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The patient is a 27-year-old stock exchange worker who presents to the ED with a complaint of anxiety, chest pain, sweating, palpitations and a feeling of “paranoia and impending doom” following the recreational ingestion of “bath salts” two hours prior at a company party.

His pulse is: 120 beat/min; blood pressure: 170/100; respiratory rate: 32 breaths/min and temperature 100.7 F. He is pacing around the triage area demanding to see the “doctor in charge.”


altBath Salt Abuse
Bath salts are designer or synthetic drugs often containing amphetamine-like substances such as mephedrone, methylenedioxypyrovalerone (MDPV) which are similar to the amphetamine-like substance metcathinoine found in Cat or Qat.  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. (Table 1) Mephedrone is a central nervous system stimulant, causing a sympathomimetic reaction with occasional psychological symptoms such as delusions, paranoia, psychosis and hallucinations. Addictive properties have been described with chronic use. The number of calls reported to national Poison Control Centers and visits to emergency departments have risen exponentially over the past several months. The most profound side effects from large overdoses include seizures, rhabdomyolysis, renal failure, and rarely death.

Like amphetamines and cocaine, the drug can be snorted, smoked, injected but can also be mixed into alcoholic beverages. Recreationally, the drug’s use was intended to be a legal synthetic high, much like the synthetic cannabinoid K-2 or Spice. The street value of a half gram package generally costs $25 to $30. Currently banned in the UK and several US States, there are plans to introduce a bill in Congress to impose a nationwide ban.

The drug can also cause combative behavior. In Panama City, Florida, two incidents alerted authorities to the drug’s serious effects. In one case, several officers were needed to subdue a man who tore a radar unit out of a police car with his teeth. In another incident, police say a woman attacked her mother with a machete, thinking she was a monster. Still another user vowed to extract his  own liver with a mechanical pencil. Never a dull moment in the world of designer drugs…

Table 1: Bath Salt Brand or Street names*
Ivory Wave
Ivory Snow
Ocean Snow
Vanilla Sky
Lunar Wave
Purple Wave
Zoom 2
Aura Bliss
Charge Plus
Red Dove
Blue Silk
Cloud 9
Blizzard
White Lightning
White Rush
Hurricane Charlie
Scarface
*containers often have the product label disclaimer: “Not for human consumption”








REFERENCES

  • NIDA: Emerging and Dangerous Products. Message from the Director on “Bath Salts” www.drugabuse.gov, March 2011
  • Drug Alert Watch: Increasing Abuse of Bath Salts. US Dept of Justice Dec, 17, 2010.
  • Allan, G:  Florida Bans Cocaine-like “Bath Salts” sold in Stores. NPR, Feb 8, 2011
  • Erowid: Connecting the Microdots. www.erowid.org March, 2011
  • Sewell, A. (28 January 2011). “Bath salts latest drug to raise alarms.” Los Angeles Times
  • Reed, J. (13 January 2010). “Clubbers are ‘turning to new legal high mephedrone’”. BBC News.
  • M., S.; Power (17 August 2010). “Ivory wave drug implicated in death of a 24 year old man.” London, The Guardian
  • Garnett N: “Mephedrone freely available on the internet despite ban.” BBC Radio Live Feb 9, 2011.
  • Saner, E. (5 December 2009). “Mephedrone and the problem with ‘legal highs’”. London: The Guardian.
  • “Europol–EMCDDA Joint Report on a new psychoactive substance: 4-methylmethcathinone (mephedrone)”. European Monitoring Centre for Drugs and Drug Addiction. 27 May 2010.
  • Schifano, F.; Albanese, A.; Fergus, S et al. “Mephedrone (4-methylmethcathinone; ‘meow meow’): chemical, pharmacological and clinical issues” Psychopharmacology, 2010
  • Yohannan JC and Bozenko JS. The characterization of 3,4 Methylenedioxypyrovalerone (MDPV) 2010 Microgram Journal, 7(1):12-15.)   
 

