Flakka: What You Need To Know

August 18, 2015

 
By Terence T. Gorski
August 19, 2015

Cautionary Note: Flakka is a relatively new drug that can cause extreme behavioral reactions during intoxication and immediately after using. There are also reports of long-lasting neurological effects. It is definitely a dangerous drug that is rapidly entering the drug-using culture. 

It is important to be cautious not to exaggerate the incident rate (number of people using it) or the type and severity of symptoms (stripping down naked and chasing people down like a fast-moving zombie). 

The information in this blog is summarized by usually reliable news reporting sources on the Internet and corresponds with real incidents reported to me by colleagues and clients. It is important, however, to be cautious about extreme reports of new designer drugs. 

According to Jacob Sullim in his blog on reason.com, there are three designer-drugs that are closely-related to Flakka that are recently entering the United States. These are — meow-meow, krokodil, and Jenkem. 

  1. Meow meow, is a nickname for mephedrone, another synthetic cathinone sold as “bath salts.” and
  2. Krokodil, is a homemade version of the narcotic painkiller desomorphine, which was first synthesized in 1932 and marketed under the brand name Permoid. Krokodil caught on in Russia as a cheap substitute for heroin because it could be made from codeine, which was available there without a prescription. 
  3. Jenkem is fermented human waste that supposedly generates intoxicating fumes when inhaled. 

When doing internet research on any new drug or controversial issue, I strongly recommend you do a Google Search on the topic and the another on the topic plus the word “hoax.” This will give your review more balance. 

To get a balanced mind-set about Flakka it may be helpful to read this blog from Reason.com: http://reason.com/blog/2015/06/17/flakka-turns-people-into-zombies-just-li

With these cautions in mind, I hope this blog will summarize some information about Flakka that will help you to better understand the epidemic of Flakka as it emerges in the USA. 

Summary:

Starting in the Spring of 2015 a new drug of abuse called Flakka or Gravel was smuggled into South Florida and rapidly made it’s way up to Northern Florida and beyond. Its use is rapidly spreading across other states leaving a trail of victims behind.

Flakka, a variation of synthetic substances known as bath salts, is an illicit drug concocted in labs overseas and shipped into North America.

Flakka delivers a cheap, powerful high while acting as an amphetamine, according to officials. The drug can be snorted, smoked or taken by mouth and can cause violent behavior.

Flakka induces paranoia, psychosis and extreme aggression. Users high on this dangerous drug have attacked authorities, caused disruptions on the streets and in emergency rooms, engaged in self-injurious behavior, including in one case, and in one case, a man impaled himself on a spiked fence.

Detailed Information about Flakka.

What is flakka?

Flakka, which  is also called gravel because its crystals resemble small pebbles, is a stimulate drug with a chemical composition similar to bath salts. The active ingredient in Flakk is alpha-PVP, a synthetic version of cathinone, the active ingredient in the stimulant shrub qat, which is also the active ingredient in bath salts. 

What Is Flakka-induced Excited Delerium?

In high doses, Flakka induces “excited delirium” in which users’ body temperature can rise to up to 42 C, which might explain why so many users end up naked while hallucinating. People report stripping off their clothing because they feel like they are on fir or burning up. 

How is Flakka ingested?

Flakka can be taken in different ways:

  • injected,
  • swallowed,
  • smoked or
  • snorted.

Can people overdose on Flakka?

Yes! Especially when it is smoked. Vaporizing and the smoking Flakka allows the drug to very quickly enter the bloodstream and may make it particularly easy to overdose.

What is the chemical composition of Flakka?

Since Flakka in manufactured in illegal labs overseas and can be cut by other chemicals before sale in the USA, there are differences in each batch of Flakka analyzed.

According to the U.S. Drug Enforcement Agency, Flakka is essentially a stimulant hallucinogenic. The main ingredient in all batches of Flakka is alpha-PVP, which is linked to cathinone, the drug found in bath salts. 

Flakka is a stimulant drug and users often mix it methamphetamine to increase the intensity of the stimulant high.

