If you’re the type who keeps tabs on the hot new drugs flooding the market, you might have come across flakka, which has been "wreaking havoc" in the U.S. this year. It has gotten a lot of attention in part because it makes people act so strangely. Users' odd trips, which have occasionally been captured on YouTube, have led them to climb bridges naked, dance in the pouring rain, kick doors, break into houses and flee from secret government agencies.
At low doses, the drug supposedly makes people feel euphoric and like they need to move a lot (which might explain the rain-dancing). At higher doses, the foul-smelling crystal can cause delusions, twitching, seizures and muscle cramps so bad your muscles jerk uncontrollably. When things go really bad, people can die from kidney failure, heart attacks and super high body temperatures, which might also explain the rain dance as well as why flakka users tend to shed their clothes.
Those are some of flakka’s reported visible effects and outcomes. But what is the drug doing in the brain?
Like cocaine, flakka is a stimulant, meaning that it’s a substance that turns up the volume on the body’s natural inner workings. The effects of cocaine on the brain are much better understood, in part, because it’s a pure substance that tends to affect the part of the brain that processes pleasure. But flakka isn't pure. It's a mutt of a drug and is probably affecting lots of different parts of the brain.
Flakka is a bath salt, a family of lab-grown drugs that have made headlines in recent years for the multiple deaths they’ve caused. Bath salts are like cocktails, in that they're a mix of different ingredients, but much more hazardous. In some cases, they’re laced with things like the anesthetic ketamine, haldol, an antipsychotic prescription medication, and benzodiazepines, which are powerful tranquilizers. Each of these separately have a different effect on the brain. Together, it’s like a dangerous ¯\_(ツ)_/¯.
And, here’s the scary part: with flakka (as with other bath salts), you never know what you’re going to get, which makes it hard to know how you’ll react or how much is too much. It’s like the illicit-drug version of Forrest Gump’s box of chocolates. It'd be one thing if you knew which of these substances–and how much of them–was in your flakka. At least that way, you might be able to do a WebMD search to try to figure out what was coming at you. But unless you're a chem wiz who can test your stash before smoking it or shooting it up, you're SOL.
This makes deciphering the effects of flakka on people’s brains tricky. At this point, no one really knows what exactly is in it, and chances are that the recipe is different from dealer to dealer.
What we do know is that the main ingredient in flakka seems to be alpha-PVP. Short for α-pyrrolidinopentiophenone, this compound is a derivative of MDVP, a psychoactive drug and one of the first compounds turned into bath salts.
"From animal studies, we know when you compare [alpha-PVP] to something like cocaine or amphetamine, it has some of the same effects," said Carl Hart, a neuroscientist at Columbia University who studies addiction. It increases heart rate, blood pressure and can give people a sense of euphoria. "But it's a lot weaker."
To understand how flakka works, you need to understand how the brain processes what's happening around it. Flakka seems to mainly mess with the amount of dopamine and norepinephrine in the brain. These are neurotransmitters that convey information from one neuron to the next; the brain uses dopamine to send messages about rewards and movement and norepinephrine in fight-or-flight responses. When your favorite song comes on the radio unexpectedly, for instance, neurons in the area of your brain that processes rewards release dopamine. This dopamine diffuses a short distance and lands on neighboring neurons that have proteins that bind dopamine. But there's usually more dopamine released than is needed to make you feel good. (It's a little bit like overselling a flight to make sure all seats are filled.) So a dopamine reuptake pathway kicks in. Special proteins on the dopamine-releasing neurons grab it and reabsorb it. Otherwise, you might get a little too euphoric about that Taylor Swift single.
The main compound in flakka, alpha-PVP, is a weak norepinephrine and dopamine reuptake inhibitor, meaning it blocks the pathways in your brain that normally vacuum up the excess amounts of these two molecules. When a person takes flakka, the vacuum is blocked and so the user's brain winds up awash in dopamine and norepinephrine. (This, incidentally, is how cocaine works too. It blocks dopamine reuptake, so over time, your brain "needs" more and more dopamine to register reward, which can lead to addiction.)
Too much dopamine in the brain has been linked to delusions and paranoia, two of the behaviors associated with flakka use. Plus, the extra norepinephrine could also prolong its fight-or-flight effects. So, you might end up acting like the guy who tried to kick in a police door.
That's the simple version. Because there are other molecules in flakka that may counteract or heighten the effects of alpha-PVP, the effects on the brain may be more complicated. Whether flakka is addictive or not remains to be seen. The drug has been out in the wild for too short a time for scientists to know for sure, plus there haven't yet been any human studies on it, like there have been for cocaine and amphetamine.
It's also important to keep in mind, says Hart, that all the media hype around flakka is probably more a function of its novelty than a sign of the impending doom it'll foist on society, care of a bunch of hyperactive, superhuman mongrels.
"There are hundreds of thousands of kids on amphetamines every day as a result of attention deficit disorder. Do we say they have superhuman strength?" says Hart. Nope. At one point, he notes, people were telling the same scary stories about marijuana because there was a lack of public knowledge about it. He suspects the same is going on with flakka and other new synthetic drugs.
For more on drugs, check out Drug Wars.
Daniela Hernandez is a senior writer at Fusion. She likes science, robots, pugs, and coffee.