These names do not reflect the product properties; they are just a cover for the drug council or the local police. Both substances can induce euphoria, heightened sex drive, increased sociability, and hallucinations. When used in excessive amounts, they can lead to severe negative effects, including high blood pressure, elevated heart rate, paranoia, aggression, panic attacks, and psychosis. Both drugs can be consumed in various ways—such as smoking, injecting, or snorting—and carry a significant risk of overdose and death.

What happened to the “Man on Flakka?”

“Flakka” is the street name for the synthetic cathinone α-pyrrolidinopentiophenone (α-PVP). Although it was developed by Boehringer Ingelheim as a central nervous system stimulant and pressor agent in the 1960s, it entered in the drug arena at an accelerated rate during the last 4 years causing intoxications, fatal or not. It can be easily manufactured and purchased through the Internet or in retail shops and is usually sold as “bath salts”. The aim of this review is to summarize the current knowledge of this drug concerning its chemistry, synthesis, metabolism, pharmacology, and toxicology.

6. Clinical Course and Health Risks

An increasing number of people are being admitted to emergency wards due to the consequences of their use. This work mainly summarizes the history, synthesis, pharmacology, toxicology, structure–activity relationship, metabolism, clinical process and health risks, poisoning and death, forensic toxicology, and legal status of α-PVP. We hope this review will help bring more attention to the exploration of this substance in order to raise awareness of its negative impacts on humans. Α-PVP can be orally ingested, smoked, snorted, used parenterally, and also vaporized in e-cigarette devices.

• Individuals with flakka overdose were isolated to a few geographic regions of the country.
• Schedule I drugs are defined as substances with a high potential for abuse, no currently accepted medical use in treatment, and a lack of accepted safety for use under medical supervision.
• The previously reported serious adverse effects of α-PVP included psychosis and catatonia 2, myocardial infarction 3, and Stevens-Johnson syndrome 4, but not stroke.
• Alpha-Pyrrolidinopentiophenone is a synthetic cathinone that acts as a stimulant similar to amphetamine, the active ingredient in certain ADHD medications.
• Many of the metabolites can form sulfates or, more frequently, glucuronides, or other conjugates as Phase II metabolites.
• In the final rules promulgated by DEA in March 2017 79, α-PVP was listed as a Schedule I drug.

What are the side effects of Flakka?

“Flakka” related cases, published or reported, including fatalities or intoxications, as well as seizures are reviewed. The existing analytical methodologies for the determination of α-PVP in biological and postmortem samples are summarized, and its current legal status is reported. A synthetic drug known on the streets as “Flakka” (α-pyrrolidinovalerophenone, α-PVP) has become popular in the United States. It is chemically similar to MDPV, also known as a bath salt, which was responsible for the increase in bizarre cases of intoxication and agitation in the United States several years ago 30.

The patient used a clean needle with a microfilter, which lowers the risk of embolic adulterants to be the direct cause of the ischemic stroke. The comprehensive evaluation ruled out other major causes of stroke, and the onset of the stroke was immediately after the α-PVP injection. The urine drug screen was only positive for benzodiazepines, which rules out other confounding substances. In some of the documented delusions, individuals’ experiences are of a typical paranoia, where the drug users feel they are being chased by a large group of people trying to kill them. 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.

Although people use α-PVP for their euphoric potential, symptoms can easily escalate into terrible delusions, paranoid psychosis, extreme agitation, and many other altered mental states. Α-PVP causes a condition called agitated delirium, where there is an excessive influx of sympathetic activation 31. This condition causes changes to the mental state, including bizarre behavior, anxiety, agitation, violence, confusion, myoclonus, and seizures 32,33. Clinical signs of agitated delirium include tachycardia, hypertension, hyperthermia, diaphoresis, and mydriasis 34.

• The growing number of seizures, intoxications, and deaths connected with α-PVP exploitation, and the lack of a relevant antidote for cathinone exposure, requires further investigation among toxicologists.
• Racemic and S-α-PVP were self-administered by rats at a 0.03 mg/kg injection, whereas R-α-PVP was self-administered at a 10-fold higher dose.
• This includes feelings of euphoria, heightened focus, increased sex drive, and being sociable.

