Flakka: The Dangerous Synthetic Drug That's Worse Than Cocaine

Flakka has is one of the most dangerous street drugs and truly worse than cocaine. It is known as alpha-PVP, this powerful synthetic cathinone causes bizarre behaviors, severe health complications, and even death. I will spend the next several paragraphs explaining what flakka is, its devastating effects, and how to get help if you or someone you know is struggling with flakka abuse. 

What Exactly is Flakka and Why Is It So Dangerous?

Flakka is a synthetic cathinone, specifically alpha-pyrrolidinopentiophenone (α-PVP). It belongs to the same chemical family as "bath salts" and works by blocking the reuptake of dopamine and norepinephrine in the brain giving it amphetamine-like behavior. Remember, dopamine is that "feel good" neurotransmitter at the heart of most addiction. Flakka, usually a white or pink substance is typically found in crystal form, often called "gravel" on the streets due to its appearance.

What makes flakka dangerous is its potency. Scientific research estimates that flakka is at least ten times stronger than cocaine. This extreme strength makes dosing unpredictable and creates a high risk of overdose. Even tiny amounts can trigger severe reactions, and users rarely know exactly what they're taking or how strong it is. The Drug Enforcement Administration (DEA) classified flakka as a Schedule I controlled substance because of its high potential for abuse and lack of accepted medical use.

How Does Flakka Relate to Bath Salts?

Flakka and bath salts are chemically similar substances that belong to the synthetic cathinone family. These compounds are derived from cathinone, a naturally occurring stimulant found in the khat plant, which has been used for centuries in parts of Africa and the Middle East.

Unlike natural cathinones, synthetic cathinones like flakka are man-made drugs that appeared on the illicit drug market around 2010. These substances were initially marketed as "bath salts," "plant food," or "phone screen cleaner" with labels stating "not for human consumption" to bypass drug laws. Bath salts often contain MDPV (methylenedioxypyrovalerone) or mephedrone, while flakka (alpha-PVP) represents a second-generation variation.

By mid-2015, α-PVP had caused 105 fatal intoxications in Europe alone, demonstrating how quickly this dangerous drug spread globally. The chemical similarity between flakka and bath salts means they share many of the same horrifying risks that have led to widespread public health concerns.

Where Did Flakka Come From?

While flakka burst into public awareness relatively recently, particularly in South Florida around 2014-2015, its origins go back much further. The compound alpha-PVP was actually first patented in 1967. However, it was never marketed as a medication and remained largely obscure until underground chemists rediscovered it decades later.

The drug's natural predecessor, cathinone, comes from the khat plant and has been used for centuries. Synthetic cathinones like mephedrone were first synthesized in the 1920s but sort of gotten lost before being resurrected as designer drugs in the 2000s.

The recent popularity of synthetic cathinones like flakka stems from chemists exploiting legal loopholes by creating new compounds that mimic illegal drugs while technically being different chemicals. Flakka became popular partly because it was cheap and readily available, often bought online or in convenience stores before it was banned.

Why Do People Use Flakka Despite Its Risks?

Despite its well-documented dangers, people continue to use flakka for several reasons that are important to understand when addressing this public health issue.

One major factor is cost. Flakka is often significantly cheaper than other stimulant drugs like cocaine or methamphetamine, making it affordable to more people. As noted in scientific research, flakka gained popularity partly due to its "simple preparation and low price." Additionally, users are initially attracted to the intense stimulant effects and feelings of euphoria the drug produces. Flakka triggers a surge of dopamine and norepinephrine, creating powerful but dangerous feelings of energy and pleasure.

Many people who try flakka don't fully understand its risks or potency. The drug may be sold under misleading names, and users might not know what they're actually taking. In some cases, people seeking other psychoactive stimulants unknowingly receive flakka instead. Once someone develops flakka addiction, continued use is driven by powerful cravings and withdrawal symptoms rather than rational decision-making.

How Is Flakka Typically Used?

Flakka can be consumed in several ways, each with different onset times and intensity of effects. People may snort, inject, smoke, vape, or swallow flakka. Smoking or vaporizing the drug in e-cigarette devices has become increasingly common, as it allows for rapid absorption into the bloodstream. This method creates a particularly high risk of overdose because the drug reaches the brain quickly and in concentrated amounts.

