What are bath salts and why are they dangerous?

Bath salts are a relatively new group of designer drugs sold as tablets, capsules, or powder and purchased in places such as tobacco and convenience stores, gas stations, head shops, and the Internet.

They are stimulants that mimic cocaine, lysergic acid diethylamide (LSD), methamphetamine, or methylenedioxymethamphetamine (ecstasy). According to a recent article in the Journal of Psychosocial Nursing, the most common bath salts are MDPV, mephedrone, and methylone. These drugs cause intense stimulation, euphoria, elevated mood, and a reportedly pleasurable “rush.” Increased heart rate and blood pressure, chest pain, hallucinations, paranoia, erratic behavior, inattention, lack of memory of substance use, and psychosis have been observed in those who have used bath salts.

The U.S. Drug Enforcement Administration recently exercised an emergency authority to name three key ingredients in bath salts as Schedule I, thereby making them illegal to possess or sell in the United States. Part of the appeal of using bath salts is the current difficulty in picking up its use on routine drug screens.

MDPV is a phenethylamine and a norepinephrine-dopamine reuptake inhibitor. It is a central nervous system (CNS) stimulant with hallucinogenic effects. A similar form of the drug, pyrovalerone, was developed in the 1960’s in the US to treat chronic fatigue syndrome but was rejected due to problems with abuse and dependency. Oral, nasal, sublingual, rectal, intravenous, and intramuscular use have been reported. A dose usually has an effect of about 2 to 3 hours. Users reportedly experience feelings of stimulation, euphoria, empathy, and being more aware of their senses. Physical manifestations include an increase in blood pressure, heart rate, and sweating. More distressing side effects include prolonged and intense panic attacks as well as psychosis, which may last up to 8 hours after use. There is a high risk of toxicity, dependence, and withdrawal.

Mephedrone is also in the phenethylamine category and is a CNS stimulant that can cause hallucinations and agitation. Users will ingest the capsules, dissolve it in water, snort it, or use it rectally (known as bombing). Effects begin within 45 minutes of use. Side effects include nausea, rapid heart rate, increased blood pressure, chest pain, irritability, dizziness, nosebleeds, and delusions. It has also been associated with impaired impulse control and violent behavior.

Methylone is a stimulant in the phenethylamine class with properties very similar to ecstasy. It is a reuptake inhibitor of serotonin, norepinephrine, and dopamine. After oral, nasal, or rectal use, effects occur within 20 minutes and last about 2 hours. Users report euphoria, a sense of well-being, and increased perception of sensory stimuli. It can cause a racing heart, elevated temperature, pupil dilation, jaw clenching, dizziness, nausea, confusion, and paranoia. Both this and mephedrone have been found to be highly addictive.

Bath salts have been packaged and labeled as “plant food” or “not for human consumption,” and product labels do not list the ingredients. Names include Vanilla Sky, Ivory Wave, plant fertilizer, Cloud 9, m-CAT, Mad Cow, and M1. The Internet is replete with stories of its use, including out-of-control violence, hallucinations, and even sensationalized reports of cannibalism and murder/suicide. Treatment usually starts with Ativan, followed by the use of antipsychotics such as Risperdal or Haldol if unresponsive to Ativan.

Its recent surge represents a disturbing trend in the use of these drugs associated with violent acts. States are trying to pass individual laws to prohibit its use. Creating standardized methods of identification in users is necessary to create an effective means of stopping or controlling its distribution, and hopefully providing treatment for those unfortunate enough to experience its effects.

-Roy Michael Stefanik is a psychiatrist who blogs at Fairfax Mental Health.

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