about the sale of Alpha-PVP.  “It’s been a big problem here in the city and in the county.”

In Broward County, Florida, flakka accounted for 34% of their crime lab reports. In the ten months prior to August 2015, 33 people died from flakka-related overdoses in Broward County alone. Hospitals in Broward County reported seeing up to 20 flakka-related patients a day. Two men in Broward County pleaded guilty in August 2015 to importing more than 24 pounds of the main ingredient in flakka from China. Also see “Flack from Flakka” and this article by McCarton Ackerman on The Fix.

Flakka is more than just fodder for crazy news stories about naked people running around saying they are Satan, or trying to break into police stations to avoid get away from 20 cars chasing them and trying to kill them. It has also caught the attention of respected addiction professionals—Terence Gorski and researchers at The Scripps Research Institute.

Scientists at The Scripps Research Institute (TSRI) have found that flakka (alpha-PVP) seems to be equivalent to MDPV (bath salts). The study was a classic animal pressing a drug-delivery lever study; and the rats increased their lever pressing for the drug as the 20 daily sessions progressed. “When the researchers increased the number of lever presses required to get one dose, the animals kept pressing—for up to hundreds of presses per dose.” Those rats must have REALLY like their flakka. Head-to-head tests of flakka and bath salts showed an almost identical potency for inducing lever presses. This suggested to the researchers that the horror stories about flakka may have been overblown. An abstract for the 2015 study discussed by Aarde et al., is here.

They noted how a 2013 study, also by Aarde et al., found that bath salts induced far more drug-seeking lever presses among rats than crystal meth. In a TSRI News & Views report of the 2013 study, researchers said the rats worked more than ten times harder to get bath salts instead of crystal meth. “Animals will self-administer MDPV like no drug I have ever seen.” Where rats would emit about 60 presses on average for a dose of meth, they would emit around 600 for bath salts. “Some rats would emit 3,000 lever presses for a single hit of bath salts.”

Another study, Aarde et al. (2015b), found that bath salts could induce rats to forgo other rewarding behaviors. Rats will almost always respond more to food and tasty flavors than drugs. In this study, wheel running, a normally rewarding activity for rats, declined significantly as they self-administered more bath salts. A subset of the rats didn’t gradually increase their intake of bath salts. Rather, they went from occasional sampling to binging on as much as they could get during a session. “That was when they stopped using the wheel—that very day they binged.” An abstract of the Aarde et al. (2015b) binge study is here.

Terence Gorski wrote an informative summary about flakka on his blog: “Flakka: What You Need to Know.” He said it can cause extreme behavioral reactions and there have been reports of long-lasting neurological damage. “It is definitely a dangerous drug that is rapidly entering the drug-using culture.” Citing Jacob Sullim on reason.com, he suggested his readers read his blog to get a balanced view on flakka. Here is a link to Sullum’s article.

Gorski noted how flakka was a relatively new drug, initially available in South Florida in the spring of 2015. It’s a variation of bath salts (MDPV). The active ingredient, alpha-PVP, is a synthetic cathinone, the active ingredient in the khat shrub. Flakka is a stimulant and induces paranoia, psychosis and aggression. In high doses, it leads to “excited delirium,” with high body temperatures rising up to 107F. This leads to many users stripping off their clothes because they feel like they are on fire. When restrained, individuals on flakka scream, flail and struggle to free themselves. The struggling causes high core body temperatures, called hyperthermia, which needs immediate medical treatment to prevent disability and death. The struggling can also cause dehydration.

Flakka can be injected, swallowed, smoked or snorted. Especially when smoked or vaped, individuals can overdose on flakka. Remember the overdose deaths in Broward County noted above. It looks like a white or pink crystal; and smells like sweaty socks. Flakka users can become very agitated, making them verbally aggressive and irrational. Muscle tissue begins to break down, releasing proteins and other cellular products into the bloodstream, a condition referred to as rhabomolysis. It can lead to complications such as renal (kidney) failure and in rare cases, death. Gorski also provided this link to the Drudge Report Archives, which tracks news stories on flakka.

If understanding the danger from this drug hasn’t gone from your head to your gut yet, watch a few of these YouTube videos of people on flakka: “Flakka drug effects;” “High on Flakka;” Crazy! Woman High on “Flakka;” “Woman in Florida on Flakka.” Here is a 6 minute video from Fusion: “We spent 24 hours living through Florida’s flakka crisis.”

05/11/15

Flack from Flakka

© Stocksnapper | stockfresh.com

© Stocksnapper | stockfresh.com

There’s a new drug in town—Flakka! A news report in January of 2015 from Broward County Florida’s WPBF 25 reported a disturbance call at a local nightclub that led to an arrest of an individual who was in possession of a bag of flakka. It looks like a cross between crack cocaine and meth. It can be snorted, smoked, ingested or shot up. And, “It has a strong odor like a sweaty sock.” Sounds inviting.

