Tag: Broward County

08/29/17

Zombie Drug

© Andrey Kiselev | 123rf.com

Flakka was big news 18 to 24 months ago, with Broward County in Florida as ground zero. People were stripping themselves naked and running through traffic; trying to break INTO police substations; impaling themselves on iron fences and other sorts of mayhem. Others were grunting and moaning incoherently; and still others were catatonic, earning flakka the nickname of “the zombie drug.” After China banned the manufacture and export of alpha-PVP (the chemical name for flakka) in early 2016, it seemed to quickly fade from the news. But like all good zombie stories, flakka seems to have risen from the dead.

The website Lovin Malta reported flakka has made its way to Malta, an island country in the Mediterranean Sea. A forensic chemist said: “Flakka has been circulating across Europe and it has definitely found its way southwards to Malta too, as is the trend for many drugs.” He couldn’t confirm if anyone had overdosed on it, or if police made any arrests, “but it is definitely here.” The Malta Police Force confirmed with Lovin Malta there was a suspected case of flakka in 2015, but they could not prosecute or arrest the person, because flakka is not an illegal substance in Maltese law. Read the Lovin Malta reports here and here.

On October 17, 2016, Carrie-Anne Greenbank reported for 9 News Queensland that flakka was thought to be responsible for a mass overdose on the Gold Coast. One person was in a two day induced coma after being given the suspected drug at the Sin City Nightclub on the Gold Coast of Australia. He had acute kidney failure, 2-3 seizures and wasn’t able to stomach even water. He was one of sixteen who overdosed and were taken to a hospital. Annastacia Palaszczuk, the Premier of Queensland, Australia, said: “Do not put your life at risk. It is not worth it.” See the video report on the 9 News Queensland Facebook page, here.

Another 9 News report on November 11, 2016 had a short video clip of a Queensland man suspected of suffering from a flakka overdose. He was screaming and resisting the restraint of eight ambulance workers. The report also mentioned Shelbi, a 24 year-old woman from Los Angeles who last used flakka nine months before, in February of 2016. Shelbi was on an episode of the TV series, Intervention, where she was filmed beginning a sentence and then completely losing her focus, unable to continue. She said: “The last time I used flakka was nine months ago, and still to this day… Huh?”

An April 3, 2017 story by The National, a Middle East English-language news service, reported that after advice from the Dubai Police, the Ministry of Health recommended that flakka and cathinone be added to the list of banned mind-altering illegal substances in the UAE, the United Arab Emirates. Flakka wasn’t found in Dubai or the UAE, so the action is a pre-emptive one. Dr. Amin Al Amiri, chairman of the narcotic review committee, said the law needed to be revised so it could keep up with new challenges, like flakka. “We are adding it after making sure it belongs in the law.”

Colonel Eid Hareb, director general of the anti-narcotics department, said: “We have not had any flakka cases or what they call ‘zombie cases’ here in Dubai or in the UAE, but we do not want it to come here. . . . We don’t want people to use this drug, that is why we put it on the list.” Anyone caught using flakka or cathinone in the UAE could face at least two years in prison. If someone is found guilty of trafficking the substances, they could get the death penalty.

The Indonesia Expat has a May 31, 2017 story about flakka that said flakka was suspected of coming into Indonesia. The Head of the National Narcotics Agency, Budi Waseso, told reporters in South Jakarta that the agency was investigating the report. There was a review on May 15-16, and the analysis was submitted to the Ministry of Health. It recommended that alpha-PVP be placed as a Group 1 substance in the annex of the Narcotics Act.

In case you didn’t check out any of the flakka YouTube videos or read any of the news stories on the drug in 2015 or 2106, here is a short flakka primer drawn from a psychiatric case report, “Flakka-Induced Prolonged Psychosis,” a Psychiatric Times article, Flakka: A Deadly High” and a World Health Report. Drug effects from flakka can last one hour, several hours, or several days. Users may seem to have “super human strength,” be very agitated or even comatose.

The primary ingredient is pyrrolidinopentiophenone (alpha-PVP), a synthetic cathinone. It is an analogue of prolintane, which inhibits norepinephrine-dopamine reuptake, meaning it acts like a stimulant. Flakka is 10 to 20 times more potent than cocaine and MDPV (methylenedioxypyrovalerone), an ingredient in bath salts. You can smoke, snort, vape, inject or use it sublingually (under the tongue). It enters the bloodstream very quickly and has a serious risk of overdose.