In July 2012, the Synthetic Drug Abuse Prevention Act made it illegal to possess, use, or distribute many of the chemicals used to make bath salts, including Mephedrone and MDPV. Methylone, another such chemical, remains under a DEA regulatory ban. Alpha-PVP, the active ingredient in Flakka, has not yet been banned. 

What are the behavioral effects of Flakka?

Alpha-PVP is a stimulant, so its users encounter:

  • alertness,
  • wakefulness,
  • tremors,
  • agitation,
  • irrational rage,
  • violence

Flakka, when taken in high doses, induces “excited delirium” in which the users’ body temperature can rise to up to 42 C, which might explain why so many users end up naked while hallucinating and panicking because they feel like they are on fire or “burning up.”

What does Flakka look like?

According to the National Institute on Drug Abuse, Flakka “takes the form of a white or pink, foul-smelling crystal,”

Dr. James N. Hall, an epidemiologist and co-director of the U.S. Center for the Study and Prevention of Substance Abuse at Nova Southeastern University, told NBC News.

“Some [users] get high, some get very sick, and many become addicted. Some go crazy and even a few die. But they don’t know what they are taking or what’s going to happen to them,” he said.

Some people experience heart problems, muscle breakdown or even kidney failure. The NIH says Flakka has been linked to deaths by suicide and heart attack.

Hall says flakka’s name has Spanish origins. “Flaco” means thin, while “la flaca” in rough translation is a party term for pretty, thin girl.

“They give [synthetic drugs] names that are hip and cool and making it great for sales,” he told NBC.

What is the street value of Flakka?

Flakka is relatively cheap. A single dose is about a tenth of a gram which has a street value of about $5.

What are common complications of Flakka? 

1. Flakka can make the drug user acutely agitated, making them irrational and vetberbally aggressive   This puts the Flakka patient at high risk of injuring self or others.  

2. These patients are a threat to themselves, the people around them, and the first responders (police, EMS) who are there to help them. It is common to hear reports that it takes multiple people to restrain and sedate these patients. 

3. Rescue crews and emergency department staff need to give sedatives to these patients as soon as possible to calm them and make them safe.

4. If police interventional be required to control an acutely aitate Flalka. This can result in officers using a  Taser or other methods to restrain the patient that have the potential to harm the individual. Officers need to rember that in these severe states of agitation, panic and adrenalin increase the patient’s strength while diminishing their perception of pain. Their paranoi is often focused on the first responders. 

5. Medically, the severe consequences of the agitation caused by the drug appear later. Patients who are agitated can go into a state called “excited delirium,” which is a medical emergency. 

6. In the excited delirium state, restrained patients struggle to free themselves, scream, flail, and can even have seizures. 

7. This struggling causes a high core body temperature called hyperthermia

8. The combination of a high body temperature and the extreme muscle overactivity can cause other metabolic problems to happen in the body. 

9. Muscle tissue begins to break down, releasing proteins and other cellular products into the bloodstream, in a process called rhabdomyolysis

10. The extreme struggling can also cause dehydration. 

11. The end result of the cellular products and proteins released during rhabdomyolysis and dehydration can impair the filtering function of the kidneys, leading to renal failure and death. 
Gorski Books: www.cenaps.com 

The Drudge Report Archives contains articles which historically track the introduction and growth in the use of Flakka: http://www.drudgereportarchives.com/dsp/search.htm?searchFor=flakka

Here is an article from Fusion.net that described the impact of Flakka from an “on-the-street” point of view: http://fusion.net/story/117767/a-complete-guide-to-flakka-the-horrible-street-drug-terrorizing-south-florida/ 

Flakka: Special Obstscles in Treatment: http://www.sun-sentinel.com/local/broward/fl-flakka-treatment-issues-20150813-story.html 

This blog describes the major complications that can occur when treating Flakka patients: http://www.medicinenet.com/script/main/mobileart.asp?articlekey=188097 

References:

REFERENCES:

“‘Bath Salts’ Intoxication.” N Engl J Med 365 Sept. 8, 2011: 967-968. <http://www.nejm.org/doi/full/10.1056/NEJMc1107097&gt;

Kaizaki, A., S. Tanaka, and S. Numazawa. “New recreational drug 1-phenyl-2-(1-pyrrolidinyl)-1-pentanone (alpha-PVP) activates central nervous system via dopaminergic neuron.” J Toxicol Sci 39.1 Feb. 2014: 1-6. <http://www.ncbi.nlm.nih.gov/pubmed/24418703&gt;.

