WHAT THIS ARTICLE COVERS: Medical assistance is recommended for people who want to stop using Flakka, especially if it is taken with other drugs and alcohol. This article reviews how to identify drug problems and how drug use is treated medically. So, if you cannot get off Flakka on your own, we are not surprised. Treatment can help!
TABLE OF CONTENTS:
- Brain Effects
- Understanding Addiction
- Why Do People Get Addicted
- Fear of Withdrawal
- In the Case of an Overdose
- Does Treatment Work?
- What Is Treatment Like?
- Inpatient vs. Outpatient
- Dual Diagnosis Treatment
- Main Therapies
- How To Help Someone
- Who Is At Risk?
- Why Has Flakka Become Popular?
Alpha-PVP (alpha-pyrrolidinovalerophenone), known on the streets as “Flakka,” is a new synthetic drug that has become an epidemic, especially in South Florida. Flakka is the latest in a series of synthetic drugs that have become popular in the United States; included on this list are Ecstasy and Bath Salts. In fact, Flakka is chemically similar to Bath Salts, which was credited for a surge of bizarre cases of intoxication and agitation throughout the U.S. a few years ago. 
Flakka takes the form of a white or pink, foul-smelling crystal that can be eaten, snorted, injected, or vaporized in an e-cigarette or similar device. Vaporizing, which sends the drug very quickly into the bloodstream, may make it particularly easy to overdose. Like other drugs of this type, alpha-PDP can cause a condition called “excited delirium” that involves hyperstimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury.
Flakka has been categorized into the cathinone class of drugs. It is created in laboratories in order to produce euphoric symptoms in people trying to obtain a cheap, quick high. Although the drug’s exact mechanism of action is unclear, it is known that Flakka is designed to flood the brain with dopamine. Cathinones have been found to stimulate the release of dopamine and inhibit the reuptake of epinephrine, norepinephrine, and serotonin in the central nervous system. This influx in dopamine causes an intense feeling of euphoria but also leads a person to the possibility of agitated delirium and psychiatric hospitalizations.
Flakka is also known to provoke a condition called agitated delirium, when there is an excessive influx of sympathetic activation. This condition causes alterations in the mental status and can include bizarre behaviors, anxiety, agitation, violent outbursts, confusion and rare cases of seizures.
Short-term effects of Flakka are similar to other stimulants. Flakka use results in a flood of dopamine in the brain. Dopamine is a neurotransmitter that helps regulate the brain’s reward and pleasure centers. Additionally, Flakka hinders the reuptake of this neurotransmitter by the brain cells, producing an intense feeling of euphoria.
The effects occur within 30 to 45 minutes of administration with a peak rush at 1.5 hours and the total “desirable” experience continuing from 6 to 8 hours. Adverse effects can continue for days.
Short-term brain effects of Flakka include:
- Aggressive behavior.
- Euphoric sensations.
- Increase in blood pressure.
- Rapid heart rate and palpitations.
Although a typical flakka high can last one to several hours, it is possible that the neurological effects can be permanent. Not only does the drug sit on neurons, it could also destroy them. And because flakka, like bath salts, hang around in the brain for longer than cocaine, the extent of the destruction could be greater.
The effects of the comedown from Flakka (the period when the drug leaves the body) include fatigue and depression. This sensation often results in users returning to the drug to get rid of the negative comedown feeling, jump-starting a cycle of use that can lead to abuse. As tolerance to the drug develops, the user will require more and more Flakka to feel high, risking dangerous effects, overdose, and even death.
At high doses, Flakka can affect the body’s temperature; it will reach high temperatures and sometimes this extreme change can lead to muscle breakdown and subsequent kidney damage. But what about long-term effects?
The immediate and long-term effects of Flakka can rival some of the strongest crystal meth and cocaine. Long-term effects of Flakka are not yet published. Flakka is one of the more recent synthetic drugs and research into its effects is not extensive. However, research that has been conducted has shown that the drug can be toxic to the kidneys and cause renal failure.
The unknown effects of Flakka have alarmed experts about its use and popularity. No one knows what exactly the drug can do to the body and brain in the long term.
Is Flakka addictive? Yes. Not only can Flakka be addictive, it can be even more addictive than methamphetamine. Further, it poses legitimate threat(s) to the health and lives of those who use it. This is why the U.S. Government has issued a temporary ban on the drug in 2014, classifying Flakka as a Schedule I drug under the Controlled Substance Act.  This puts it alongside other substances with no currently accepted medical use and a high potential for abuse.