Injection carries similar risks of rapid onset and overdose, along with additional dangers of infection, vein damage, and blood-borne disease transmission if needles are shared. When snorted or swallowed, the onset may be somewhat slower, but still produces powerful and dangerous effects. Regardless of how it's taken, flakka enters the bloodstream and quickly crosses the blood-brain barrier, leading to its potent effects on the central nervous system.

What Immediate Effects Does Flakka Have?

While flakka may be similar to the street drug cocaine, flakka causes a more powerful stimulant effect far stronger than those of cocaine. The immediate impact on both body and mind can be extreme and dangerous.

Physical effects include dramatically increased body temperature (hyperthermia), extreme agitation, rapid heart rate, high blood pressure, and excessive sweating. Users often strip off clothing due to feeling intensely hot. The drug causes what medical professionals call "excited delirium," a condition characterized by extreme physical strength, agitation, and overheating that can lead to organ failure.

Psychologically, flakka initially produces feelings of euphoria but quickly leads to disturbing effects. Users typically experience intense paranoia, hallucinations, and delusions—often believing they're being chased or attacked. This can trigger violent behavior or self-harm. Back in 2016, there was a famous news report about someone high on flakka "eating" someone's face.  It was the first time I heard about flakka and I made sure to learn everything about it back then. Scientific research has documented cases where people on flakka exhibited bizarre behavior, extreme anxiety, confusion, and seizures. These effects make flakka dangerous not only to users but potentially to those around them.

What Are the Frightening Symptoms of Flakka Use?

Recognizing the symptoms of flakka use is crucial for early intervention. The signs can be dramatic and concerning, often requiring emergency medical attention.

Physical symptoms include excessive sweating, extraordinarily high body temperature (often over 105°F), rapid pulse, increased strength, dilated pupils, and jerky movements. Clinical signs of agitated delirium from flakka include "tachycardia, hypertension, hyperthermia, diaphoresis, and mydriasis," according to research. These signs mimic those of methamphetamine making it difficult to distinguish one from the other. However, an extended urine drug screen test will be negative for methamphetamine and it doesn't test for flakka.

Behavioral and psychological symptoms are often the most alarming. These include extreme agitation, paranoia, delusions (particularly of being pursued), hallucinations, confused speech, and unpredictable or violent behavior. Scientific studies note that flakka can cause "terrible delusions, paranoid psychosis, extreme agitation, and many other altered mental states." People high on flakka appear disconnected from reality and unable to communicate rationally.

In severe cases, users experience "excited delirium," a dangerous state where extreme agitation and overheating can lead to cardiac arrest if not treated immediately. This condition represents a true medical emergency requiring immediate professional intervention.

Is Flakka More Dangerous Than Cocaine?

Flakka produces effects similar to other stimulants such as cocaine or methamphetamine but is far more potent and unpredictable, making it substantially more dangerous than traditional stimulants.

Flakka inhibits the reuptake of dopamine and norepinephrine but has minimal effect on serotonin, creating an intense but unbalanced stimulation. While cocaine typically produces effects lasting 15-30 minutes, flakka's effects can persist for hours (typically 2-3 hours, but sometimes longer). The severe psychotic symptoms and agitated delirium associated with flakka are much more common and intense than with cocaine use. Recovery from flakka-induced psychosis often takes longer than from other stimulant-induced states, sometimes requiring days or weeks of hospitalization rather than hours.

The unpredictable composition of street flakka adds another layer of danger not always present with more established drugs like cocaine. The combination of extreme potency, lengthy duration, severe psychiatric effects, and unpredictable composition makes flakka is a dangerous substance with an even higher immediate risk profile than cocaine.

What Are the Long-Term Effects of Flakka Abuse?

While research on the long-term effects of flakka is still developing, evidence suggests that chronic use can lead to lasting damage to both physical and mental health.

Physically, repeated flakka use can cause cardiovascular damage, including heart muscle deterioration and increased risk of heart attack or stroke. The drug's intense stress on the kidneys and liver can lead to chronic organ dysfunction. Neurological damage may occur due to repeated episodes of hyperthermia and oxygen deprivation to the brain. Research has found that α-PVP can cause direct myotoxicity (heart muscle damage), noting that "the direct effects of α-PVP on skeletal muscle mitochondria may lead to myotoxicity in susceptible cathinone users."