Comments   

# Dru Mouser 2011-07-07 13:29
"Rarely, death"? Check your facts better. I know two people who died from bath salts ingestion in a two week period, my sister included. This was just in one town. Death from overdose, renal failure, and suicide are all over the news. Great to hear about the potential nationwide ban!
Reply
# Anthony 2011-08-03 05:51
It's not rocket science. If you are going to use something at the very least do some research on it. Getting a buzz is not important enough to kill yourself over. www.bathsaltinfo.com has some good stuff. better yet... just google it
Reply
# su 2011-08-04 18:34
In my small town ER, in NE PA, this has reached epidemic proportions. The practice was imported by gas workers coming here from LA and other southern states. The Bigtown Toxicology center contracted by my hospital, had no idea what we were talking about. We gained more experience by, actually treating and observing these patients, helped by Googling for experiences by actual users! Yes, it can be dangerous and deadly.
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# The Holder and Obama can of wormsDavid Paulson 2011-08-06 03:09
I'm waiting to hear about some slick defense lawyer using the Holder and Obama argument of federal preemption. Obama and Holder opened the can of worms by claiming that states -- who have been enacting laws to help deal with the problem of illegal immigration -- cannot enact legislation on things which the federal government already regulates. By extension, this would include dangerous chemical substances, which the federal government has long regulated. See what happens when you don't think!
Reply
# merritt 2011-12-26 15:46
i find it kind of ironic that much safer drugs (such as MDA or MDMA or any of the 2-C series of drugs) have been so restricted that people keep coming up with newer but more dangerous substances..lik e my neuroscience and pharmacology professors at Columbia U say "keeping drugs illegal makes them 20x more expensive and of unknown purity"...MDA/M DMA has a proven track record dating back to the late 60's and their has never been a proven death attributed to pure MDA/MDMA...the deaths that have happened were caused by toxic substances mixed in with the drug..andf when they make this drug illegal another even more dangerous one will appear...but i always take all the hype and horror stories with a grain of salt..for example they say if you do methamphetamine just once you will be addicted..yet meth is a schedule 2 drug (not schedule 1) and you can get a prescription for it...it is used to treat ADD/ADHD and extreme obesity..it is 1 methyl group (CH3) added to d-amphetamine and from a neuroscience perspective they are exactly the same..
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# Trena Tripp 2012-03-17 22:13
[Ok well i was wondering if this bath salt stuff is worse than real methamphetamine ///it has the same mental and pretty much physical affects as meth does....i have not done meth for 13 years after doing it every day for a ten year period of my life...i never relapsed in those sober 10 years...and not alot of people can do that who could not get out of bed without it for that ten year period...but when the salt was introduced to me i thought that there is no way that they can sell something legal that is just like speed and a lot of people i know started doing and i felt like since it was legal i would try it ...mostly because i did not beileive that it could be anything like speed...well i gave in and tried it and wow wee i was absolutely amazed that this "bath salt stuff actually had just about the same affect as speed..i used the excuse thatits legal so its ok to do it..i tried it once and liked it kind of brought back the same get up and go feeling i loved so much with meth....im worried that this stuff might be as adicting as meth but wont make u want to sell the family jewels...or whatever else a desprate dope addict does...u name it ive done it....use your imagination and magnify the bad horrible things one does for this substance....i mean people do things they would not normaly do...such as selling personal sometimes expensive belongings for a very little bit of methamphetamine ...one guy brought his xmas tree....yeah u heard right..xmas tree and if that were not bad enought he even brought the presents from the family as well. I mean who does that and why? Is the need for that stuff so strong tht you have to sell it to the dope man...to get high...and no matter what its worth....]or how menieal or expensive it is ...you will still get the crumbs that the dope man is willing to give...and now matter how expensive or valued it is ....a drug addict will sell what ever he can to get his next fix....its very sad and its very sad and i am disapointed in myself for trying this bath salt and really guilty for kind of liking it..i swore i would never do that again...it was such a proud moment when the first year when bye...then the second and then the third and when i thought i could never live with out it or get out of bed unless i had it....I feel good knowing that once i put it down i never touched it again not even once...in ten years...that is rare because I hear that meth does not have a very successful rate of people staying off of it for good or for as many years as i was able to do....what it really comes downt to and we all know this is that u have to want to do it...u have to want to quit or else u wont....when u are ready and you really want to quit then that is when you are succsessful at doing so....but not until then ...i make up my mind to quit because i was sick of the people....the people were horrible people...not always horrible mabye but had to turn that way in order to dealwith the people who do this drug..anyways thats my story...so here i am worried that this bath salt stuff might make me start this whole thing all over again....but im stronger than that ive proved that to myself already....and well like i said i had to just try it once and let me tell u it was pretty good....but curiosity will get u every time u let it and i let it but i tried it ....im done and my life is much to precious throw away on a substance that is one of the worst things you can put in your body...i love me...and well ....that means everything to me.
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# keai 2012-06-15 15:43
A person took bath salt here at my town (17 years old,) and he stabbed his friend thinking he was from the Illuminati... crazy shit.
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