Flakka addiction typically occurs when users take it repeatedly for a prolonged period of time. Those who use it often take it by:
- Vaping (via e-cigarettes).
Flakka is physically and psychologically addictive. It changes the way the brain works, causing a change in your psyche and behavior. Moreover, its intense effects can be felt for weeks or months after using.
If you or someone close to you are struggling with Flakka abuse, there is a way out. Professional medical help can help you get to the bottom of an addiction and increase your chances for long-term success. You can start living a sober life today! For a start, think about the power of one phone call. Help is ready and waiting for you.
Why Do People Get Addicted (And Others Do Not)?
First, you need to understand that addiction is not a moral failing. Usually, the brains of people prone to addiction can be “hard wired” to react more effectively to certain drugs than others. The rush of euphoria and the action on the pleasure centers in the brain can be highly efficient for some of us. However, many causes and risk factors can increase the likelihood that a person will use drugs for their effects, including the following:
Current substance abuse.
Numerous studies and surveys indicate that 30% – 50% of synthetic cathinone users meet the clinical diagnostic criteria for dependence. Nevertheless, these surveys also show that people who use Flakka have a higher likelihood of abusing other drugs and alcohol. 
The likelihood of developing a substance use disorder has also been determined to have a strong genetic component. Heritable traits such as impulsivity and novelty seeking may significantly increase your chances to engage in some form of substance abuse. 
Living in a home or community where substance abuse is commonly present and you can easily access Flakka, or being associated with persons who engage in Flakka abuse can strongly influence a person to also abuse Flakka.
There are a number of additional risk factors that can contribute to substance abuse and the potential onset of Flakka addiction. These may, but do not necessarily have to include:
- Personal or family history of substance abuse.
- Personal or family history of mental health conditions.
- Childhood trauma.
- Diminished self-control.
- Psychological trauma or injury.
Fear of Withdrawal
Flakka withdrawal is risky and uncomfortable, but continuing to take the drug chronically can be more dangerous, and even fatal. If you have used Flakka before, you probably have experienced some of the following withdrawal effects. But you don’t need to do it alone! Medical detox can make the process more comfortable. More importantly, medical detox can make the process safer.
Psychological symptoms of Flakka withdrawal include:
- Extreme irritability.
- Mood swings.
- Suicidal thoughts and actions.
Because of physical damage caused by Flakka abuse, withdrawal may also be accompanied with medical issues, such as:
- Epileptic Seizures.
- Heart arrhythmias.
- Liver and lung damage.
- Permanent kidney damage.
These conditions are manageable if detected early and usually resolve with time and medical treatment. In fact, medical monitoring and management of withdrawal symptoms can make the process far less painful and uncomfortable. Medical care is especially needed if you have a case of liver and tissue damage, or have thoughts of suicide.
In the Case of an Overdose
Flakka can lead to overdose and life-threatening health effects. If a person overdoses on Flakka, they need immediate medical attention. When someone close to you is displaying the following symptoms:
- Erratic and bizarre behavior.
- Hallucinations (visual and auditory).
- Increased body temperature.
- Internal bleeding.
- Organ failure.
- Violent outbursts.
STEP 1: Provide details about symptoms and location.
When you call the ambulance, inform the contact representative that the person has taken Flakka and perhaps any other substances with it. Then, provide clear instructions about your location.
STEP 2: Stay on the phone and wait for paramedics.
If the person is unconscious, you can stay on the phone with medical professionals to receive instructions about how to aid the person until they arrive on the scene. In case the person is still acting erratically and angry, it is recommended that you stay at a secure location for your own safety and wait for the paramedics (and possibly police) to arrive.
STEP 3: What to expect.
In the emergency room, the physicians may use medications such as benzodiazepines to help reduce the anxiety and panic. They can also provide the person with an oxygen mask and an IV for hydration to increase comfort.
KNOW THIS: The National Institute on Drug Abuse has warned that, because flakka enters the bloodstream very quickly, there is a very real risk of overdose. The drug is reported to be stronger and more dangerous than other synthetic cathinones, so health care workers, parents, and adolescents need to be aware of the potentially catastrophic outcomes concerning fatalities and intoxications caused by its use. 
The drug has been linked to deaths by suicide as well as heart attack. It can also dangerously raise body temperature and lead to kidney damage or kidney failure. It is so difficult to control the exact dose of flakka. Just a little bit of difference in how much is consumed can be the difference between getting high and dying. It is that critical.
