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Bath Salts Drug

Medically reviewed on Sep 18, 2018 by L. Anderson, PharmD

Common or street names: Flakka, Ivory Wave, Vanilla Sky, Cloud Nine, Blue Silk, Purple Sky, Bliss, Purple Wave, Red Dove, Zoom, Bloom, Ocean Snow, Lunar Wave, White Lightening, Scarface, Hurricane Charlie, Drone, Energy-1, Meow Meow, Sextasy, Ocean Burst, Pure Ivory, Snow Leopard, Stardust, White Night, White Rush, Charge Plus, White Dove, plant fertilizer, plant food

What are bath salts?

Bath salts are a designer drug of abuse with reports of dangerous intoxication from emergency departments across the US. "Bath salts" are not a hygiene product used for bathing, as the name might imply, but are dangerous synthetic cathinones. These mind-altering drugs are strong central nervous system stimulants that inhibit the dopamine-norepinephrine reuptake system (neurotransmitters in the brain). They can lead to serious, and even fatal adverse reactions. The drug effect is a high or "rush" that is similar to methamphetamine (speed). They are often sold on the street as cheap substitutes for other stimulants such as methamphetamine and cocaine.

What is in bath salts?

The most commonly reported ingredient is methylenedioxypyrovalerone (MDPV), although other stimulants may be present, such as mephedrone and pyrovalerone.1 MDPV is of the phenethylamine class and is structurally similar to cathinone, an alkaloid similar in structure and effects to amphetamine and found in the khat plant. Khat is a shrub found in East Africa and southern Arabia. Mephedrone has been reported to have a high potential for overdose.

MDVP is structurally related to methylenedioxymethamphetamine (MDMA) and cathinone derivatives. MDMA is a schedule I hallucinogenic substance and cathinone derivatives (cathinone, methcathinone) are listed as schedule I stimulants. Animals studies have demonstrated elevated levels of extracellular dopamine 60 minutes after administration of MDVP.3

Are bath salts illegal in the U.S.?

The US Drug Enforcement Agency (DEA) announced emergency scheduling in 2011 to control MDPV, mephedrone and methylone, all chemicals found in bath salts. In 2012, U.S. President Barack Obama signed into law a ban on mephedrone, methylone and MDVP by placing them on the Schedule I controlled substances list.

Schedule I controlled substances cannot be sold under any circumstances and cannot be prescribed for medical purposes. The law also bans any future designer chemical compounds meant to mimic the effects of bath salts. Having possession or selling these chemicals or any product that contains them is illegal in the US.1,12

How do people use bath salts?

Users usually snort the drug up the nose, but it can also been injected, smoked, swallowed or used rectally. Toxic doses for the newer synthetic cathinones such as bath salts have not yet been determined9, and doses can be variable due to the illegal nature of the drug. There is a great risk for overdose because retail packages may contain up to 500 milligrams. If ingested orally, absorption is rapid with a peak "rush" at 1.5 hours, the effect lasting 3 to 4 hours, then a hard "crash". The total experience may last upwards of 8 hours or longer.1 Snorting and injecting the drug can be especially hazardous.

What are the effects of bath salts?

Bath salts are noted for producing a "high" similar to methamphetamine: the sought after effects may include:

  • euphoria
  • increased wakefulness, concentration
  • elevated sex drive
  • hallucinations
  • talkativeness
  • empathy
  • a "rush".

Acute side effects may include:

  • rapid heart rate
  • chest pain
  • high blood pressure
  • hyperthermia (elevated body temperature)
  • excess sweating (diaphoresis)
  • pupil dilation (mydriasis)
  • vessel constriction
  • reduced appetite
  • muscle spasm or tremor
  • seizures.

Higher doses can lead to serious behavioral and psychiatric effects such as:

  • severe panic attacks
  • psychosis (hallucinations, delusions)
  • paranoia (extreme distrust)
  • agitation
  • confusion
  • insomnia (inability to sleep)
  • irritability
  • violent behavior.

In one series of cases, the most common signs and symptoms of toxicity were agitation (66%), tachycardia (63%), and delusions or hallucinations (40%). Sympathomimetic effects are similar to those caused by methamphetamine, ecstasy, and cocaine. 
Breakdown of skeletal muscle tissue (rhabdomyolysis) may occur, leading to kidney failure. Accidental deaths due to overdose and bath salt-related suicides have been reported.1,4,5,6,8,10

How long does the high last from bath salts?

The effects or "high" of using bath salts can last up to four to eight hours, but it may take a full two days to come down from the high according to some reports. Dangerous physical side effects, such as such as fast heart rate and high blood pressure, can be prolonged. Hallucinations and psychotic behavior can also be long-lived, even after the drug is eliminated from the body.7,9

Extent of bath salt use

The use of bath salts has been reported to be on the rise.10 In addition to use in the U.S., DEA reports of illicit MDPV use have been noted in Europe and Australia. The first reports of MDPV seizure was from Germany in 2007.3 The United Kingdom, Australia, Canada and Israel have banned the chemicals.In 2015, authorities in Florida cited the use of a new type of cathinone called "flakka" that leads to a delusional state in it's users. Prior to the federal ban, many states had enacted their own bans on at least some of the chemicals found in this these products.

