Synthetic cathinones remained in the shadows of the drug abuse world for years, sold as “bath salts” or “plant food” in convenience stores, gas stations, and other venues right under the nose of the public and drug enforcement agencies. They were labeled with the warning “not for human consumption” and given the health effects they cause that is not bad advice.
However, starting in 2015, the use of synthetic cathinones flared in Florida where in Broward County alone, 60 people died and 20% of drug treatment program slots were for patients using Flakka. Nationwide one in a hundred 12th graders have tried a synthetic cathinone, which is similar to the use of heroin, crack, and methamphetamine. Our pharmacist, Dr Michael White from the UConn School of Pharmacy has just authored a review in the Journal of Clinical Pharmacology on synthetic cathinones and is here to tell us what we need to know.
Cathinone is derived from the Khatt plant which is commonly used in Africa and the Arabian Peninsula. In Somalia and Yemen over 1/3 of the population use the product every week. Synthetic cathinones are made in the laboratory and chemically altered to heighten the effects of the drug making it more potent and more dangerous. First made in Russia as an appetite suppressor but removed from the market due to abuse, it spread across Europe before ending up here in 2008. The most common synthetic cathinones are mephedrone, MDPV, and flakka which is chemically called alpha-PVP. They are structurally very similar to methamphetamine and people use it for increased energy and a feeling of euphoria. It causes this by increasing serotonin, dopamine, and norepinephrine in the brain. It is the intense release of these brain chemicals that also cause adverse effects.
The most common adverse effects associated with synthetic cathinone include mental issues such as agitation, hallucinations, delusions, or psychosis; heart effects like racing heart-beat, elevated blood pressure, and arrhythmias; severe muscle damage leading to kidney damage; and seizures. The mental effects can be very pronounced with several people fleeing imaginary monsters, scorpions, or people; stripping off their clothes; jumping off bridges; drowning; and other self-inflicted harm. These hallucinations and delusions make the heart risks even higher as the panic they induce drive adrenaline concentrations up.
People take drugs like these during raves, parties, or concerts to give them energy and to make them feel happy and up for the long haul. They like these drugs versus marijuana because it is much harder to detect by the smell it leaves behind and is harder to detect by laboratory testing as well. However, any time you buy an illegal drug you have no idea how much active ingredient is in it, whether it has other drugs in it to enhance the effects, and how you will react to it versus your friends. In addition, these drugs are broken down by CYP liver enzymes and there are important potential drug interactions that can occur. So you can’t say that since you tried it before that taking the same amount this time will give the same effect or because your friend tried it before that your experience will be the same. These drugs are also addictive and there are many reports of people being hospitalized or undergoing treatment and then relapsing. Like with crack, trying it a time or two for a high can result in addiction that is incredibly hard to break.
Dr. Michael White, UConn School of Pharmacy
