Pubdate: Mon, 15 Jun 2015
Source: Sun-Sentinel (Fort Lauderdale, FL)
Copyright: 2015 Sun-Sentinel Company
Author: Anne Geggis


The latest drug craze, flakka, is coming on with a rush, sending up 
to 20 people a day to emergency rooms across Broward County.

Such a flood of cases from a single street drug has doctors striving 
to devise treatments, and medical researchers laboring to understand 
the drug that delivers an instant high - and causes organ failure, 
scours kidneys like drain cleaner and sends users into a state of 
gibbering helplessness.

Holy Cross Hospital's Dr. John Cunha calls flakka "the perfect storm."

Over the last month, Broward County's largest hospital system has 
started seeing up to 20 emergencies a day related to the designer 
drug known as "flakka," "gravel" or by its shortened chemical name, 
alpha-PVP, according to North Broward Hospital District's CEO, Dr. 
Nabil El Sanadi, director of the system's emergency services.

Jim Hall, a drug epidemiologist at Nova Southeastern University, said 
he hasn't seen a recreational drug emerge on the scene with this much 
intensity since crack cocaine in the 1980s.

"It's producing [more] severe issues than most any other drug we've 
seen in the last 30 years," he said.

Flakka is similar to cocaine in the way it stimulates the brain, but 
its chemical composition makes it the second generation of bath 
salts, synthetic compounds related to the natural stimulant drug khat.

Illicit drug laboratories altered bath salts' chemical composition 
slightly to get around laws and, in the process, made it 30 times 
more potent, according to Dr. Parham Eftekhari, a nephrologist who 
consults with hospitals throughout Broward County and is an assistant 
professor of medicine at Nova.

"It's not meant for human consumption," he said.

Because it's traded on the street and combined with other drugs, it's 
difficult to gauge what a safe flakka dosage would be. But studies 
say reactions to flakka range from enhanced alertness to an excited 
delirium and hallucinations that can cascade into a wholesale 
shutdown of the body's critical functions.

Eftekhari said he's seen a flakka injection poison the blood to the 
point it required an arm amputation. He's seen suicides. He's also 
seen depression.

Unlike Broward County, where there were 16 flakka deaths between 
September and May, just two Palm Beach County deaths from flakka 
occurred in 2014 and one in 2015. However, 11 corpses autopsied had 
flakka present during that same time period.

Flakka's chemical composition prevents the brain's neurons from 
metabolizing the excitement hormones. That, in turn, forces the body 
to endure extended "fight or flight" impulses that can turn someone 
into the "Incredible Hulk," Eftekhari said.

"These people are so hyped up on these hormones, they will do 
anything," he said. "The body can't regulate."

With hours of sustained hormone escalation, the body temperature 
spikes as much as 10 degrees, leading to the sensation of being on 
fire - explaining why flakka users often tear off their clothes. 
Sustained temperatures like that can lead to internal bleeding and 
multi-organ failure.

"Some of these people we're seeing in the hospitals are just not 
normal again," Eftekhari said.

Eftekhari said he's seen users, oblivious to the limits of their own 
bodies, twitching and moving in such a prolonged, excitable state 
that muscles break down and deteriorate. This, in turn, produces an 
effect like pouring Drano into the kidneys. Some flakka users must 
then go on dialysis for the rest of their lives, he said.

The drug's extreme effects have been thrust into the public's 
consciousness through autopsy reports, in headlines about users 
stripping naked and confronting passers-by with superhuman strength 
or, in one case, becoming impaled on a spiked fence around the Fort 
Lauderdale police department.

Flakka has come onto the scene too recently to gauge its long-term 
effects among those who survive the high. There is some indication 
that neurons are permanently damaged in their ability to regulate the 
excitement hormones, said epidemiologist Hall.

Schizophrenia also has been observed among flakka users, Eftekhari 
said. More immediately, though, it's highly addictive, as proven in 
laboratory rats that keep pressing the bar for more of the drug, and 
patients who come in swearing over how unpleasant flakka's high is, 
said Dr. Cunha, who is also the medical director for Oakland Park 
Emergency Medical Service

But then he sees them again.

"People who are taking it say they don't want to take it again, but 
it's so highly addictive, they do," he said.
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