EMS: Get Ready for Flakka

It seems that no community has found a safe harbor during this country’s heroin and opioid crisis. It does not matter if you live in the richest community or the poorest community, families in all types of communities have felt the tragic effects.

Despite the best efforts of law enforcement to crack down on street dealers and even those who write prescriptions out of a doctor’s office, the number of people dying from heroin and opioids has increased each year and has nearly doubled in just a few short years. According to the Centers for Disease Control and Prevention, “Among the more than 72,000 drug overdose deaths estimated in 2017, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (synthetic opioids), with nearly 30,000 overdose deaths.” 

Fire and EMS personnel have gone through tons of Narcan to save those patients we reach early. One firefighter-paramedic in Memphis, TN, told me he administered Narcan to nine patients during one shift.      

Even with the staggering news about opioids, we need to prepare for the next street drug, Flakka, which is starting to gain prominence due to its cheaper price tag. Flakka has been called a “poor person’s drug,” particularly with nicknames like the “$5 insanity drug,” as it sells for about half the price of other street drugs. In some places, it has reportedly been for sale for as low as $3.

Flakka is a highly addictive synthetic drug that’s similar to cocaine but can be more potent when it comes to overdosing. Just the slightest difference in the dosage can mean the difference between life and death. The drug also has a street name of Gravel because the white crystal chunks look like the rocks at the bottom of an aquarium. It can be smoked, injected, snorted or ingested. Some have been packaged and put into capsules. Some Flakka has also been packaged for vaping.

Flakka increases the brain’s levels of dopamine, which results in alert and euphoric feelings. The effects of taking Flakka can last anywhere from 3 to 4 hours or up to several days. Some users will take more even when they are already on a high to sustain the euphoria.

Additionally, the high makes the user feel invincible with strength and violent behavior. Flakka has some of the same chemical components that are found in bath salts. Watch some of the YouTube videos of Flakka users and you’ll see people acting bizarre, running into the back window of a car and smashing through it, rolling around on the sidewalks, or wrestling with law enforcement officials.

One of the largest areas to be hit is south Florida, but it seems to be traveling beyond its borders into Southern states such as Mississippi, Georgia and Alabama, and as far north as New Jersey, Tennessee, Pennsylvania and Missouri. In several recent incidents attributed to Flakka in Bonne Terre, MO, the police chief said in a local paper: “It took approximately five to six officers to hold that subject down just to keep him from hurting himself or anyone else, and it took at least four paramedics to subdue him and get enough medication in him to balance him and was still violent until we got him to a hospital where a doctor could administer the type of medication to counteract whatever he was on.”                       

If you encounter a patient who you suspect is on Flakka, you may need four or more law enforcement, fire and/or EMS personnel to restrain the person so they do not hurt themselves or others. It may be necessary to use soft restraints. Follow your local or state medical protocols, which will probably include starting an IV and administering Valium or Diazepam to control the agitation. Further chemical restraint, such as Ketamine, may also be necessary. The inner core temperature of Flakka patients can spike as high as 105 degrees F. Therefore, their temperature should be monitored and cooled as necessary. Remember, never restrain your patient in a prone position due to the potential for positional asphyxia.           

Encountering a patient who is high on Flakka can be a challenging experience. Safety should always be the primary concern for yourself, bystanders and the patient. The use of restraints should be used as necessary but also maintaining dignity for the patient.