Many cases, both fatal and non-fatal, have been reported worldwide with acute intoxications of alpha-PVP for which hospitalizations were required. There were 6 fatal cases related to this drug which have been reported in Ohio. 
Does Treatment Work?
Yes, treatment can be successful in people who are motivated to change. Treatment programs for Substance Use Disorders such as Flakka Addiction focus on addressing person needs and providing personalized, effective care. Creating a customize treatment plan has been shown to help you recover safely and successfully.
Why address addiction individually?
Because your underlying triggers for addictive behavior, drug use history and severity, mental health issues, and treatment goals are not the same as the next person’s.
Individualized treatment plans address the disease of addiction by treating every aspect of your health: physical, mental, emotional, nutritional, and spiritual factors.
Treatment usually includes a number of successive steps that progressively move you from drug abuse and addiction toward recovery. The most important aspect of addiction treatment is that it offers a supportive and safe environment where you can:
- Deal with psychological issues that accompany addiction.
- Go through withdrawal until physical stabilization.
- Learn new coping skills and ways to address relapse triggers.
What is Addiction Treatment Like?
Medical addiction treatment is a safe and monitored process that is a little like a mix of adult continuing education and overnight camp. Most importantly, it allows you to overcome addiction in a supportive environment. It equips you with the needed knowledge to continue building a sober life. Treatment offers a supportive and safe environment where:
- You’ll deal with mental and emotional issues caused by past trauma.
- You’ll learn coping skills.
- You’ll stabilize physical symptoms.
Inpatient vs. Outpatient
The two main choices for where you receive addiction treatment are:
1. Inpatient treatment.
Inpatient (residential) treatment programs range from 28 days minimum and can last up to several months. Residential treatment is the most highly recommended rehab option, because it removes you from your life for a period of time so that recovery can become the main focus. During your stay, you can expect to receive comprehensive care in the form of person, family, and/or group therapy, nutrition classes, assistance on lifestyle changes, and exercise and relaxation classes.
2. Outpatient treatment.
Outpatient treatment programs incorporate elements of inpatient rehab but allow you to live at home while attending treatment and counseling meetings for several hours daily, each day or several days a week. In order for outpatient rehab to work, you will need to have a sober and supportive community at home because the level of flexibility these programs provide could also put an additional strain on you.
Dual Diagnosis Treatment
People who abuse or become addicted to Flakka may also have a heightened risk for experiencing other mental health disorders such as:
- Anxiety disorders.
- Antisocial personality disorder.
- Bipolar disorders.
- Depressive disorders.
- Other drug problems
When addiction is associated with another psychoactive substance, or aggravating or causing mental health problems, then it is a part of a “Dual Diagnosis.” Once you receive a Dual Diagnosis, an appropriate treatment program is required. Dual Diagnosis facilities offer simultaneous mental health and substance abuse treatment, which is crucial for many people to be successful in their sobriety.
The cost of these programs vary according to treatment type. Residential treatment will frequently be more expensive than outpatient care. Luxury drug rehab centers can cost as much as tens of thousands of dollars per month to attend. Average costs follow.
Detox = Average stay of 3 days, $3,000-6,000,
Inpatient rehab = $700-2,000 per day.
Outpatient rehab = $150-300 per day.
Counseling = $75-150 per hour.
That being said, it is important for anyone considering rehab to understand that the cost of Flakka addiction is far more expensive than the cost of treatment, with or without coverage, endangering the mental and physical health of a person.
In the instance that insurance does not cover the entire cost, other methods of paying for treatment include:
- Employee assistance programs.
- Private loans (help from friends and family).
- Public loans or publicly funded rehab stints.
- Selling personal assets.
At the start of an addiction treatment program, plan to go thorough a process of physical and psychological assessment. The initial evaluation helps addiction treatment professionals to customize the treatment plan according to your needs and make sure that the most effective treatment design is applied to your situation. You can expect a 1-2 hour interview, physical examination, and drug testing during this phase.
Medical detox is the process of removing a psychoactive drug from your system. It helps you resolve acute withdrawal symptoms by treating symptoms as they arise (in the case that you have become physically dependent on a drug). The primary focus of detox is to make a safe and more comfortable transition from the withdrawal stage to the next steps of treatment.
