A Trip on “Bath Salts” Is Cheaper Than Meth or Cocaine But Much More Dangerous
Authors: Anita Slomski
Journal: JAMA (2012)

BATH SALTS, THE PSYCHOACTIVE DEsigner street drugs that emerged in the United States in 2010, have left a trail of bizarre and alarming reports: the man who slashed himself to remove the “wires” in his body; the mother who left her “demon-ridden” 2-year-old in the middle of a highway; the 21-year-old son of a family physician who, after snorting bath salts once, shot himself following 3 days of acute paranoia and psychosis, including hallucinations of police squad cars and helicopters lined up outside his house to take him away. The fine powder in small packets doesn’t even resemble the large crystals intended for a soak in the tub. The drug merely borrows the name of an innocuous product so it can be sold openly. “Take all the bad attributes of ecstasy, PCP, LSD, cocaine, methamphetamine: lump them together, and that’s what you get with bath salts,” says Mark Ryan, PharmD, director of the Louisiana Poison Center and assistant professor of clinical emergency medicine at Louisiana State University Health Sciences Center in Shreveport. In late 2010, as Chinese suppliers began shipping the raw ingredients of illicit bath salts to the Port of New Orleans, Ryan found himself at the center of a widening outbreak of cases of intoxication from what he calls “the worst drug I’ve seen in 20 years.” By December 2010, the American Association of Poison Control Centers reported 304 cases of bath salts intoxication across the country. In 2011, poison centers fielded 6138 calls from hospital emergency departments for advice on how to treat bath salts abuse. SoldundernamessuchasWhiteLightning, Cloud 9, or Ivory Wave, bath salts represent a category of illicit drug that typically contains combinations of various synthetic cathinones, including3,4methylenedioxypyrovalerone (MDPV), mephedrone,andmethylone.Peoplewere abusing a synthetic cathinone in Russia and eastern Europe for several decades before the drug appeared in western Europe and the United Kingdom in the 2000s.Andcathinone,analkaloidderived from east Africa’s khat plant, has been chewed by people for hundreds of years for its stimulant effect. Promoted as providing a “legal high” that can escape detection in drug tests, bath salts are intended to mimic the hallucinogenic and euphoric highs of methamphetamine or cocaine. At lower doses, they’ve also been marketed as a substitute for methylphenidate (Ritalin) to sharpen mental concentration and as an aphrodisiac. Adding to the attraction is the cheap price; a 200-mg package of bath salts—which may be 3 hits—sells for as little as $15 to $20. “Bath salts are basically amphetamine derivatives and carry all the same cardiovascular risks,” which include hypertension, tachycardia, hyperthermia, diaphoresis, seizures, arrhythmias, and respiratory distress, says Louis Nelson, MD, professor of emergency medicine, New York University School of Medicine, New York City. “And they can be deadly for people with underlying cardiovascular disease.” Cases of myocardial infarction, stroke, cerebral edema, coma, cardiovascular collapse, and death have been reported in people using bath salts. The effects of the drugs also vary based on the route of administration; they can be swallowed, snorted, injected, or inserted into the rectum or vagina.