Use of flakka has declined in South Florida since last year, but other chemical compounds continue to be sold under the same name, according to a drug prevention specialist in Broward County, Florida.

The county has been monitoring hospital admissions for flakka, a highly addictive synthetic drug that hit Southern Florida hard last year. According to Heather Davidson of the United Way of Broward County Commission on Substance Abuse, between June 1 and December 27, 2015, there were 1,863 flakka-related hospital admissions. They peaked in July with an average 11.6 admissions daily. By December, the rate had dropped to two per day.

The decline began in October, after China stopped production and exportation of flakka and other synthetic drugs, Davidson said recently at the Community Anti-Drug Coalitions of America (CADCA) 26th National Leadership Forum in Washington, D.C.

The synthetic drug ban resulted from bad publicity and intense pressure from abroad, Davidson said. Last year a delegation of law enforcement officials from South Florida visited their counterparts in China to discuss synthetic drugs.

Flakka first appeared in Florida in 2014. Last year, South Florida officials said flakka was outpacing cocaine in popularity. It was coming through the mail from China. The drug, also called “gravel,” was available for $5 a vial or less for a single dose. Its main ingredient is a chemical compound called alpha-PVP.

According to the National Institute on Drug Abuse (NIDA), alpha-PVP is chemically similar to other drugs known as “bath salts,” and takes the form of a white or pink crystal that can be eaten, snorted, injected or vaporized in an e-cigarette or similar device.

Vaporizing, which sends the drug very quickly into the bloodstream, may make it particularly easy to overdose, NIDA notes. Alpha-PVP can cause a condition called “excited delirium” that involves extreme stimulation, paranoia and hallucinations that can lead to violent aggression and self-injury.

A coalition of public health officials, law enforcement officials, community groups, treatment providers and academics worked together to educate the public and the media about the dangers of flakka, Davidson said. The United Way of Broward County Commission on Substance Abuse, which was originally started in reaction to the crack cocaine epidemic in South Florida, began to focus on flakka in 2014 when the drug started showing up in crime labs. The commission formed a Flakka Community Action Team in response to the growing problem. “We were hearing crazier and crazier stories, and our law enforcement was getting 20 calls a day about it,” Davidson said.

The action team came up with a plan to blanket the community with education. “We targeted the homeless population initially, because that’s where the flakka use started,” she said. “We went to shelters, the Salvation Army and other places where they were.” The group conducted school visits, town hall meetings, classes in jails and partnerships with organizations connected with young people.

The county, particularly Broward Health, created a public safety protocol that instructs people who see someone they think might be on flakka to call 911, instead of approaching the person themselves. “Operators are trained to respond with between two and six officers, as well as EMS,” Davidson noted. “They are trained in how to deal with a person on flakka, to maintain the peace and make sure the person is not a danger to themselves or those around them.”

Neighborhoods that used to have high rates of flakka use are now seeing more crack cocaine, as well as heroin and fentanyl, Davidson said. “Synthetic drugs continue at a high rate in South Florida, as they have for the past few years,” she added. “Young people have this misconception that synthetic drugs are safer than other illicit drugs. But there’s still a lot we don’t know about the long-term effects of these drugs.”

She has seen that synthetic drugs such as flakka can affect a person’s cognitive abilities. “Weeks after they take flakka, some people can’t fill out paperwork, they can’t be in a group setting, they can’t feed themselves—they still have trouble processing information and participating in conversations, and they still have feelings of paranoia.”