By Richard J. Geller, MD, MPH, California Poison Control System
Beginning in September, 2010, US poison control centers began to receive reports of patients ill from the effects of a series of previously unreported drugs of abuse collectively known as “bath salts”. These agents have nothing to do with bathing, and, like the synthetic cannabinoids marketed as “spice”, are marketed as something other than what they really are. Most recent data as of this week is that U.S. poison centers took 236 calls for 2010. We are at 220 to date for 2011.
“Bath salts” are powders, which are often sold in 250 mg amounts, packaged in either small zip-lock bags or in jar-like containers, costing $15-65. Like methamphetamine, they are ingested, snorted, smoked or injected, and have been placed in the rectum and vagina. Users are most often males aged 20-25 years.
What is known about “bath salts” is that they combine the more dangerous effects of a number of previously identified drugs of abuse: visual and sometimes auditory hallucinations similar, and possibly worse, than LSD, rapid tolerance and craving similar to crack cocaine, extremely violent behavior similar to PCP and methamphetamine, an unusually long duration of effect and psychotic behavior which may not resolve after the drug is eliminated from the body.
“Bath salts” were first observed in Louisiana, where over two hundred exposures have been reported to the Louisiana Poison Control Center. Several “bath salt” users have mutilated themselves with knives; one shot himself in the head. Law enforcement officials believe that eventually they will have to use extreme force with “bath salt” users. Visual hallucinations caused one user to barricade himself in an attic with a shotgun, threatening to kill the occupants of the home. Significant “bath salt” use is now being reported in Kentucky, Florida, Mississippi and Missouri.
On both the federal and state levels, “bath salts” have been legal to sell and to use. Louisiana’s Secretary of Health and Hospitals signed an emergency declaration in January 2011 banning the sale of “bath salts” in that state, resulting in an immediate slowing of reports of illness to the state’s poison control center. Other states are considering similar measures.
The most common substance identified in “bath salts” is 3,4-Methylenedioxypyrovalerone, also known as MDPV, and marketed as Ivory Wave and Energy-1. Commonly found is Mephedrone, also known as 4-Methylmethcathinone, a compound very similar in structure to Methamphetamine, and marketed as Bounce, Bubbles, M-CAT, Mad Cow and Meow Meow. Other substances implicated as “bath salts” are 3,4-Methylenedioxymethcathinone (Methylone), 4-Methoxymethcathinone, 4-Fluoromethcathinone and3-Fluoromethcathinone. The latter 4 substances are derivatives of Methcathinone, also known as Khat, Jeff and Cat, a drug structurally and pharmaceutically similar to methamphetamine. Methcathenone has a long history as a drug of abuse in Asia.
The Louisiana experience suggests that law enforcement personnel encountering “bath salt” users should be prepared to deal with extremely confused (visual hallucinations) and possibly very violent individuals who may be armed. Health care professionals encountering “bath salt” users should be aware that the usual sedative medications, i.e., benzodiazepines, may not be effective, and that major tranquillizers, especially ziprasidone, have been useful.
The California Poison Control System believes that “Bath Salt” products are a grave danger to public health, and urges that immediate steps be taken to ban their sale in California.
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