“The Science of Alpha-PVP (‘Gravel’), a Second-Generation Bath Salt.” The Poison Review. Mar. 14, 2014. <http://www.thepoisonreview.com/2014/03/14/the-science-of-alpha-pvp-gravel-a-second-generation-bath-salt/&gt;.

“Violent, Impaired and/or Excited Delirium (ExDS) Patient.” Greater Broward EMS Medical Director’s Association. <http://www.gbemda.org/adult-2/2-5-adult-neurologic-emergencies/2-5-2-violent-andor-impaired-patient&gt;.


THE RELAPSE PREVENTION CERTIFICATION SCHOOL (RPCS) – 2015

August 8, 2015

Earn 44 CEUs, In 5 Days, for $695!
  Instructed By: Terence T. Gorski and Dr. Stephen F. Grinstead

November 9-14, 2015

Ft. Lauderdale, FL

Terence T. Gorski’s advanced relapse prevention training has been “a turning point” in both the professional and personal lives of many former participants. The Gorski schools began in 1982 in Chicago, IL. Since that time, over sixty schools have been conducted with over 4,000 people completing the training.

This advanced clinical skills training experience is designed for professional therapists who are good and want to get better. It may be the most challenging and effective training that you have ever attended.

Upon completion of this training, participants will be able to develop comprehensive Relapse Prevention Plans for identifying and managing both high risk situations in early recovery and the core personality and lifestyle problems that lead to relapse in later recovery, after initial stabilization.

The Gorski Relapse Prevention Certification School (RPCS) is continuously updated with the latest research and uses a proven training method that includes:

(1) Brief Lectures that explain the purpose of each technique and why it is important;

(2) Clinical Demonstrations of each RP technique,

(3) Role Play to practice and receive feedback on your use of each technique,

(4) Small Groups to discuss progress, problems, and applications to your personal style;

(5) Discussions of how to apply the techniques in your professional setting.

Do you want to take your current clinical skills and integrate them with new and powerful approaches for identifying and managing the high-risk situations and core personality and life-style patterns that lead to relapse? If you do, this is the training for you!

Important Notice: An optional RPT Competency Certification that requires the completion of a competency portfolio and an additional fee.

Training Fee: The cost of the training is $695 for the five-day training experience (travel, meals, and lodging are not included in this fee).

Florida Location: HYATT REGENCY PIER SIXTY SIX, 2301 SE 17th Street Causeway Fort Lauderdale FL 33316 USA Telephone: 1-954-525-6666 on November 10-14, 2014 (Special hotel rates will be available for those who register early!

For information and Registration:
Tresa Watson at 1-352-596-8000 or tresa@cenaps.com

Website: www.cenaps.com


Thank God for the Atom Bomb

August 7, 2015

 Nuclear Weapons: A Time-Lapse History 

By Terence T. Gorski 

All people with a conscience have mixed feelings about war and the weapons of mass destruction used in modern day warfare. 

The fear of nuclear war is once again raising its head. Many of us would prefer to ignore the issue and pretend “it can never happen again.” The current deal with Iran over nuclear weapon development and the possibility of widespread nuclear proliferatio in the Middle East is raising the issue and the fear of the real possibility of nuclear war. 

People without a conscience (i.e. psychopaths/sociopaths) are not hobbled in their decision making about nuclear weapons by issues of morality, empathy, and fighting for the good. When making decisions involving the use of weapons of mass destructions psychopathic/sociopathic leaders will do anything necessary to expand their power even if it means destroying humanity in the process. 

In my opinion, the reality is that people of conscience need to come to terms with the need for violence to protect personal freedom. This means facing the issue of using violence on all levels to protect individual freedom. This includes, of course, coming to terms with the production and use of nuclear weapons. If they don’t, people motivated by high moral standards will eventually be killed, imprisoned, or controlled by psychopaths/sociopaths who are well armed and organized. This is especially true if evil intent can be cloaked by a religious ideaology. 

