Protect them before the damage becomes irreversible

A LETHAL synthetic drug mixture, colloquially known as “Piu Piu” or “Piao Piao” (Mandarin for “floating”), is rapidly creating a public health emergency across Malaysia. Disguised in brightly coloured, sweet-smelling e-cigarette pods, this Trojan horse is infiltrating our schools and communities.

Because “Piu Piu” is a street-level mixture with zero quality control, users are unknowingly engaging in extreme polydrug use. Mixing these synthetic chemicals does not simply add their effects together, it multiplies them unpredictably.

Here is what happens when this cocktail hits the nervous system:

• The “floating” illusion (fentanyl): This potent synthetic opioid binds to the brain’s receptors, triggering a massive, unnatural flood of dopamine. This creates the intense “floating” euphoria. However, while the reward centre is firing, fentanyl simultaneously attacks the brainstem, dangerously suppressing automatic functions like breathing and heart rate.
• The disconnect (ketamine and etomidate): While the opioid slows the body down, fast- acting dissociative anaesthetics go to work on the brain’s glutamate receptors. By blocking these main neural “on” switches, the drug physically severs the sensory connection between the brain and the body, causing severe loss of spatial awareness and motor control.
• The “zombie” collision: When the brain is hit simultaneously by a synthetic opioid and powerful anaesthetics, neural pathways are thrown into absolute chaos. The brain receives deeply conflicting signals: it experiences a massive artificial reward, yet simultaneously “forgets” how to keep the lungs breathing.

This neurological gridlock traps the user in a paralysed, zombie- like state, where the margin between severe intoxication and fatal respiratory failure is virtually non-existent.

The targeted marketing of these laced vapes towards youth is devastating. The adolescent brain is still under major development. Introducing a violent cocktail of opioids and anaesthetics during this critical window drastically rewires the brain’s reward pathways, accelerating the risk of severe addiction and lifelong cognitive impairment. Many young users believe they are simply vaping nicotine and are entirely unprepared for a rapid, lethal overdose.

We are losing our children to a silent predator disguised as a harmless trend. As parents, educators, and a community, we can no longer afford to look the other way while the vibrant, potential-filled lives of our youth are stolen and replaced by a hollow, paralysed existence.

Please, look closely at your children. Watch for sudden behavioural changes, unexplained lethargy, or glassy eyes, and listen for terms like “Piao Piao” or “Kpods”.

Talk to them and shatter the deadly illusion that vaping is safe. We must demand stringent regulatory action and integrate drug prevention into our education system immediately. Do not wait until it is your child struggling to take their next breath. We must protect them before the damage becomes a tragedy we cannot reverse.

ASSOC PROF DR JAYAKUMAR MURTHY

Addiction neuroscientist

Department of Physiology

Faculty of Medicine

Universiti Kebangsaan Malaysia