Bath salt abuse making headlines
Robert Glatter, MD, Emergency Medicine, 12:09AM Jul 18, 2011
A recent article in the Sunday New York Times [7-17-11] describes the epidemic abuse of bath salts
throughout the US. Although 28 states have banned them, concentrated bath salt products are widely
available on the internet and can be found in stores, truck stops and gas stations under names like Zoom
2, Aura, Vanilla Sky, Ivory Wave and White Rush.
Bath salts contain synthetic chemicals like mephedrone and methylenedioxypyrovalerone, or MDPV,
also known as substituted cathinones. Both drugs are related to khat, an organic stimulant found in Arab
and East African countries that is illegal in the United States.
Mephedrone is a central nervous system stimulant, causing a sympathomimetic reaction with
psychological symptoms such as delusions, paranoia, psychosis and hallucinations. Addictive properties
have been described with chronic use. The most serious side effects from large ingestions include
seizures,rhabdomyolysis, renal failure, and rarely death.
Robert Glatter, MD
DEA Moves to Make 'Bath Salts' Illegal as Overdoses Rise
September 7, 2011 ( UPDATED September 8, 2011 ) — In the wake of a growing number of overdose
visits to emergency departments, the US Drug Enforcement Administration (DEA) has moved to make
psychoactive "bath salts" (PABS) a controlled substance.
In a statement released today, the DEA announced it is using its emergency scheduling authority to
temporarily control methylenedioxypyrovalerone and 2 other synthetic stimulants: mephedrone and
methylone.
As of September 7, 2011, possessing and selling these chemicals or the products that contain them are
both illegal in the United States for at least 1 year while the DEA and the US Department of Health and
Human Services mull over whether the substances should be permanently controlled.
"This imminent action by the DEA demonstrates that there is no tolerance for those who manufacture,
distribute, or sell these drugs anywhere in the country, and that those who do will be shut down,
arrested, and prosecuted to the fullest extent of the law," DEA Administrator Michele M. Leonhart, said
in a statement. "DEA has made it clear we will not hesitate to use our emergency scheduling authority to
control these dangerous chemicals that pose a significant and growing threat to our nation."
In the last 6 months, the DEA has received increasing reports from poison centers, hospitals, and police
involving one or more of the now-controlled substances.
Increasing Emergency Visits Related to Overdose
People who overdose on the bath salts are showing up in emergency departments with increasing
frequency, concerned clinicians Edward A. Ross, MD, Mary Watson, MD, and Bruce Goldberger, PhD,
from the University of Florida College of Medicine, Gainesville, write in a letter to the editor, that
appears in the September 8 issue of the New England Journal of Medicine.
"Despite growing efforts to ban these products through legislation, [PABS] often skirt substance-control
laws and are readily available at low cost," the authors write.
Until now easily obtained over the Internet, these bath salts, which have nothing to do with any hygiene
product, go by such names as Ivory Wave and Vanilla Sky.
The main ingredient in PABS is methylenedioxypyrovalerone, which is structurally related to
pyrovalerone and a-pyrrolidinophenone compounds that inhibit norepinephrine-dopamine reuptake
and act as central nervous system stimulants.
Touted for giving a high similar to that of methamphetamine, PABS are also known as alertness
enhancers or aphrodisiacs and are sometimes called "legal cocaine."
PABS are taken orally, intranasally, intravenously, or rectally, and doses as low as 3 to 5 mg will produce
an effect. The average dose ranges from 5 to 20 mg, and the risk for overdose is high because packages
can contain up to 500 mg. Taken orally, the bath salts are rapidly absorbed and produce a rush that
peaks at 1.5 hours after ingestion and lasts for 3 to 4 hours.
The physical effects of PABS include tachycardia, hypertension, arrhythmias, hyperthermia, seizures,
stroke, myocardial infarction, and even death. Behavioral and mental effects include panic attacks,
anxiety, paranoia, hallucinations, psychosis, aggressive or violent behavior (such as self-mutilation,
suicide attempts, and homicidal activity), insomnia, anorexia, and depression.
The consequences of a PABS overdose can be particularly nasty, and clinicians need to be aware of
several issues, the authors warn.