Detox usually occurs during the first few days to one week after your last Flakka use. Withdrawal can be very painful and uncomfortable, and it is important be under medical supervision so that symptoms are monitored and managed. To help manage the symptoms of Flakka withdrawal, doctors usually prescribe benzodiazepines and other sedatives (only short-term) to manage the more acute symptoms of intoxication and detoxification from Flakka.
The major challenges facing the clinicians managing a person with cathinone intoxication are control of agitation and other signs of sympathetic excess. Acute decompensation can occur if immediate measures are not taken. Although most respond to aggressive treatment, the course is usually prolonged and many never return back to baseline.
In sum, detox facilities can help you or your loved one through the acute withdrawal symptoms that will occur during the first few days to a week after you decide to quit flakka. Interventions may include medication therapy, group therapy, individual therapy, and recreational therapy. But the primary focus will be helping you or your loved one transition out of the withdrawal stage of treatment in the safest and most comfortable way possible.
Staying off drugs after detox can be difficult without proper support. This is why addiction treatment programs should provide a combination of evidence-based therapies including medication assisted treatment (when possible) and talk therapy. Therapies can help you get to the root causes of your addiction and help you adopt your new behaviors that don’t involve drugs.
Various therapies that may be offered during addiction treatment include:
- Cognitive behavioral therapy (CBT).
- Dual diagnosis counseling.
- Family therapy.
- Group therapy.
- Person therapy.
- Motivational interviewing.
- Nutritional counseling and wellness activities.
- Support groups.
- Thorough planning for aftercare.
Other therapies that might be offered include thhose fall under the alternative or holistic spectrum such as art therapy, EMDR, equine therapy, yoga therapy, or acupuncture. When applied together, a mix of therapies can maximize your chances of successful recovery and long-lasting sobriety.
Treatment of cathinone use is symptomatic. The mainstay of acute intoxication treatment is benzodiazepines. The administration of lorazepam allows for a more careful titration of dose based on symptoms compared with a longer acting benzodiazepine. 
Psychotic symptoms can persist after autonomic symptoms have abated and may necessitate antipsychotic medication and psychiatric hospitalization. Psychosis usually resolves within 4 days, but there are reports of psychosis lasting for weeks.
How To Help Someone With Flakka Addiction
It is usually more likely that someone close to an addict will seek out help than the person them self. Therefore, it is very important to take action when you notice a problem. If you wait for things to get worse, addiction can progress over time. In fact, early intervention for drug problems shows patterns of success but, the longer you wait the harder recovery can be.
People who are addicted or suffer from dependence to Flakka will often exhibit certain behaviors that are impossible to go unnoticed. As a fairly new drug, not all signs and symptoms of use are known, but people tend to go into a delirium, feel superhuman strength, and display psychotic behavior when under the influence.
If your loved one has displayed some non-typical behaviors and addiction symptoms, consider speaking to someone who can help you find the right recovery program.
Questions typically include:
- Could you (and/or other close family members) help them out financially?
- Does the addicted person suffer from any mental, behavioral, or co-occurring disorders?
- How do they abuse Flakka (orally, smoking, injecting, vaping)?
- How long do you suspect they have been using?
- How long they’ve been showing signs of addiction?
- How much can they afford to pay for treatment?
- Is insurance an option?
- What other drugs or alcohol do you think they’re using?
- Which substance/drug does the person abuse?
It is not appropriate or recommended that you attempt to tackle your loved one’s addiction problem alone. There are professionals who are trained to provide therapy or counseling for someone facing a Flakka problem. Seek professional help from:
- A psychologist (APA therapist finder)
- A medical doctor trained in addiction (ASAM doctor finder)
- A licensed clinical social worker
- Your family doctor or general physician
Instead, focus on finding a professional for your family and/or lour loved one to talk to. You can also look into the CRAFT Model of family training, as well as 12 Step groups like A.A. or N.A. to encourage peer support for yourself and your loved one. This is a much more appropriate and useful place to extend your energy.
When formal treatment programs are complete, you receive a comprehensive aftercare to keep you on the right track in recovery. Treatment centers typically offer aftercare options in the form of:
- Drop-in sessions that allow you to stop by the center for a meeting whenever you need additional support.
- Support programs that consist of group therapy, support groups, family therapy, or person therapy.
- Weekly check-ins by phone, Skype, or in person are conducted in order to monitor your progress and help with any obstacles.
Relapse prevention coaching should also be part of your discharge process and include:
- Addressing pleasant memories of Flakka (or other stimulant) use.
