Use of synthetic drug Flakka rare among high school seniors, but most users take numerous drugs

The study, published online in the journal Drug and Alcohol Dependence, is the first to estimate the prevalence of Flakka use among adolescents in the United States.

Synthetic cathinones -- psychoactive substances known as "bath salts" -- have been associated with tens of thousands of emergency department visits in the United States. One such compound called alpha-PVP, commonly referred to as Flakka, was associated with at least 80 deaths in Florida between September 2014 and December 2015 alone.

Flakka has cocaine-like stimulant effects and is as potent as methamphetamine. The drug -- which can be eaten, snorted, injected, or vaped -- is associated with adverse effects such as rapid heart rate, elevated body temperature, anxiety, seizures, agitation, aggression, hallucinations, paranoia, and suicidality.

"Flakka is infamous for being tied to rashes of bizarre behavior which has led the media to refer to it as the 'zombie' or 'cannibal' drug," said CDUHR researcher Joseph Palamar, PhD, MPH, the study's lead author and an associate professor in the Department of Population Health at NYU Langone Health. "Flakka has not turned users into cannibals, but the drug can in fact be very dangerous." He further explained that this stimulant drug is very potent and chronic use has led to death from heart attacks, accidents, suicides, and homicides.

Because few studies have looked at Flakka use, Palamar and his colleagues sought to understand how prevalent use is among adolescents. The researchers analyzed data from the 2016/2017 Monitoring the Future study, which surveyed a national sample of 3,786 high school seniors across the U.S.

Overall, 0.8 percent of high school seniors in 2016-2017 reported using Flakka in the past year. Students who do not live with their parents and students whose parents have less than a high school education were at higher odds for use.

Notably, Flakka users reported using other drugs, particularly Spice/K2 (synthetic cannabinoids) (85.6 percent), ketamine (72.3 percent), and marijuana (59.1 percent). Flakka use was associated with using a higher number of other drugs and using other drugs more often, with more than half of Flakka users (51.7 percent) using four to 12 other drugs.

The authors note that Flakka use may be underreported in surveys; recent studies have found that the use of Flakka and other "bath salts" is often unintentional, as these drugs are frequently added to the party drug known as Ecstasy or Molly.

"Flakka use rarely occurs in isolation, as most users also frequently use other drugs. This suggests that the use of Flakka or other 'bath salts' alone is rare and the use of multiple substances may compound adverse effects of these drugs," said Palamar.

The study, "'Flakka' Use among High School Seniors in the United States," is published in the journal Drug and Alcohol Dependence and was authored by Palamar as well as Katherine Keyes and Caroline Rutherford of Columbia University Mailman School of Public Health. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health (K01DA038800, R01DA044207, and R01DA001411).