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.”
Bath 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*
*containers often have the product label disclaimer: “Not for human consumption”
- 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.)