- Coaching in addressing slips.
- Developing a lifestyle that is protective of your acquired sobriety.
- Developing coping skills and stress-management skills.
- Education about the relapse process.
- Training in identifying warning signs and high-risk situations.
Aftercare extends into the weeks and months that follow formal treatment. This type of ongoing care allows you to stay involved with the sobriety community, and prompts you to continue to work on your recovery, so you will not slip back into destructive habits.
Who Is At Risk?
Users tend to be young, economically disadvantaged adults. The risk of overdose is high, especially because larger amounts can be purchased and consumed at once and in quick succession, either accidently or on purpose.
The adolescent brain is undergoing significant neural development that continues until around age 25. The brain becomes more efficient and refined during this time. Emotional centers of the brain develop before the parts of the brain involved in judgment, impulse control and decision making. This is thought to increase the chances of teens taking risks, like using alcohol or other drugs excessively. Because the adolescent brain is still developing, alcohol and other substance use may negatively interfere with this normal brain development and these effects may be long-lasting.
Why Has Flakka Become Popular?
There are two major reasons why flakka has become increasingly popular in a short amount of time. The first reason is the fact that the drug is extremely versatile and the effects of flakka on the brain are the same no matter the route of administration. The drug can be snorted, injected, swallowed and can be discreetly hidden in an e-cigarette or vape.
The second reason for its sudden rise in popularity is its cost. Flakka is extremely cheap and those who deal the drug can make excellent profits. Currently, a kilogram of flakka is world about $1,500 and it can produce approximately 10,000 individual doses that can be sold on the street for as little as $5 per dose. The target customer base for flakka dealers are those who live in low-income neighborhoods.
Use of Flakka originated in China, Pakistan and India and has been on the rise in the U.S. in the last few years. In 2010, there were zero reported cases in the U.S., in 2012, 85 cases and in 2014 ; there were 670 reported cases nationwide of those affected by this drug. The white crystals of Flakka are widely available for purchase on the Internet.
“Flakka” has been the latest plague of the synthetic substances causing havoc on the streets and in hospitals. South Florida is the epicenter of multiple Flakka episodes, with users displaying bizarre and psychotic behaviors.
Modern science, and the internet age, have created flakka and allowed it to spread; the drug is a manmade substance manufactured primarily in India and China, and is often sold online sometimes for less than $5 per dose, making it an attractive alternative to many more expensive drugs that have to be grown, harvested, and transported, all while evading law enforcement.
While many sales of flakka have been completed via regular websites based outside of the United States. Chinese government declared alpha-PVP to be a controlled substance, an action that will likely drive some sellers to utilize other venues, but is extremely unlikely to curtail the sale of flakka to people in the U.S.
Flakka, for example, is already sold via marketplaces that utilize the Tor network–promising both buyers and sellers a great deal of anonymity. Once it arrives in the United States, flakka is also sold on the street like other illegal drugs. While it is often sold as white, pink, or blue crystals, flakka can be distributed in multiple formats: powder, crystals, pills, within liquid, etc; facilitating shipping, and making its detection by parents and law enforcement more difficult than finding and identifying many other kinds of drugs.
Flakka is cheap and extremely addictive. Some states have passed laws explicitly outlawing it; others rely on a temporary de facto DEA ban that went into effect last year.
Flakka arrived in the United States a few years ago, but it is becoming increasingly popular. According to an article in Forbes, the DEA charted no cases involving flakka in this country in 2010, only 85 cases in 2012, and under a thousand in 2014. It was reported last week that in New York City alone there are now 150 hospital admissions per week related to flakka usage. Likewise, the DEA noted in a report issued last week that “in 2015 there was a sharp rise in the number of overdoses” from flakka usage.
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Reference Sources:  NCBI: Flakka-Induced Prolonged Psychosis
 DEA: Drug Scheduling
 NCBI: Synthetic Cathinone Abuse
 NCBI: The Genetic Basis Of Addictive Disorders
 PSYCHIATRY TIMES: Flakka: A Deadly High
 TEXAS POISON CENTER NETWORK: The Dangers Of Flakka
 PSYCHIATRY TIMES: Synthetic Cathinones: Signs, Symptoms And Treatment: Page 2 of 2
DEA: Synthetic Drugs
MUSC: Dangerous New Drug Trend Poses Threat To Teens
All of the information on this page has been reviewed and verified by a licensed medical professional.