People of good will must recognize and name the true nature of the enemy –those who don’t are usually condemned to be defeat by the enemies they refuse to name. 

The following article was forwarded to me by Buck Yancy, a friend and mentor who keeps challenging me to face and think about the hard issues of life. It is the reprint of an essay written in 1981by the late Paul Fussell, a cultural critic and war memoirist. 

Reading this essay was unsettling. It contrasted two perspectives of making decisions about using nuclear weapons: the anstract perspective of those who make and critique policy; and the personal perspective of the troops whose lives were spared because the land invasion of Japan became unnecessary because the use of nuclear weapons forced Japan to surrender. 

Here is an article by the same name in The New Republic

Below is the original essay I received:

Thank God for the Atom Bomb  

 

Wed Aug 5, 2015 7:36 pm (PDT) . Posted by: “Jim Baker” baycur on Aug 5, 2015, at 11:42 AM, by Jeff Murray tamu73@sbcglobal.net [CHAT_281AHC] <CHAT_281AHC@yahoo groups.com> who wrote:

The headline of this column is lifted from a 1981 essay by the late Paul Fussell, the cultural critic and war memoirist. In 1945 Fussell was a 21-year-old second lieutenant in the U.S. Army who had fought his way through Europe only to learn that he would soon be shipped to the Pacific to take part in Operation Downfall, the invasion of the Japanese home islands scheduled to begin in November 1945. 

Then the atom bomb intervened. Japan would not surrender after Hiroshima, but it did after Nagasaki.

I brought Fussell’s essay with me on my flight to Hiroshima and was stopped by this: “When we learned to our astonishment that we would not be obliged in a few months to rush up the beaches near Tokyo assault-firing while being machine-gunned, mortared, and shelled, for all the practiced phlegm of our tough facades we broke down and cried with relief and joy. We were going to live.”

In all the cant that will pour forth this week to mark the 70th anniversary of the dropping of the bombs—that the U.S. owes the victims of the bombings an apology; that nuclear weapons ought to be abolished; that Hiroshima is a monument to man’s inhumanity to man; that Japan could have been defeated in a slightly nicer way—I doubt much will be made of Fussell’s fundamental point: Hiroshima and Nagasaki weren’t just terrible war-ending events. They were also lifesaving. The bomb turned the empire of the sun into a nation of peace activists.

I spent the better part of Monday afternoon with one such activist, Keiko Ogura, who runs a group called Hiroshima Interpreters for Peace. Mrs. Ogura had just turned eight when the bomb fell on Hiroshima, the epicenter less than 2 miles from her family home. She remembers wind “like a tornado”; thousands of pieces of shattered glass blasted by wind into the walls and beams of her house, looking oddly “shining and beautiful”; an oily black rain. 

And then came the refugees from the city center, appallingly burned and mutilated, “like a line of ghosts,” begging for water and then dying the moment they drank it. Everyone in Mrs. Ogura’s immediate family survived the bombing, but it would be years before any of them could talk about it. 

Because Hiroshima and Nagasaki were real events, because they happened, there can be no gainsaying their horror. Operation Downfall did not happen, so there’s a lot of gainsaying. Would the Japanese have been awed into capitulation by an offshore A-bomb test? Did the Soviet Union’s invasion of Manchuria, starting the day of the Nagasaki bombing, have the more decisive effect in pushing Japan to give up? Would casualties from an invasion really have exceeded the overall toll—by some estimates approaching 250,000—of the two bombs?

We’ll never know. 

— We only know that the U.S. lost 14,000 men merely to take Okinawa in 82 days of fighting. 
— We only know that, because Japan surrendered, the order to execute thousands of POWs in the event of an invasion of the home islands was never implemented. 

— We only know that, in the last weeks of a war Japan had supposedly already lost, the Allies were sustaining casualties at a rate of 7,000 a week. 

— We also know that the Japanese army fought nearly to the last man to defend Okinawa, and hundreds of civilians chose suicide over capture. 

Do we know for a certainty that the Japanese would have fought less ferociously to defend the main islands? We can never know for a certainty. 

