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New recreational drugs are hitting the international scene at a rapid-fire pace by some estimates one novel substance a week. In 2015, one of these made the news in Florida and was also reported in other states across the country. This drug goes by the name of “flakka,” derived from the Spanish word “flaca,” which means “skinny.” It is also sometimes referred to as “gravel” because it looks like white aquarium gravel, perhaps with some pink mixed in. Flakka is one of the many so-called “bath salts” which are synthetic cathinone drugs. Specifically it is alpha-pyrrolidinopentiophenone, which is a mouthful in any language. Scientists shorten it to simply “alpha-PVP.” Although many bath salt derivatives have already been banned, the process takes time and flakka is still on the loose, although use has rapidly declined since its introduction in 2015.


Flakka is very versatile for the drug-user because it can be swallowed, snorted into the nose, injected or smoked. It can even be vaporized in an e-cigarette. It is very potent, and overdoses are frequent.

Its effects are similar to other stimulants such as Ecstasy, methamphetamine, cocaine, and the other bath salts. The users take it to get intense euphoria and enhanced alertness. But like other drugs of this type, too much alpha-PVP can cause “excited delirium” with agitation, hyperactivity, elevated body temperature, paranoia, and hallucinations that can lead to violent aggression or self-injury. It can also lead to muscle damage and renal failure. Some users will have critical hypertension causing a stroke or heart attack.

Researchers are still discovering how flakka and its chemical relatives function. These drugs cause a surge in two neurotransmitters: dopamine, which is responsible for euphoria as well as addiction, and also norepinephrine, which raises heart rate, blood pressure, and level of alertness.

Like other abused stimulants, the flakka “high” comes with the flakka “low,” when the drug is eliminated and the user feels drained and depressed. This high-and-low cycling often induces users to return to the drug. This starts them on the path to addiction with all of its consequences. Brain chemistry alterations encourage users to take larger and larger doses to get the same high.


Flakka is the tip of an iceberg of an alarming trend in drug abuse in which new and dangerous chemicals are synthesized and “marketed” via the internet and social media. Distributors boldly exploit the loopholes in the drug control laws by claiming that the chemicals are “for research purposes.” Once flakka is outlawed, others will take its place, with new and unpredictable effects. Be alert to signs of bath salt hallucinogenic cathinones no matter their name or chemistry: unusual behavior, agitation, fever, hallucinations, paranoia, or “sleeping in” for a day or two. Those in your care who are “under the influence” need emergency department evaluation. Call the Missouri Poison Center. Our specially trained nurses, pharmacists and medical toxicologist can provide you with the most up to date treatment advice and trends reported in our state.

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