On March 13, 2015, there was a report by NBC South Florida that a fifty year-old man was trying the BREAK INTO the Fort Lauderdale Police Department because he thought 25 cars were chasing him down Broward Boulevard. He was kicking the hurricane glass with enough force that both the glass and the door were shaking. Again, he was high on flakka. Here is a security video of the man in the act of trying to break into the locked door of the department.

A thirty-four year-old man wearing only sneakers and socks was running on Broward Boulevard (again). He thought that people had stolen his clothes and were trying to kill him. He said he’d rather die than be caught by these people. He told police he was running down the middle of the street because if he was hit by a car, they would stop chasing him. You guessed it: high on flakka. Here is a video and report on the streaker.

In addition to these incidents, there was a naked man with a loaded gun on the roof of a building in Lake Worth shouting that someone was trying to kill him. When he saw the responding police officers approaching, he placed the pistol to his head and pulled the trigger. He misfired. Again, he’d smoked (vaped) flakka. And a twenty-six year-old man faces attempted murder charges after attacking an 86-year-old woman when he was high on flakka. You can access reports and videos on these two incidents here.

Now this flakka story is just too weird. Police in Melbourne Florida responded to a burglary call and discovered a naked man (of course) who claimed he was God before he got into a “tussle” with a police officer. This was after the officer hit the man TWICE with a taser. But he pulled out the probes and attacked the officer with his fists. Aleksander Chan for Gawker quoted a report by WKMG saying: “The officer punched Crowder in the face and a scrum ensued, with Crowder saying that he was Thor and trying to stab the officer with the officer’s badge, police said.”

Flakka is a new psychoactive substance (NSP) typically made from alpha-PVP, a synthetic cathinone. Cathinones are chemicals from the khat plant grown in the Middle East and Somalia. Effective February 27, 2014, the DEA listed alpha-PVP and 9 other synthetic cathinones as Schedule I controlled substances with a temporary ban. How it works (pharmacologically) is not known. It is believed to be similar to MDPV, which acts as a norepinephrine-dopamine reuptake inhibitor (NDRI). But no substantive research has been conducted yet on alpha-PVP.

In 2012, an Australian man died after injecting alpha-PVP. He stripped off his clothes, jumped a barbed wire fence into a shipping yard and smashed a window in a psychotic fit. He was restrained by several security guards inside the shipping yard and went into cardiac arrest. His girlfriend, also high on alpha-PVP, was covered in blood as she fell from their truck. She then took her top off and ran away, yelling, “Help me, help me.”

Jim Hall, an epidemiologist, said in a CBS News report that cathinones like flakka are the next—and more potent—class of drugs taking over after MDMA. They are designed to flood the brain with dopamine, and then block the pre-synaptic neuron from removing the dopamine from synapse. The result is an intense feeling of euphoria. Hall said that “snacking,” taking more flakka or other drugs while high, often leads to serious health problems, such as rapid heart rate, agitation, extreme aggression and psychosis. He said they are starting to see cases of excited delirium with flakka, as noted in the above reports.

[Excited delirium] is where the body goes into hyperthermia, generally a temperature of 105 degrees. The individual becomes psychotic, they often rip off their clothes and run out into the street violently and have an adrenaline-like strength and police are called and it takes four or five officers to restrain them. Then once they are restrained, if they don’t receive immediate medical attention they can die.

The drug’s name has several meanings. The word flaca in Spanish means skinny. But flakka is also a Hispanic colloquial word that means a “beautiful, elegant woman who charms all she meets.” It has been reported in other parts of the country, such as Ohio and Houston. Outside of Florida it’s often sold under the street name of “gravel” because it looks like the grainy pebbles or gravel in an aquarium.

Flakka and other cathinone-based drugs are produced in China and sold online to individuals and drug gangs in the US. An investment of a few thousand dollars can make a dealer as much as $75,000. These drugs aren’t always pure, meaning neither the dealer nor the customer actually knows what is in them, or how strong the dose is. Hall said: “We’re referring to these as the guinea pig drugs. Often the dealer might not even know what they’re selling.” In 2013 there were 126 reported deaths due to synthetic cathinones in Florida.

Then on April 10, 2015 the Broward Sheriff’s office were called to the scene of what appears to have been an accidental fatal shooting. A 31 year-old man was on a three-day flakka and molly (MDMA) binge when his friend came over. They added vodka and more molly to the mix. After spending the rest of Friday morning selling heroin, they decided to go to the home of the one man’s sister. When one individual was trying to unload a shotgun, it accidentally fired, ripping through the side of a car and hitting the other man in the face.  The shooter is in jail on manslaughter charges and possession of a firearm by a felon.

CBS News in Chicago did a story on April 24, 2015: “Scary new designer drug flakka hits Chicago.” And again, there was a naked man running around southwest Chicago. He had no memory of what he did while on flakka. “I went to jail, and I don’t remember anything until my third day in jail. I was completely out of my mind.” There is a whole new world of mind-altering substances and the problems associated with them out there. I don’t think we have not heard the end of flakka. And as long as there are willing guinea pigs, there are more NPSs to come.