A dangerous drug blamed for an outbreak of bizarre behaviour in Florida, including a "cannibal attack" which saw a man chew off another's face, has arrived in Plymouth.
So-called 'zombie drug' Flakka has ravaged parts of the United States.
And now the highly addictive designer drug, initially created to get around legislation covering party drugs like Ecstasy and cocaine, has reared its ugly head on our own doorsteps.
A young woman who died following a drug-fuelled house party in the city had Flakka - also known as Alpha PVP, or alpha-Pyrrolidinopentiophenone - in her system, an inquest found.
Andrea Horvathova was just 23 years old. A toxicology report found her blood also contained amphetamine, Ecstasy and cocaine.
It is believed to be the first time Flakka has been recorded in Plymouth.
What is Flakka?
According to the US Drugs Enforcement Agency (DEA) alpha-Pyrrolidinopentiophenone is defined as a "dangerous drug" which usually comes in a crystal form, hence its nicknames "crystal", "gravel" and "bath salts".
Like many other designer drugs, Flakka can be eaten, snorted, injected or even vaporized in e-cigarettes.
The DEA has stated that its effects include "paranoia and hallucinations that may lead to violent aggression and self-injury", adding that "overdose and death have beenlinked to the use of this drug".
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Alpha PvP first appeared in the early 1960s and was patented in 1967 as a nervous system stimulant.
The drug became available in the United States in 2013 in a tablet form but within a year its popularity and distribution quickly spread under the 'Flakka' name.
It was not deemed illegal until 2014 when the US government classified it as a Schedule 1 controlled substance - joining heroin, Ecstasy, LSD, marijuana and magic mushrooms.
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The cannibal attack
In 2015 police in Florida, USA reported an outbreak of extremely bizarre behaviour by people after using a drug named as Flakka.
Reports began to come in of excessively violent incidents, such as one man Rudy Eugene, who who chewed off another man's face during an attack.
This incident, in Miami in 2012, was described in some quarters as an alleged "cannibal attack" and the perpetrator dubbed the "Miami Zombie" in numerous news reports around the globe.
While initially blamed on Flakka, toxicology reports on the body of the user - Eugene was shot dead by police during the attack - found only marijuana in his system.
Despite this, police from the region appeared to be convinced Eugene had been on a drug of some sort, saying his behaviour was consistent with someone on "bath salts" - which in Britain was often termed "bubble" or "spice" - and one senior officer insisted the toxicologists "are not testing for everything that may be out there".
The director of toxicology at the University of Florida, Dr Bruce Goldberger retorted: "We are not incompetent... We have the tools, we have the sophistication and know-how. But the field is evolving so rapidly it is hard for us to keep track. It's almost as if it is a race we can never win."
The synthetic drug is based upon the khat plant which grows in East Africa and Southern Arabia.
The leaves are chewed and are a mild stimulant. However, chemists then broke it down and created the synthetic - and much more potent - version, named alpha-Pyrrolidinopentiophenone, similar to amphetamine.
How the designer drug is made
Flakka is one of a number of psychoactive substances, like mephedrone, which were created and regarded by users to be "legal highs" until advice from the Advisory Council on the Misuse of Drugs (ACMD) persuaded the Government to bring in legislation to ban the substances.
Chemists, invariably working in small labs in Europe but working for suppliers from countries like China or Pakistan, would tinker with the drug DNA to create a similar "high" but effectively skirt around the slow-moving legislative process. In 2018 there was an estimated 160,000 synthetic drug labs operating in China alone.
It was only when the Psychoactive Substances Act of 2016 was brought in that it finally closed down each of these kinds of recreational synthetic drugs and made them all illegal in one fell swoop.
The Texas Poison Center Network, a help and advice group in the USA, say Flakka is "chemically similar to other synthetic cathinone drugs" but "has the potential to be much more dangerous than cocaine."
The Network website notes how the vaporizing of the the foul-smelling crystal form in e-cigarettes can send the drug into the bloodstream exceptionally quickly, but increases the danger of a user overdosing.
The website says that the drug causes "a condition called 'excited delirium' that involves hyperstimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury", possibly explaining the more lurid reports in the American press about the behaviour of users.
In the US the drug has also been linked to deaths by suicide as well as heart attack.
Andrea Horvathova's death
Plymouth Coroners Court heard a pathologist's toxicology report found Andrea's heart and liver had been damaged.
The combination of drugs she consumed on the evening of Sunday March 4, 2018 would have very likely resulted in a heart attack, the court heard. Paramedics who attended the address performed CPR on on Andrea in an effort to revive her.
As it was, medical staff at Derriford Hospital continued to battle to save Andrea's life over the following three days, but to no avail and she passed away on March 7.
The inquest heard that Andrea had already take a number of drugs during the evening but at some stage, while at a property in Connaught Avenue, Mutley, she was offered an unidentified pill by a man which she consumed.
The effects of Flakka
The Texas Poison Center Network notes how Flakka can "dangerously raise body temperature and lead to kidney damage or kidney failure".
As regularly stated by police, the Network points out how it is "so difficult to control the exact dose of Flakka - just a little bit of difference in how much is consumed can be the difference between getting high and dying. It's that critical."
According to the website, which advises the American public on a vast range of legal and illegal substances, although a typical Flakka high can last "one to several" hours, "it is possible that the neurological effects can be permanent".
