Bath salts are the latest trend on the growing list of substances teens and young adults use to get high. This product is so new that our knowledge about long-term effects is minimal. But what we do know suggests proactive efforts are needed to minimize the public health impact.

In a one-month period in 2011, the U.S. Poison Centers received more than 250 calls related to bath-salt use.² But what exactly are these drugs?

Bath salts contain amphetamine-like chemicals, such as mephedrone and/or methylenedioxypyrovalerone (MDPV), and are typically administered by inhalation or injection. Worse outcomes have been associated with snorting and/or intravenous administration. People in the 20- to 29-year-old age group are most likely to use this drug.

Typically sold as a synthetic powder described as “fake cocaine,” bath salts can be purchased legally online under multiple pseudonyms including ivory wave, purple wave, red dove, cloud nine, vanilla sky and hurricane lightening.¹

Much like cocaine, bath salts brings on euphoric feelings, followed by very bad feelings such as paranoia, depression and intense cravings for more. If ingested orally, users experience a rapid rush followed by a prolonged high that can last six to eight hours, and then a hard crash.³

Users describe the effects of bath salts as being similar to methamphetamine, ecstasy and cocaine. This is a very powerful drug, and first-time users have increased risk for accidental overdose. The drug is still available for legal purchase in the United States, but it is marketed as not for human consumption.⁴

Healthcare providers, parents, teachers and the public must be prepared to recognize symptoms associated with bath salts, as they can mimic the effects of other dangerous substances or symptoms of other disorders. Users may exhibit anxious and jittery behavior, decreased need for sleep, lack of appetite, severe paranoia, and erratic behavior such as hallucinations, violence and self-mutilation. Differential diagnoses include hypertensive crisis, thyroid storm, hyponatremia, panic disorder, amphetamine toxicity, cocaine toxicity and methamphetamine toxicity.⁵

Distinguishing bath salt-use from other substances, such as cocaine, methamphetamine or ecstasy may be difficult for healthcare providers. MDPV overdose can lead to unpredictable outcomes including rapid heart rate, suicidal thoughts, kidney failure, hypertension and renal failure. A bath salt toxicity diagnosis should be based on pertinent patient history and clinical presentation at the time of the visit.

Users that overdose on bath salts may require admission to intensive care and administration of intravenous sedatives, antipsychotics and/or restraints to protect them.² Supportive care is often given in overdose situations, because there is no known antidote for the drug.

Bath salt abuse is hard to battle because it continues to be legal in the United States, and teens will likely continue to abuse the substance even if it’s made illegal. This makes it even more important for healthcare providers to be able to recognize bath salt abuse in our teen populations.

Kristen Hileman, MSN, FNP, CRNP, practices at LaVale Primary Care Center in the Western Maryland Health System.

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