Between 2014 and 2015 an outbreak of bizarre behavior and cases of excited delirium in South Florida reported in local, national and international media accounts, brought attention to the use of flakka. During that period more than 60 deaths from flakka intoxication were reported throughout the region. Treatment and intervention of potentially flakka intoxicated patients was complicated by the infrequent testing in health centers to confirm the drug’s identity as reported by users or concerned others, and the challenges of determining the toxicology of the drug itself. The study described in this article reports on suspected “flakka” intoxications of patients treated at Broward Health Medical Center’s Emergency Department, in Ft Lauderdale, to correlate the clinical presentation and toxicological analysis of the substances used in “flakka". The subjects’ oral fluid samples were extensively analyzed by liquid chromatography, and time of flight mass spectrometry for therapeutic,recreational and novel psychoactive drugs. All six subjects recruited were male with a median age of 37; all admitted to a past history of substance use. The presence of alpha-PVP was discovered in only one subject. All subjects tested positive for multiple other drugs. Samples from five of the six subjects contained a stimulant. Nicotine/cotinine and antipsychotic medications were present in four and antihistamines were discovered in three of the samples. The routine urine drug screen was negative for half the subjects. Our knowledge of the clinical features of confirmed “flakka” intoxication is limited. Clinicians should be aware that individuals who believe they are ingesting novel psychoactive substances such as “flakka” are unknowingly using other psychoactive substances.
Daniel Castellanos, Benny Menendez, Barry K Logan, Amanda LA Mohr, Debra Ayer, Melvin
Thomas and Adriana Foster
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