It is known to provoke a condition called agitated delirium, causing bizarre behaviors, anxiety, agitation, violent outbursts, confusion, myoclonus (muscles twitches and jerks), and rare cases of seizures. Individuals with agitated delirium from flakka use can hallucinate and be violent, aggressive and paranoid. Self-injury and suicidal tendencies have been reported as well. “Clinical symptoms of agitated delirium involve tachycardia [abnormally rapid hear rate], hypertension [abnormally high blood pressure], hyperthermia [abnormally high body temperature], diaphoresis [excessive, abnormal sweating], and mydriasis [pupil dilation].” Multiple fatalities have been reported with flakka.

The WHO Report recommended placing flakka under international control as a Schedule II controlled substance. The WHO Schedule II is for substances whose liability for abuse constitutes a substantial public health risk and which have very little if any therapeutic value. It also indicated multiple member states have taken measures to curb the misuse of alpha-PVP.

Fifteen member states of the EMCDDA (Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Poland, Romania, Slovenia, Sweden, and the United Kingdom) as well as Turkey and Norway reported that alpha-PVP is controlled under drug control legislation. Four member states (Austria, Cyprus, Portugal and Slovakia) reported alpha-PVP is controlled under drug control legislation prohibiting the unauthorized supply of defined or qualifying new psychoactive substances. Other two member states (Belgium and Czech Republic) started the process of controlling the substance using drug control legislation. In the United State of America, alpha-PVP has been temporarily scheduled into schedule I pursuant to the temporary scheduling provisions of the Controlled Substance Act (CSA). In Japan, alpha-PVP has been controlled under the Narcotics and Psychotropics Control Act.

The psychiatric case report described a 17 year-old girl with no prior history of psychiatric diagnosis and who was never previously seen by a mental health professional. She was involuntarily committed to a psychiatric hospital after being transferred from a local Emergency Department “for altered mental status with agitation and psychotic behaviors, including auditory hallucinations.” She was treated with olanzapine (Zyprexa) and lorazepam (Ativan) for agitation. At first, she was bizarre and illogical and needed staff assistance with activities of daily living.

During the initial evaluation, she was drowsy and incoherent; unable to give an accurate history of the events leading up to her altered state. According to her mother, she was alone in her bedroom yelling, “Go away!” The mother said she was not sleeping and has no history of nightmares or sleep terrors. Her bizarre, disorganized and psychotic behavior continued through the fifth day of her hospitalization. She had mentioned she might have taken flakka, but was vague about the circumstances.

Finally, on day six, the patient became coherent, alert and oriented to person, place, time, and situation, and capable of completing her activities of daily living. She remained somewhat constricted and at times required redirection and instructions to complete tasks. When asked about her symptoms for the past week, she described an incident that happened at school the day before being admitted to the hospital. She claims that a group of her “friends” were pressuring her to try Flakka with them. Although she refused, she believes that they put some on the food she was eating because she claimed it tasted funny and felt weird ever since. She also denies any recent major stressors or traumatic events that could have led to her behaviors. After one more day of observation, the patient did not display any more overt psychotic symptoms and was discharged home with the appropriate scheduled outpatient appointments.

The reported circumstances for how she ingested flakka seem suspect to me. I’d guess she tried flakka voluntarily, perhaps under pressure from her friends. The sweaty socks smell with flakka would be the signal not to eat the food. Left unsaid in the case report, but more than likely, the girl would have continued to take her medications after discharge; at least the antipsychotic olanzapine. Although she didn’t have any “overt” psychotic symptoms at the time of her discharge she continued: “to have residual symptoms including psychomotor agitation and slowing of cognition.”  (Hmmm… Could these symptoms be side effects from the medication?) A bad trip with flakka seems to have started her on a journey through the world of psychiatric treatment, with its own series of complications. Would she have gone there without the flakka? It’s hard to tell.

I’ve written previously about flakka on this website; and you can read those articles, which are linked here: “Fading Flakka Fad,” “High on Flakka,” and “Flack from Flakka.” You can also read about potential problems with psychiatric medications here: “Antipsychotic Big Bang,” Worse Results with Psych Meds,” and “Blind Spots with Antipsychotics,” Part 1 and Part 2.  There are several additional articles on the concerns with psychiatric medications.

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.”

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.