Cocaine Addiction and Abuse

Doctors have to take this into consideration in order to provide appropriate treatments and minimize undesirable damage. Stimulant-induced neurochemical changes may occur at different times for different brain regions or neurotransmitter systems. This study sought to examine the behavioral and neurochemical effects of extended access to α-pyrrolidinopentiophenone (α-PVP) and 4-methylmethcathinone (4MMC). Amygdala, hippocampus, hypothalamus, prefrontal cortex (PFC), striatum, and thalamus were extracted, and tissue was analyzed with electrochemical detection and liquid chromatography mass spectrometry. Rats acquired self-administration of α-PVP and 4MMC, and LgA rats showed more escalation of self-administration than ShA rats. Synthetic cathinone administration produced several effects on neurotransmitters.

What are the Long-Term Effects of Flakka?

In other words, Flakka is a type of bath salt, but not all bath salts are Flakka. Some bath salts may be more potent than Flakka, others less, and there is really no way of telling beforehand. Flakka, a street name for the inexpensive and dangerous “designer drug” Alpha-PVP, is one such newcomer. Manufacturers frequently mix α-PVP with cheap fillers such as caffeine or sugar to alter appearance and maximize profit. These additives rarely affect the psychoactive strength of the drug but can further complicate health risks. We are dedicated to transforming the despair of addiction into a purposeful life of confidence, self-respect and happiness.

Many of the metabolites can form sulfates or, more frequently, glucuronides, or other conjugates as Phase II metabolites. Eleven metabolites of α-PVP were detected in rats, as well as in drug abusers’ urine samples. Some complications of flakka drug abuse can happen while the drug user is acutely agitated if they were to harm themselves or others; however, medically, the severe consequences of the agitation caused by the drug appear later. Agitated patients can go into a state called “excited delirium,” which is a medical emergency. In the excited delirium state, restrained patients struggle to free themselves, scream, flail, and can even have seizures. The combination of a high body temperature and extreme muscle overactivity can cause other metabolic problems to happen in the body.

Florida, especially Broward County, once experienced a spike in flakka-related emergencies. Reports show this synthetic drug traveling to states like Georgia, Kentucky, Tennessee, and Ohio. While flakka may not be as widespread as opioids or methamphetamine, it has made substantial inroads in specific regions, particularly in pockets of the Southeastern United States. By preventing cells from reabsorbing dopamine and norepinephrine, flakka prolongs the “rush” effect.

Internationally, the legal status of flakka varies by country, but many countries have taken steps to control its use due to its dangerous effects. Ark Behavioral Health offers 100% confidential substance abuse assessment alpha-pyrrolidinopentiophenone and treatment placement tailored to your individual needs. It may, however, cause an excited delirium resulting in wild, unpredictable, and severely violent behavior in those under this drug’s influence.

In March 2014 77, the DEA temporarily included 10 types of synthetic cathinones, such as α-PVP, in the Schedules of Controlled Substances, and they extended this control period in March 2016 78. In the final rules promulgated by DEA in March 2017 79, α-PVP was listed as a Schedule I drug. Law enforcement and community activists were instrumental in limiting the damage done by the drug’s dangerous effects.

Below, we’ll explain flakka, why it can be so dangerous, and how communities can respond with both precaution and compassion.

Overall, while more research is needed to fully understand the extent of Flakka’s addictive properties, current evidence suggests that it poses a serious threat to users’ health and well-being. Use or possession of Flakka is a serious crime and a major health risk as well. The patient was evaluated, and rehabilitation was initiated by an occupational therapist. However, the patient left the hospital on the fifth day of his own will before a complete physiotherapy evaluation. At discharge, the patient had a mild right-sided hemiparesis but could walk with the aid of forearm crutches he had already been using because of osteoarthrosis.

Although α-PVP is not a risk-free drug, this new synthetic Cathinone is beginning to dominate the drug arena in the US and Europe 35. Synthetic cathinones (e.g., mephedrone) were first synthesized in the 1920s and have chemical properties analogous to cathinones 11. However, the term cathinone only appeared 40 years ago, and the term synthetic cathinone is even more recent 12. However, due to legal gaps, underground chemists started to exploit them in designer drugs 13,14,15.

“Baths salts” is a term used to refer to synthetic cathinones as a whole, some of which may cause far more intense hyperstimulation than others. While psychoactive substances like alcohol, opium, and cannabis have been around for thousands of years, many other drugs appearing on the streets in 2021 are far more recent and far less well understood. A Finnish male patient in his sixties with hepatitis C and osteoarthrosis of both knees was admitted to the emergency department because of acute right-sided hemiparesis that had started a day before the admission. Prior to the onset of hemiparesis, the patient’s friend had injected a dose of α-PVP into the patient’s neck. The intended injection site was the left external jugular vein, since the peripheral veins were damaged due to numerous injections.