‘$5 Insanity’: What You Should Know About Flakka

Medically Reviewed by Hansa D. Bhargava, MD on May 21, 2015
From the WebMD Archives

May 21, 2015 -- Some call it “$5 Insanity.”

Flakka, a new designer drug, is surging in popularity. Poison control centers in states including Florida, Alabama, Mississippi, and Texas are responding to an increasing number of incidents involving it.

Here’s what you need to know:

What is flakka?

It’s a man-made stimulant called an alphaPVP. It’s similar to “bath salts,” another dangerous drug that’s grabbed headlines in recent years.

Its off-white, coarse crystals sell for as little as $5 a hit. The name comes from la flaca, a Spanish club-slang term for a sexy, skinny girl.

“It looks like aquarium gravel,” says Alfred Aleguas, PharmD, managing director of the Florida Poison Information Center, Tampa.

How is it used?

People have tried taking it in a number of ways, says Jeffrey Bernstein, MD, medical director of the Florida Poison Information Center, Miami.

Those ways include:

  • Snorting
  • Mixing with food
  • Drinking like a tea
  • Pressing into pill form
  • Inserting it into the rectum
  • Vaping in an e-cigarette
  • Injecting

“With injecting, you’re really asking for trouble, because the drug is likely to be cut with … dirt, with talc, who knows what else -- and you’re putting all that in your veins,” Bernstein says.

How does it work on the brain?

Users feel a sense of euphoria, Bernstein says. “It plays with your neurotransmitters, [brain chemicals] like dopamine and serotonin.”

That can lead to a state called excited or agitated delirium in a high that lasts for several hours.

What are the risks?

People who are high on flakka often lose touch with reality, Aleguas says.

“They don’t know what they’re doing, they’re hallucinating, they’re paranoid, they’re aggressive, they’re super-agitated,” he says. “That’s why you see news stories of people running down the street naked, banging on cars in traffic and just crazy, crazy stuff.”

Other health effects that Aleguas and Bernstein often see include:

Another dangerous effect is hyperthermia, or elevated body temperature, which Bernstein says can reach 108 degrees. At that temperature, he says, blood can no longer clot and a person starts to bleed internally.

“They bleed and they go into multi-organ failure,” he says. “Lung, liver, kidney, and brain injury can each occur when their temperature stays too high for too long.”

In an emergency room, doctors attempt to cool the person, to calm them. They may also use diazepam, midazolam, or another similar drug to slow a user’s heartbeat.

“We give them symptomatic and supportive care, try to keep them from hurting themselves and hospital staff,” he says.

Who's using flakka?

Bernstein says most users are male and in their teens, 20s, or 30s, although some are older.

“I haven’t seen any regular users,” he says. “It tends to be used sporadically and is associated with concerts and parties and things like that.”

And those users don’t always know what they’re getting, says Bernstein, who gets a call about flakka every day, and more on the weekends. About one-third of calls are from users looking for help, he says, while the others are from emergency personnel caring for users and looking for guidance.

“There’s no quality control on the street, so no one knows for sure what they’re taking,” he says. “Just because they bought something called flakka, no one knows if that’s really what they used, much less what kind of concentration you’re getting. It’s an unknown drug at an unknown dose, and any dose is abuse.”

WebMD Health News



Alfred Aleguas, BS Pharm, PharmD, D.ABAT, managing director, Florida Poison Information Center, Tampa, FL.

Jeffrey Bernstein, MD, medical director, Florida Poison Information Center, Miami.

© 2015 WebMD, LLC. All rights reserved.