Before the DEA ruling making them illegal, bath salts were noted to be easily accessible in convenience stores, gas stations, over the Internet and in "head" or smoke shops. Packaged in powder form in small plastic or foil packages of 200 to 500 milligrams, they sold for roughly $20. Most packages were labeled "not for human consumption". The powder appears white, off-white or slightly yellow.4,7,10

Overdose with bath salts

The pharmacological activity of MDPV, and related chemicals may result in serious and potentially fatal adverse effects. MDPV inhibits the norepinephrine-dopamine reuptake system (involving neurotransmitters in the brain) and leads to central nervous system stimulation.1,4

Care of patients with an overdose and acute psychomotor agitation may require admission to the intensive care unit, use of intravenous sedatives such as benzodiazepines, antipsychotics, and/or restraints, or other measures to protect the patient and health care providers from harm. Hydration, cardiac care and electrolyte abnormalities such as hyponatremia should be addressed. Rhabdomyolysis (the destruction of muscle fibers and the release of myoglobin, a protein, into the bloodstream that may lead to kidney damage) may occur, as well.1,5 Supportive and symptomatic care is given in overdose cases as there is no known antidote.8,9

Are bath salts addictive?

Bath salts have been reported to have a powerful addictive potential, as well as the ability to induce tolerance (more of the drug is required over time to get an equivalent "high"). Reports note intense cravings similar to what methamphetamine users experience.2

Withdrawal symptoms can include:

  • depression
  • anxiety
  • tremors
  • problems sleeping
  • paranoia

As these agents bought on the street or online may be cut with other unknown and potentially addictive substances, the true magnitude of toxicity and addiction may be even higher. Routine urine and blood drug screens do not usually test for bath salt psychoactive ingredients; however, tests are available to screen for synthetic cathinones. 1,9,11

There are no FDA-approved medicines for synthetic cathinone addiction, such as with bath salts. Treatment for addiction to bath salts may involve a combination of cognitive-behavioral therapy and motivational incentives.7

Related:

See Also

Sources

  1. Ross EA, Watson M, Goldberger B, et al."Bath Salts" Intoxication. N Engl J Med 2011; 365:967-968. http://www.nejm.org/doi/full/10.1056/NEJMc1107097. Accessed online 9/18/2018
  2. National Institute on Drug Abuse (NIDA). Nora D. Volkow, MD. Message from the Director on "Bath Salts" - Emerging and Dangerous Products. Accessed 9/18/2018.
  3. DEA Fact Sheet. Bath Salts of Designer Cathinones (Synthetic Stimulants). https://www.dea.gov/factsheets/bath-salts Accessed 9/18/2018.
  4. Emergency Department Visits After Use of a Drug Sold as "Bath Salts" - Michigan, November 13, 2010-March 31, 2011. MMWR Morb Mortal Wkly Rep 2011;60:624-27. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a6.htm. Accessed 9/18/2018
  5. United States Drug Enforcement Administration. Methylenedioxypyrovalerone (MDPV). https://www.deadiversion.usdoj.gov/drug_chem_info/mdpv.pdf. Accessed 9/24/2011
  6. ABC News. Lee Ferran. DEA Announces Emergency Ban on Bath Salts. http://abcnews.go.com/Blotter/bath-salts-dea-announces-emergency-ban/story?id=14467134. Accessed 9/18/2018
  7. National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. Synthetic Cathinones ("Bath Salts"). Accessed 9/18/2018 at https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts
  8. Houser E. High on bath salts: what to know. Clinical Advisor. Accessed 9/18/2018 at https://www.clinicaladvisor.com/commentary/high-on-bath-salts-what-to-know/article/216899/
  9. Arnold TC. Ryan ML, Traub S, et al. Acute amphetamine and synthetic cathinone ("bath salt") intoxication. Up to Date. August 2018. Accessed 9/18/2018 at https://www.uptodate.com/contents/acute-amphetamine-and-synthetic-cathinone-bath-salt-intoxication#H350266331
  10. German CL, Fleckenstein AE, Hanson GR. Bath salts and synthetic cathinones: An emerging designer drug phenomenon. Life sciences. 2014;97(1):2-8. Accessed 9/18/2018 at doi:10.1016/j.lfs.2013.07.023.
  11. Narcochek. Identification test: Synthetic Cathinone. Accessed 9/18/2018 at https://www.narcocheck.com/en/identification-tests-for-drugs-of-abuse/identification-id-test-mephedrone-mdpv-methylone-cathinones-bath-salts.html.
  12. U.S. Department of Justice. Drug Enforcement Administration (DEA). Background, Data and Analysis of Synthetic Cathinones: Mephedrone (4-MMC), Methylone (MDMC) and 3,4-Methylenedioxypyrovalerone (MDPV). August 2011. Accessed 9/18/2018 at https://www.deadiversion.usdoj.gov/fed_regs/rules/2011/HHS%20PDF/background.pdf#search=United%20States%20Drug%20Enforcement%20Administration.%20Methylenedioxypyrovalerone%20%28MDPV%2029

Further information

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