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;.


Kava and Relapse

January 1, 2015

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By Terence T. Gorski
Author

This information on Kava is reproduced from a Medline Article http://m.medlineplus.gov/druginfo/natural/872.html

Introduction

Kava is mind altering and mood altering substance that produces an effect on the brain similar to sedative drugs such as Librium or Valium. They are cross addictive with other mood altering drugs. Many people use Kava as they move into relapse process thinking that it will be a free high with no adverse consequence.

Many treatment programs use drug testing regimes that will detect and report Kava use. Lava impairs judgment and impulse control and generally does not produce the desired high or the desired mood altering effect of the drug of choice.

As a result of impaired judgment or impulse control it is easier to rationalize going back to the use of their drug of choice. Using Kava is the start of active drug use episode. It is usually preceded by many early relapse warning signs.

You can do an evaluation of your relapse risk using The Aware Questionnaire

Midline Article On Kava

Scientific name: Piper methysticum
Rank: Species
Higher classification: Piper

Kava or kava-kava is a crop of the western Pacific. The name kava is from Tongan and Marquesan; other names for kava include ʻawa, ava, yaqona, and sakau. The roots of the plant are used to produce a drink with sedative and anesthetic properties.

What is kava?
Kava—or kava kava—is a root found on South Pacific islands. Islanders have used kava as medicine and in ceremonies for centuries.

Kava has a calming effect, producing brain wave changes similar to changes that occur with calming medicines such as diazepam (Valium, for example). Kava also can prevent convulsions and relax muscles. Although kava is not addictive, its effect may decrease with use.

Traditionally prepared as a tea, kava root is also available as a dietary supplement in powder and tincture (extract in alcohol) forms.

What is kava used for?
Kava’s calming effect may relieve anxiety, restlessness, sleeplessness, and stress-related symptoms such as muscle tension or spasm. Kava may also relieve pain.

When taken for anxiety or stress, kava does not interfere with mental sharpness. When taken for sleep problems, kava promotes deep sleep without affecting restful REM sleep.

Kava may be used instead of prescription antianxiety drugs, such as benzodiazepines and tricyclic antidepressants. Kava should never be taken with these prescription drugs. Avoid using alcohol when taking kava.

Is kava safe?
Kava may have severe side effects and should not be used by everyone. Kava has caused liver failure in previously healthy people. You should not use kava for longer than 3 months without consulting your doctor.

Before you use kava, consider that it:

Should not be combined with alcohol or psychotropic medicines. Psychotropic medicines are used to treat psychiatric disorders or illnesses and include antidepressants and mood stabilizers. Alcohol exaggerates kava’s sedating effect.
Can affect how fast you react, making it unsafe to drive or use heavy machinery.
May gradually be less powerful as you use it.
Eventually may cause temporary yellowing of skin, hair, and nails.
Can cause an allergic skin reaction (rare).
Long-term kava use may result in:

Liver problems.
Shortness of breath (reversible).
Scaly rash (reversible).
Facial puffiness or swelling (reversible).
The U.S. Food and Drug Administration (FDA) has investigated whether using dietary supplements containing kava is associated with liver illness. Reports from Germany and Switzerland about kava causing serious liver problems have led to the recent removal of these products from shelves in Britain. Other countries have advised consumers to avoid using kava until further information is available.

In the United States, the FDA advises people who have liver disease or liver problems, or people who are taking medicines that can affect the liver, to consult a doctor or pharmacist before using products that contain kava. People who use a dietary supplement that contains kava and experience signs of illness should consult a doctor. Symptoms of serious liver disease include brown urine as well as yellowing of the skin or of the whites of the eyes. Other symptoms of liver disease may include nausea, vomiting, light-colored stools, unusual tiredness, weakness, stomach or abdominal pain, and loss of appetite.

The FDA does not regulate dietary supplements in the same way it regulates medicine. A dietary supplement can be sold with limited or no research on how well it works.

Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.

When using dietary supplements, keep in mind the following:

Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medicines or other supplements you might be taking. A side effect or interaction with another medicine or supplement may make other health conditions worse.
The way dietary supplements are manufactured may not be standardized. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.

Reference:
1. http://m.medlineplus.gov/druginfo/natural/872.html

2. http://www.thefix.com/content/mood-and-mind-altering-substances00417?page=all

Gorski Books


The Matrix Model – Stages of Recovery

July 11, 2014

By Terence T.Gorski, Author
www.relapse.org

20140711-213822-77902045.jpg

The Matrix Model for Cocaine Addiction was originally developed by Richard Rawson. http://www.sciencedirect.com/science/article/pii/074054729400080B

I believe the recovery chart depicted her is modified from the framework of the Matrix Recovery Model.

The model is developmental in nature (i.e. their are a series of developmental steps and stages of recovery). The idea of Post Acute Withdrawal is built into the model by intruding the the concept of “hitting the wall” which is a severe episode of PAW. PAW however, was not specifically mentioned in early versions of the model.

The Matrix Model was popular during the years of “The Cocaine Epidemic” in the 1980”s and 1990’s. It was an empirical model growing out of treatment experience and I clinical practice.

As with many other models it was expanded to include all addictive substances without any real evidence it was valid. It implies progressive recovery, with relapse as a treatment recovery failure.

There is no specific relapse prevention plan or emergency plan to stop relapse quickly should it occur. As a result the model, toy knowledge, has not adapted to integrate the chronic life-style related disease model and the need for relapse prevention and management of the course of the entire lifespan.

The model has been used in many programs and helped many people to recover.

The Matrix Model has been recognized as an evidence-based program and practice by NREPP – http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=87

I cannot locate the specific diagram and it is not referenced. The idea that neurological symptoms of recovery (PAW) can be predicted by days abstinent is controversial. Stage of addiction, type and amount of drug(s) used, age and health status of the patient, type of treatment, nutrition and stress management effect the progression of recovery.