Individuals who are experiencing symptoms of PABS overdose need to be cared for and monitored in the
intensive care unit. In addition, routine drug screens are unable to detect bath salts. Bath salts also can
be cut with other psychoactive substances, which can further confuse the clinical presentation, the
authors write.
Overdose victims may also require physical restraints and high doses of sedatives to prevent harming
themselves or others.
Treatment involves intravenous benzodiazepines to control seizures or for sedation and intravenous
fluids for suspected rhabdomyolysis.
'Bath Salts' Have Effects Similar to Meth, Ecstasy
August 18, 2011 — Mephedrone, a key ingredient in the designer-drug mix sold as "bath salts" or as
other substances, induces methamphetamine-like cravings in rats.
But mephedrone isn't exactly like meth, cocaine, ecstasy (MDMA), or other new designer drugs,
according to rat studies led by pharmacologist Annette E. Fleckenstein, PhD, and colleagues at the
University of Utah.
It has its own unique combination of effects and toxicities:
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Like meth but unlike ecstasy, rats quickly develop a craving for mephedrone and will keep
pressing a lever in order to get more.
Like meth, mephedrone increases brain levels of dopamine.
Like ecstasy, mephedrone increases brain levels of serotonin.
Like ecstasy, repeat doses of mephedrone damages the brain's ability to respond to serotonin
(although human users of bath salts frequently binge, while ecstasy users usually don't).
Like both ecstasy and meth, mephedrone causes the body to overheat.
"Mephedrone is a unique psychostimulant of abuse that shares pharmacological properties similar to,
and yet distinct from, both meth and MDMA," Fleckenstein and colleagues conclude. "Its ability to cause
subjective effects resembling MDMA reportedly likely contributes to its abuse. However, its ability to
cause dopamine release greater than MDMA may be particularly problematic in that, in comparison to
MDMA, this drug hay have enhanced abuse liability more resembling dopamine-releasing agents such as
meth."
Bath Salts, Plant Food, Decorative Sand, and Toy Cleaner
Mephedrone is sold as "bath salts" or as other innocuous products in an effort to sidestep drug laws,
DEA Special Agent Gary Boggs tells WebMD.
"In order to escape law enforcement scrutiny, products are labeled 'not for human consumption,' but
they know full well it is intended for that," Boggs says. "The federal analog statutes let us prosecute
someone selling a specific analog of a controlled substance, but it has to be similar -- chemically similar
and pharmacologically similar -- and intended for human consumption. ... So the veiled attempt is to put
these things on the market as something they are not."
In addition to being called bath salts, mephedrone has also been sold as plant food, decorative sand,
and even as toy cleaner. It goes by a variety of brand names. Two very popular ones are Ivory Wave and
Vanilla Sky; others include Purple Wave, Red Dove, Blue Silk, Zoom, Bloom, Cloud Nine, Ocean Snow,
Lunar Wave, White Lightning, Scarface, and Hurricane Charlie.
Mephedrone has never been approved for human consumption -- hence the initial studies in rats -- nor
are these illicit products made under the kind of good manufacturing practices necessary for legal drugs,
supplements, and foods.
Mephedrone is a so-called designer drug. It's a man-made derivative of the psychostimulant cathinone,
which comes from the plant called khat.
Bath salts and similar substances are a growing problem. As of July 31, U.S. poison control centers had
received 4,137 calls about bath salt "exposures." In all of 2010, there were only 303 such calls.
Last May, the Michigan health department reported a surge in emergency-room visits from people who
had swallowed, snorted, or injected bath salts. Seventeen of the patients were hospitalized; one was
dead on arrival.
Several states already have introduced legislation to ban sale of bath-salt products, but the substances
remain available via online sellers.
"I would like to urge parents, teachers, and the public at large to be aware of
the potential dangers associated with the use of these drugs and to exercise a
judicious level of vigilance that will help us deal with this problem most
effectively," Nora D. Volkow, MD, director of the National Institute on Drug
Abuse, says in a news release.
Fleckenstein and colleagues report their findings in the online edition of the Journal of Pharmacology
and Experimental Therapeutics.