FORT LAUDERDALE, Fla. – Florida has been home to some of the most highly publicized drug incidents in recent months, due largely to the use of a highly addictive synthetic drug known as Flakka. When we set out to investigate Florida’s problem with this dangerous drug, we expected to get some startling overdose statistics, but unfortunately found out a more sinister system at play – an international combination that not only traps people in the addiction, but makes it harder for dealers to be prosecuted. To get the latest information on this, we talked to Jim Hall, an Epidemiologist at Nova Southeastern University who is at the forefront of collecting valuable information on this drug.
“Flaca”, when spelled with a “c”, is the Spanish word for “skinny”. When spelled with a “k”, it is an Hispanic colloquial term that means “a beautiful woman who charms all she meets”. While it is in the same family with drugs like bath salts, which were made popular a few years ago, it is part of a new wave of highly potent, more addictive synthetic cathinones known as Alpha-PVP (alpha-Pyrrolidinopentiophenone). Cathinones are synthetic drugs derived from the Khat plant, grown in Somalia and parts of the Middle East. The bark of the plant is chewable, and has been used for centuries as a relatively mild stimulant. Until recently, the plant was not easily marketed and distributed outside of where it was grown because of its very short shelf life. Within just a few weeks of being harvested, it loses its effect – unless it is copied and mixed with other chemicals by a manufacturer. Doctors have found this second generation of Alpha-PVP to be much more potent and addictive than the first generation.
“Certain properties found in this drug are more intense than methamphetamine or cocaine,” says Hall. “It blocks the brain’s re-uptake process of neurotransmitters such as dopamine and serotonin and basically floods the brain.”
Hall goes on to say that Flakka, also known as Gravel (a popular term for the drug in Ohio), is very dose-specific. Just a small amount will present the euphoria desired, but more of it can produce serious adverse effects. A general dose of the drug is just 1/10 of a gram.
Hall told the New York Times recently “I have never seen such a rash of cases, all associated with the same substance” and that “it’s probably the worst I have seen since the peak of crack cocaine. Rather than a drug, it’s really a poison”.
Manufactured in China, the drug is often sold on an underground internet known as the darknet. It’s then sold at around $1500 per kilogram. One kilogram will produce 10,000 1/10 of a gram doses, which sell for around $3-$5, proving to be a quite profitable business, but also requiring widespread distribution to make the most profit.
“Because of the price, flakka is marketed to very poor neighborhoods,” says Hall. “Even the homeless population.”
A person who is high on flakka may exhibit agitation, aggressiveness, paranoia and delusional behavior – similar to someone high on methamphetamines or cocaine. In dangerous cases, users reach a point of their high known as Excited Delirium Syndrome, during which their body temperature reaches 105 degrees or higher – explaining why many people with the syndrome rip their clothes off. During EDS, a user will exhibit paranoia – feeling like a human or an animal is chasing them.
“They sometimes exhibit super strength,” says Hall. “It often takes 4-5 law enforcement officers to restrain them.”
Perhaps the most publicized incident with flakka happened last month in Melbourne when officers responded to Parsons and Edgewood in response to a male that was jumping in front of a vehicle and chasing it. According to the Melbourne Police Department, Kenneth Crowder was then observed running through various yards of residences naked and yelling that he was a god. An officer was flagged down by someone who pointed to Crowder, saying he was attempting to gain access to the vehicles in the area and that he was performing sexual acts on a tree nearby. When Crowder allegedly approached the officer with clenched fists identifying himself as “God”, the officer used his taser, which the officer says had no effect on Crowder, who approached the officer again and was tased a second time. He was knocked to the ground, and then got up and again approached the officer yet again. It wasn’t until 2 more officers arrived to help that they were able to subdue him, after Crowder ripped the badge off of the responding officer and allegedly held it with the pin side out to use as a weapon. He was rushed to the hospital because of the possibility of EDS, and later charged with 3 counts of assault on a law enforcement officer, one count of battery on a law enforcement officer, 4 counts of resisting with violence, and one count of assault with a deadly weapon on a law enforcement officer.
If someone has reached the point of EDS and they don’t receive immediate medical attention, they could die from symptoms similar to having a heat stroke. If they survive, the user could face side effects like renal failure, and have to be on dialysis the rest of their life.
The Broward County United Way Commission on Substance Use has noticed an escalating number of deaths due to the effects of flakka, and has laid out an action plan targeted at educating communities and law enforcement. They are in the process of helping emergency rooms develop protocol for dealing with patients experiencing excited delirium.
“One local hospital here is seeing around 20 patients in the emergency room a day,” says Hall. “Florida’s had 28 overdose deaths from flakka since September. Most of those have occurred in the last 30 days.”
Hall says between April 24 and May 22, the state saw 10 overdose deaths. Just in the past week 10 more deaths have occurred that are still under investigation, presumably but not confirmed to be flakka. Concentrated cases have been seen in Broward, Brevard and Palm Beach Counties, but the drug and cases of Excited Delirium have shown up scattered throughout the state. While there is a large surfing population in these counties, Hall says there is not a reason to connect the drug to the surfing community.
“Broward County has seen the most action, but in 2014 Southeast Florida had 21% of all crime lab cases associated with flakka,” says Hall. “That means 79% of the cases originated elsewhere.”