Mental health consequences may be even more profound. Persistent psychosis can develop, with some users never fully recovering their previous mental function. Memory problems, cognitive impairment, and mood disorders commonly persist after stopping use. Chronic paranoia and anxiety may become permanent issues, even after the drug is no longer being used. Additionally, withdrawal symptoms from flakka can be severe, including intense depression, anxiety, fatigue, and powerful cravings that make recovery challenging without proper support.

Can Someone Recover From Flakka Addiction?

Yes, recovery from flakka addiction is possible, though it presents unique challenges compared to other substance use disorders. A comprehensive approach is necessary for successful treatment.

Medical detoxification is always the first step, requiring supervision by a knowledgeable healthcare professionals who can manage withdrawal symptoms and address any medical complications. This often requires hospitalization, particularly if the person is experiencing psychosis or other severe symptoms. Following detox, residential or intensive outpatient treatment programs provide the structure and support needed in early recovery.

Therapeutic approaches such as cognitive-behavioral therapy (CBT) have shown effectiveness in treating stimulant use disorders. These therapies help address underlying issues that may have contributed to drug use and develop coping strategies for triggers and cravings. Support groups can also play a crucial role in maintaining long-term recovery by providing community understanding and accountability.

The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline (1-800-662-HELP) offers information about local treatment facilities, support groups, and community-based organizations. It's important to remember that recovery is possible with the right support, even from powerful substances like flakka.

What Should I Do If Someone I Know Is Using Flakka?

If someone you know is using flakka, quick action could save their life. The extreme nature of flakka's effects demands an urgent and thoughtful response.

For immediate emergencies—such as someone experiencing agitated delirium, psychosis, or showing signs of overdose—call 911 immediately. First responders have experience dealing with drug-related emergencies and can provide life-saving medical intervention. Be honest about the substances involved, as this information is crucial for proper treatment.

When approaching someone about their flakka use outside of an emergency situation, choose a moment when they are not under the influence and are relatively calm. Express concern without judgment, focusing on specific behaviors you've observed rather than making accusations. Offer to help them find treatment resources rather than simply telling them to stop using.

Professional help is essential. Connect them with addiction specialists who understand synthetic cathinones like flakka. The National Institute on Drug Abuse website provides evidence-based information about treatment approaches. Remember that recovery requires professional support, and your role is to help facilitate connection to that support, not to provide treatment yourself.

Key Points to Remember About Flakka

• Flakka (α-PVP) is a synthetic cathinone that is at least ten times stronger than cocaine, creating a high risk of overdose.

• It is typically white or pink crystals (sometimes called "gravel") and can be swallowed, snorted, injected, smoked, or vaped.

• Flakka is ofent referred to as bath salts.

• Flakka may be used in combination with other drugs

• The drug causes both physical symptoms (hyperthermia, tachycardia, hypertension) and severe psychological effects (paranoia, hallucinations, delusions, psychosis, lead to violent aggression) making it extremely dangerous.

• Flakka and bath salts are chemically related; both are synthetic derivatives of cathinone, a stimulant found naturally in the khat plant.

• Users may experience "excited delirium," a dangerous condition characterized by extreme agitation, overheating, and erratic behavior that can lead to death.

• The immediate effects of flakka include euphoria and stimulation, but these quickly give way to dangerous and frightening symptoms.

• Treatment for flakka addiction requires medical detoxification followed by comprehensive addiction treatment, including therapy and ongoing support.

• If someone is experiencing a flakka-related emergency, call 911 immediately, as the condition can be life-threatening.

• Long-term flakka use may cause permanent cardiovascular damage, persistent psychosis, and cognitive impairment.

• Start your recovery journey from flakka addiction as soon as possible with proper professional help, which can be found through resources like SAMHSA's National Helpline (1-800-662-HELP).

Patocka, J., Zhao, B., Wu, W., Klimova, B., Valis, M., Nepovimova, E., & Kuca, K. (2020). Flakka: New dangerous synthetic cathinone on the drug scene. International Journal of Molecular Sciences, 21(21), 7943. https://doi.org/10.3390/ijms21217943

About the author:

Dr. Harold Pierre is a board-certified anesthesiologist, board certified addiction medicine specialist, and a concierge addiction doctor with over 26 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine. If you are seeking care, you may schedule an appointment with him by calling 918-518-1636.

*Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition before making any changes. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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