It adds: "Not only does the drug sit on neurons, it could also destroy them. And because flakka, like bath salts, hang around in the brain for longer than cocaine, the extent of the destruction could be greater."
Another serious, potentially lingering side effect of Flakka is the effect on kidneys. The drug can cause muscles to break down, as a result of hyperthermia, taking a toll on kidneys. Experts worry that some survivors of Flakka overdoses may be on dialysis for the rest of their life.
Flakka is sold at a cut-price rate with doses costing anywhere between $3 and $5, making it a very cheap alternative to cocaine.
In 2015 James Hall, an epidemiologist at the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University in Florida, claimed that the danger of the drug came from its potency.
He suggested that a typical dose was just 0.003 ounces (0.1 grams), but "just a little bit more will trigger very severe adverse effects," Hall told Live Science. "Even a mild overdose can cause heart-related problems, or agitation, or severe aggression and psychosis."
Because of the drug's addictive properties, Hall claimed that users may take the drug again shortly after taking their first dose, but that can lead to an overdose. Following this he said that users had reported that "they can't think," and experience what's known as the excited delirium syndrome: Their bodies overheat, often reaching 105 degrees Fahrenheit, they will strip off their clothes and become violent and delusional, he said.
The drug also triggers the adrenaline-fueled fight-or-flight response, leading to the extreme strength described in news reports.
"Police are generally called, but it might take four or five or six officers to restrain the individual," Hall said.
Flakka in the UK
In Britain there have been very few reported cases of Flakka, while the drug has mainly been found in the US, with occasional incidents in Australia and New Zealand.
However, in November last year global news agency AFP reported on how Russian police had seized two-tonnes of Alpha PVP, along with 5.8 tonnes of raw materials after searching an illegal lab around 65km from St Petersburg. The entire haul was estimated to be worth around 100 million Euros, or £84.6m.
Over the past 12 months the only UK report of the drug has come from examination of tablets seized in Bury, Greater Manchester in January 2019 after two teens were left critically ill and a third in a coma.
Police initially stated that the tablets contained amixture of MDMA, ketamine and methadone. However, it was later revealed the pills contained an 'extremely high dose' of Alpha-PVP.
The Greater Manchester Drug Early Warning System - a network of police, health and prison staff set up to alert the public to strong or dangerous batches of drugs in circulation - warned the dose was eight times higher than what is normally considered a strong batch.
Drug misuse on the rise - the facts
Drug misuse related hospital admissions (England)
- There were 7,545 hospital admissions with a primary diagnosis of drug-related mental health and behavioural disorders. This is 12 per cent lower than 2015/16 but 12 per cent higher than 2006/07
- There were 14,053 hospital admissions with a primary diagnosis of poisoning by illicit drugs. This is 7 per cent lower than 2015/16 but 40 per cent more than 2006/07.
Deaths related to drug misuse (England and Wales)
- In 2016 there were 2,593 registered deaths in England and Wales related to drug misuse. This is an increase offive5 per cent on 2015 and 58 per cent higher than 2006
Deaths related to drug misuse are at their highest level since comparable records began in 1993
Drug use among adults (England and Wales)
- In 2016/17, around one in 12 (8.5 per cent) adults aged 16 to 59 in England and Wales had taken an illicit drug in the last year.
- This level of drug use was similar to the 2015/16 survey (8.4 per cent), but is significantly lower than a decade ago (10.1 per cent in the 2006/07 survey).
Drug use among children (England)
- In 2016, 24 per cent of pupils reported they had ever taken drugs. This compares to 15 per cent in 2014.
- The likelihood of having ever taken drugs increased with age, from 11 per cent of 11 year olds to 37 per cent of 15 year olds.
Under the heading 'WARNING Dangerous pills in circulation in Greater Manchester' the warning stated: "The pills are described as badly made and crumbly and were believed to have been home-made. They are beige in colour and stamped with the UPS logo. They are described as smelling of vomit.
A drug expert for Devon and Cornwall Police told Plymouth Live their first encounter with Alpha-PVP was back in 2016. They said their notes at the time referenced it as a class B drug under the Misuse of Drugs Act and was "part of the cathinone" group of drugs, which included mephadrone.
Noted as being one of the "newly developed drugs" they said Alpha-PVP was sometimes sold as Ecstasy/MDMA which underscored the main concern the authorities had that "people just don't know what they're getting or taking."
The drug expert said: "People don't know the strength of the drugs they are taking. The internet market, which is where people are buying illegal drugs, has increased and as a result the drugs quality, strength and purity has increased and the effects are unpredictable.
"Fortunately we don't see a lot of it, but Alpha-PVP is one we have seen in the past and has certainly been in Plymouth before. However, it has probably fallen under the cathinone category in our reports rather than its specific name.
"However, it's not something we have seen on a weekly basis - maybe once or twice a year per area [Cornwall/Plymouth/Devon].
"In this case, as with many others, the risky behaviour is from poly-drug use and the dangerous effect a combination of drugs has on a body. It's really, really sad when someone loses their life like this."
Ruth Harrell, Director of Public Health in Plymouth, said: “Almost all UK drug deaths are, like this case [Andrea Horvathova], attributed to 'poly-drug' use, where drugs that are commonly known to be dangerous are used in combination with alcohol and other drugs.
"We do monitor the use of novel psychoactive substances but the real crisis in drug deaths is the increased quality, availability and potency of heroin and cocaine used in combination with depressant drugs like alcohol and benzodiazepines."