Another issue in cutting the supply of flakka is that it is mostly carried by smaller, mid-level dealers. It is not associated with major drug cartels, but mostly dealt by individuals or small gangs who purchase it on the darknet, repackage it, and deal it out.
“It’s very easy to overdose on flakka because it’s very dose-specific,” says Hall. “Just a little bit more can push you to a state of Excited Delirium.”
Flakka can be consumed a number of ways. It can be dissolved in the mouth, vaporized in an e-cigarette device, and in extreme cases injected. Flakka addicts present similar behavior to methamphetamine and cocaine addicts (disoriented, rapid change of behavior, hyper with significant cognitive impairment).
“Because this drug floods the brain in this way, it can take up to 30 days before someone can begin to think clearly and process thoughts again,” says Hall. “These addicts require a specific type of treatment because the drug severely damages the brain.”
Flakka leaves its users with a short memory span and it’s hard to pay attention in treatment. Hall recommends trimming 90 minute sessions down to 30 minute increments, because it’s harder for the flakka addict to retain the information.
While flakka is illegal in most states because of its high potency, the threshold of drug trafficking doesn’t exist. A few grams can produce 20-30 doses, so when a dealer is caught, it’s difficult to charge them with trafficking or intent to sell because it’s such a small amount. Often they are charged with simple possession and walk.
Pressure has been put on China to ban distribution of the drug. A few years ago the country put a ban on the production of methylone and ethylone, commonly found in what’s known as Molly or MDMA (Methylenedioxy Phenethylamine).
“We need extra training for law enforcement and emergency rooms,” says Hall. “Hopefully it will begin to unsell itself because of its negative effects. But laws also need to be able to produce a conviction for selling it.”
Another issue contributing to the epidemic is treatment.
“It’s been my experience, when dealing with insurance companies and synthetic drugs, that you can have the best insurance in the world, but they do not feel that it requires an inpatient or residential level of care,” says Rebecca Baillie, Treatment Specialist at Vertava Health. “Because the detox is not harmful to you physically, even though we all know that synthetic drugs have the ability to kill and even paralyze.”
Insurance companies don’t see it that way, because detox from synthetic drugs typically is not as dangerous as detox from alcohol or benzodiazepine. The danger is more in the high.
“The drug itself is so new to the market, not a lot of research has been done by these insurance companies,” says Baillie. “Most insurance companies don’t see the need for long term, high-level care that we in the business know that they need. We run into the same problem with crack, because the detox is not typically deadly.”
Scientists at Scripps Research Institute in La Jolla, Calif. recently proved through the testing of rats that flakka is in fact as addictive as bath salts.
While flakka is having catastrophic effects on users in Florida, it has not yet caught up with the more common heroin problem. The state receives a large supply of the opiate from Mexico and the state has seen many prescription painkiller addicts switch to it, as it is a much cheaper alternative. On the other side of Florida’s drug problem, heroin is distributed in much larger criminal distribution networks on a national scale.
Just a few years ago, Broward County was seen as the epicenter of pill mill activity – birthing the new wave of heroin users. Deaths have increased in recent years among newer, younger heroin users. While many anti-drug coalitions in other states have blamed the crack-down on prescription pain killers for their spike in heroin use, Hall doesn’t believe that’s the case in Florida.
“Prescription painkiller addiction is a breeding ground for heroin use,” says Hall. “If anything, without the strategy to reduce painkiller distribution, the heroin problem would be even greater.”
Florida has taken action in fighting addiction on the supply side, but have completely ignored expanding treatment opportunities.
“Legislatures often view this as a criminal issue,” says Hall. “But it’s also a medical issue.”
The United Way of Broward County Commission on Substance Use is the oldest in the state, founded in 1988. They receive both public and private funding, and are one of the most active coalitions in the country. The organization says there has been a sharp escalation in statewide heroin overdoses since 2011. In 2013, Florida saw 199 deadly heroin overdoses. In just the first 6 months of 2014, they saw 156, up from just a handful a few years ago. And that’s just the ones that were reported.
“Heroin often gets reported as a morphine death,” says Hall. “When someone dies from a heroin overdose, within about 6 minutes the chemicals turn to 6-MAM (6-Monoacetylmorphine) in the body. After about 40 minutes, it turns to morphine.”
Still, prescription opioids continue to increase in the state. The Fentanyl-laced heroin batches that have killed many across the United States have also shown up in Florida, not only from clandestine lab production in Mexico, but also from prescriptions. Often prescribed in a thermal patch, it can be used by opening the package and ingesting the drug so that it’s all at once and not time released.
Jim Hall serves as Epidemiologist with the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University. For the past 30 years, he has tracked patterns and trends of substance use in Florida as the State’s representative on the National Institute on Drug Abuse’s (NIDA) Community Epidemiology Work Group. Jim’s work has focused on converting research about emerging drug use problems into community-based solutions for South Florida drug prevention coalitions. He has represented the United States at several Organization of American States conferences over the past six years and is assisting a US Government project in the development of a substance use epidemiology work group in Iraq. Jim is the recipient of the 2010 Patha of Public Health Award for Epidemiology and Disease Surveillance from Florida International University. He was presented a Lifetime Achievement Award by the South Florida Coalition Alliance in June 2014. Jim has been named to the Scientific Advisory Panel of the National Institutes of Health’s (NIH) recently established National Drug Early Warning System and the US Food and Drug Administration’s Substance Use Advisory Panel.
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