“Understanding the past,” Fussell wrote, “requires pretending that you don’t know the present. It requires feeling its own pressure on your pulses without any ex post facto illumination.” Historical judgments must be made in light not only of outcomes but also of options. Would we judge Harry Truman better today if he had eschewed his nuclear option in favor of 7,000 casualties a week; that is, if he had been more considerate of the lives of the enemy than of the lives of his men?

And so the bombs were dropped, and Japan was defeated. Totally defeated. 

Modern Japan is a testament to the benefits of total defeat, to stripping a culture prone to violence of its martial pretenses. 

Modern Hiroshima is a testament to human resilience in the face of catastrophe. It is a testament, too, to an America that understood moral certainty and even a thirst for revenge were not obstacles to magnanimity. In some ways they are the precondition for it.

For too long Hiroshima has been associated with a certain brand of leftist politics, a kind of insipid pacifism salted with an implied anti-Americanism. That’s a shame. There are lessons in this city’s history that could serve us today, when the U.S. military forbids the word victory, the U.S. president doesn’t believe in the exercise of American power, and the U.S. public is consumed with guilt for sins they did not commit.

Watch the lights come on at night in Hiroshima. Note the gentleness of its culture. And thank God for the atom bomb.


Divorced With Children 

August 6, 2015

By Terence T. Gorski, Author, Trainer, and Consultant
GORSKI BOOKS: www.relapse.org

We usually get divorced to leave our Ex behind. We want them permanently out of our lives. We want to be free to get on with our own lives. 

If we are divorced with children, the problem is obvious — children are forever. They can never become the “ex-child” of either partner. So your Ex is never really your Ex. This is because your Ex is not and probably never will be your child’s Ex! Your children love and need your Ex just as much as they did before you were divorced.

This means that if you love your children and think things through, you come to realize that it is important to follow some rules: 

  1. Do not talk down about someone your children love — in this case your Ex. 
  2. Do not make you child feel bad for loving their own parent. 
  3. Above all, do not force your children to choose which parent to love and which to leave behind. Children who are alienated from one parent by the other are forced to leave  the alienated parent behind buried in a heap of unresolved emotion they can’t really understand. 
  4. Remember, it is your divorce. You made the decision, not your children. They did not choose this. Choose your kids well being first and let them do what all children must do — love both parents.

These are great rules — they even carry the ring of sobriety and responsibility. Unfortunately, we are fallible human beings. We strive in all things for progress knowing we can never achieve perfection. 

The rules are simple — put human fallibility makes them difficult to follow. Part of the difficulty is that we got divorced because we wanted or needed to leave our “ex” behind, or our “”Ex” wanted or needed to leave us behind. The goal of divorce, from the parents point of view, is to get their spouse permanently out their lives so they can get on with rebuilding of their own lives.

The problem here is obvious — children are forever. They can never become the “ex-children” of either partner. If we love our children, we will strive to never force them to make a choice between their parents unless their physical safety or life is at risk.

If we love our kids we deal with visitation schedules, shared holidays, staying silent when we want to scream at our “ex” in front them. We do it all for them, not for our Ex. 

What’s even worse is when “our children” are away from us “visiting” with our Ex we must deal with our fears. Ask almost any divorced parents and they will tell you the truth as they see it: “I am a better parent than my Ex and I have “serious concerns” about my Ex’s parenting style. 

So, at some point, we must deal with the reality that we are divorced from our Ex, yet our lives are forever connected to our Ex through our children. 

For the love of our children we try our best to make “joint parenting” as normal as possible for them. We do our best to rebuild our lives within limits — the primary limit being that children love and need both parents. Therefore, if we love our children, total disconnection from our Ex is usually not an option.

Divorced with children means we almost get free from the problems of our marriage — almost, but not quite. 

We try to follow the simple rules spelled out above. But being a fallible human being we at times fail miserably. Fortunately, most children forgive their parents because children tend to love their parents in spite of their human fallibility. 

GORSKI BOOKS: www.relapse.org 

Check out the book: Getting Love Right – Learning The Choices of Healthy Intimacy


Addiction: Frequently Asked Questions

August 4, 2015

 The source of these question and answers is: http://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
Treatment and Recovery

Frequently Asked Questions

1. Can addiction be treated successfully?

Yes. Addiction is a treatable disease. Research in the science of addiction and the treatment of substance use disorders has led to the development of evidence-based interventions that help people stop abusing drugs and resume productive lives.