GORSKI BOOKS


Molly – The Street Drug

May 15, 2014

imagesA street drug named Molly is becoming a common drug of abuse that is ripping apart the lives of young people and their families. It is important to learn about it. The depression or dysphoria which is part of the withdrawal process can be severe and contribute to suicide. Since the drug is most widely abused by teenagers, the risk of suicide during Molly withdrawal, coupled with the normal tendencies of adolescents to experience bouts of depression, can contribute to an elevated risk of suicide.

See the CNN Report on Molly:

(CNN) — The drug called Molly isn’t what most of its users think it is. If you Google “Molly,” many articles say the drug is “pure” MDMA, the active ingredient in Ecstasy.
Users often talk about the “purity” of taking Molly, as if it’s somehow better; after all, MDMA was originally developed as a medication to treat depression. But today’s Molly is most often not MDMA — in the last few years, the drug has become a toxic mixture of lab-created chemicals, according to the U.S. Drug Enforcement Administration.
Here are nine things everyone should know about this rapidly changing party drug:

1. What is Molly?

‘2C-P’ and ‘Molly’ involved in overdoses Drug deaths spur fear of bad batch Hot party drug has deadly consequences Patient: Ecstasy eased my PTSD
Someone who buys or takes Molly now is probably ingesting dangerous synthetic drugs that have not been tested and are produced in widely varying strengths. The DEA says only 13% of the Molly seized in New York state the last four years actually contained any MDMA, and even then it often was mixed with other drugs. The drugs frequently found in Molly are Methylone, MDPV, 4-MEC, 4-MMC, Pentedrone and MePP.

2. What does Molly do?

The lab-created chemicals mimic the effects of MDMA; most of them are central nervous system stimulants that cause euphoric highs. They can also cause a rapid heartbeat, high blood pressure, blood vessel constriction and sweating, and can prevent the body from regulating temperature. Some of the chemicals have been reported to cause intense, prolonged panic attacks, psychosis and seizures. After they wear off, the chemicals can cause devastating depression. Several of these compounds have caused deaths.

3. Who is using Molly?

Molly is being marketed to young first-time drug abusers between the ages of 12 and 17, as well as traditional rave, electronic dance music fans who may think they’re getting MDMA. “Our kids are being used as guinea pigs by drug traffickers,” says Al Santos, associate deputy administrator for the DEA.

4. What does Molly look like?

Molly can take many different forms, although it’s most often found in a capsule or powder. The DEA has also seen Molly applied to blotting paper, like LSD, and in injectable form.

5. What makes Molly so dangerous?

Molly is dangerous because of the toxic mix of unknown chemicals; users have no idea what they’re taking or at what dose. Unlike MDMA and other illegal drugs that have known effects on the body, the formulas for these synthetic drugs keep changing, and they’re manufactured with no regard to how they affect the user.

“You’re playing Russian roulette if you take these compounds because we’re seeing significant batch-to-batch variances,” Santos says.

For example, officials have found completely different ingredients in drugs sold in the same packaging. Santos also says the amount of active ingredients can be dangerously different, because “the dosing for these sorts of drugs are in the micrograms. The room for error is tremendous, and we’ve seen a lot of deaths with some of these compounds.”

The DEA has developed its own reference materials for state and local law enforcement because they were encountering so many different drug compounds they’d never seen before. At the DEA testing lab, technicians are constantly trying to unravel the chemical makeup of newly discovered drug compounds that have been seized.

What you need to know about synthetic drugs

6. Where do the chemicals come from?
Almost all the chemicals in Molly and other synthetic drugs come from laboratories in China. Chinese chemists sell the drugs online, and middlemen in the United States and around the world cut it with other substances, and either place it in capsules or sell it as powder. Other kinds of synthetic drugs can be sprayed onto plant material and smoked, such as synthetic marijuana.

But it’s difficult for law enforcement to keep track of all the chemicals. The DEA says it’s seen about 200 individual chemical compounds since 2009 and 80 new compounds since 2012. As soon as a compound is discovered and banned, another one is created to take its place.

Interestingly enough, the formulas for these drugs were discovered by legitimate scientists working on new medications. The formulas couldn’t be used as medicine because of the stimulant or hallucinogenic effects they had users, but the “recipes” for the drugs still remain.
Clandestine chemists have used the scientific literature to create hundreds of new chemical compounds for the sole purpose of getting people high. There is no known legitimate purpose for any of these chemicals.

Music festival canceled after 2 deaths blamed on drugs

7. How widespread is the problem?

Huge. The fastest-emerging drug problem in the United States is the synthetic drug market, which now includes Molly. The chemicals in Molly have been found in nearly every state in the U.S.
And it’s a multibillion-dollar business. In two days, the DEA seized $95 million off drug traffickers during a crackdown. It is a growing problem in Australia, New Zealand and Europe as well.

8. What’s being done about it? Why can’t the government just make it illegal?

Congress passed the Synthetic Drug Abuse Prevention Act in July 2012, which controlled 26 compounds by name. But there are hundreds of compounds, and every time the government makes one illegal, chemists alter the formula slightly to make it a substance that is no longer controlled.

U.S. officials say they are discussing the issue with the Chinese government, but most of these chemicals are legal in China.

There’s something (potentially dangerous) about molly

9. How can I tell if someone is using or has used Molly?

The effects can vary widely, depending on the chemical, but while users are under the influence, they may exhibit the following symptoms: sweating, jaw clenching, violent or bizarre behavior and psychosis.

After the drug has worn off, a user may show signs of depression or may not be able to get out of bed for an extended period of time.

Molly, MDMA, Ecstasy Withdrawal


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