A 21-year-old man slashed his throat and ended his life with a gunshot to his head. An 11-year-old boy was found dead after hanging himself in his bedroom. A girl attacked her sleeping mother with a machete. 

These are just a few of the alarming stories associated with new synthetic drugs called “bath salts.” Far from your typical bath-enhancing products, these bath salts are intended to be snorted, smoked or injected. According to the American Association of Poison Control Centers and the U.S. Department of Justice, “bath salts” were being sold on the Internet and at gas stations, smoke shops and convenience stores under such street names as
 “Blizzard,” “Cloud Nine” and “Ocean Snow.”

They are typically found as white, light tan or brown powders, and are believed to contain psychoactive chemicals known as mephedrone and/or methylenedioxypyrovalerone (MDPV). MDPV is structurally related to cathinone, an active alkaloid found in the khat plant (a stimulant plant that produces leaves that are chewed much like coca leaves), methamphetamine and methylenedioxymethamphetamine (MDMA, or “ecstasy”).

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MDPV functions as a dopamine-norepinephrine reuptake inhibitor, producing stimulatory effects on the central nervous system and cardiovascular system. Sympathomimetic reactions are similar to those caused by methamphetamine, ecstasy, and cocaine. 

Side effects include tachycardia, hypertension, euphoria, hallucinations, psychosis, paranoid delusions, agitation and diminished requirement for food and sleep. The psychosis can cause extreme violent, combative and self-injurious behavior. The most profound side effects from large overdoses include seizure, rhabdomyolysis and renal failure.

The subjective effects of bath salts last approximately three to four hours, but the physical side effects, such as tachycardia and hypertension, can last six to eight hours. Some reports indicate it can take 36 to 48 hours to come down from a bath-salt “high,” and that hallucinations and psychotic behavior can be long-lasting, enduring even after the substance is eliminated from the body. Bath salts are thought to be highly addictive, even in small doses.

MDPV is undetectable with routine urine and blood drug tests. Tests that detect both MDPV and mephedrone can be costly, and the detection window is limited to approximately 48 to 72 hours. 

Treatment of bath-salt users is symptomatic and supportive, generally involving fluid administration; benzodiazepines for chemical sedation; and physical restraints for severe combativeness, agitation or physical hallucinations. Psychiatric monitoring is also recommended until hallucinations and suicidal or homicidal ideation pass. 

Reports to poison-control centers involving bath salts increased from 303 in 2010 — when the drugs first surfaced — to 4,720 by August 31, 2011, according to the American Associations of Poison Control. On September 7, 2011, the U.S. Drug Enforcement Administration used its emergency scheduling authority to make these substances illegal for at least one year.

All electronic documents accessed October 15, 2011.