2. Can addiction be cured?

Not always—but like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s powerful disruptive effects on their brain and behavior and regain control of their lives.

3. Does relapse to drug abuse mean treatment has failed?

No. The chronic nature of the disease means that relapsing to drug abuse at some point is not only possible, but likely. Relapse rates (i.e., how often symptoms recur) for people with addiction and other substance use disorders are similar to relapse rates for other well-understood chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors, and relapse does not mean treatment has failed. For a person recovering from addiction, lapsing back to drug use indicates that treatment needs to be reinstated or adjusted or that another treatment should be tried.28

What are the principles of effective substance use disorder treatment?

Research shows that combining treatment medications (where available) with behavioral therapy is the best way to ensure success for most patients. Community support grouos are also important in supporting long-term recovery.

How can medications help treat drug addiction?

Different types of medications may be useful at different stages of treatment to help a patient stop abusing drugs, stay in treatment, and avoid relapse.

    Treating Withdrawal. When patients first stop using drugs, they can experience a variety of physical and emotional symptoms, including depression, anxiety, and other mood disorders, as well as restlessness or sleeplessness. Certain treatment medications are designed to reduce these symptoms, which makes it easier to stop the drug use.

      Staying in Treatment. Some treatment medications are used to help the brain adapt gradually to the absence of the abused drug. These medications act slowly to stave off drug cravings and have a calming effect on body systems. They can help patients focus on counseling and other psychotherapies related to their drug treatment.

        Preventing Relapse. Science has taught us that stress, cues linked to the drug experience (such as people, places, things, and moods), and exposure to drugs are the most common triggers for relapse. Medications are being developed to interfere with these triggers to help patients sustain recovery.

        How do behavioral therapies treat drug addiction?

        Behavioral treatments help engage people in substance use disorder treatment, modifying their attitudes and behaviors related to drug use and increasing their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive use. Behavioral therapies can also enhance the effectiveness of medications and help people remain in treatment longer.

        Treatment must address the whole person.

        How do the best treatment programs help patients recover from the pervasive effects of addiction?

        Gaining the ability to stop abusing drugs is just one part of a long and complex recovery process. When people enter treatment for a substance use disorder, addiction has often taken over their lives. The compulsion to get drugs, take drugs, and experience the effects of drugs has dominated their every waking moment, and abusing drugs has taken the place of all the things they used to enjoy doing. It has disrupted how they function in their family lives, at work, and in the community, and has made them more likely to suffer from other serious illnesses. Because addiction can affect so many aspects of a person’s life, treatment must address the needs of the whole person to be successful. This is why the best programs incorporate a variety of rehabilitative services into their comprehensive treatment regimens. Treatment counselors may select from a menu of services for meeting the specific medical, psychological, social, vocational, and legal needs of their patients to foster their recovery from addiction.

        Cognitive Behavioral Therapy seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
        Contingency Management uses positive reinforcement such as providing rewards or privileges for remaining drug free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
        Motivational Enhancement Therapy uses strategies to evoke rapid and internally motivated behavior change to stop drug use and facilitate treatment entry.
        Family Therapy (especially for youth) approaches a person’s drug problems in the context of family interactions and dynamics that may contribute to drug use and other risky behaviors.
        Relapse Prevention Therapy: Helps peopld to identify and mamage the early warning signs that leD from stable recovery back into addictive use.

        What Is The Difference Between the Term “DISEASE” and “DIDORDER?”

        If you look up disease (medical psychobabble) and disorder (psychological psychobabble) they both mean the same thing (two of the following four criteria): 

        (1) known etiology, 

        (2) progressive course of predictable symptoms, and 

        (3) predictable course — acute, chronic, or terminal; and 

        (4) a course of treatment With the goal of remission or palliative care (maximum comfort and symptom management until death.) 

        See What is a disease: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1299105/pdf/5-7400195.pdf&nbsp;

        GORSKI BOOKS: www.relapse.org


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