In late 2010, police blotters across the United States began reporting cases of drug-related behavior disturbingly reminiscent of the 1970s PCP craze. Users arrived in emergency rooms agitated, violent and delusional. Some required a mob of medical workers and a slew of sedatives to bring them under control. Once treated, the worst cases were admitted to psychiatric care, having apparently suffered a psychotic break [source: Goodnough and Zezima].
Thus did a new drug, popular with club kids and ravers, announce itself to the world. Nicknamed "bath salts" after its colorful, crystalline and powdered appearance, its effects were far from soothing. Moreover, for a time, this designer drug was perfectly legal and widely available.
To give you some idea of bath salts' fearful reputation, consider this: When Miami police confronted a naked Rudy Eugene as he chewed the face of a 65-year-old homeless man, they initially assumed the 31-year-old attacker -- who bystanders described as zombielike and growling like an animal, and who required several shots to put down -- was on bath salts. In truth, the only drug in Eugene's system was marijuana [sources: CNN; Haiken; Hiaasen and Green].
The police had seen a recent uptick in drug-related attacks, including two cases of users removing their clothes. In one case, it took 15 officers to detain the suspect, who had previously shrugged off Taser fire. Both cases involved LSD mixed, it was believed, with another drug or drugs. Bath salts seemed the likely culprit, but no clear connection existed linking the substance to the incidents [sources: AP; CNN; Hiaasen and Green].
So dreadful was bath salts' reputation that it quickly became the proverbial "usual suspect" in drug cases involving psychotic episodes, hallucinations, extreme delusions, combative behavior and high pain thresholds. News reports supported the assumption: According to a New York Times article, an Indiana man on bath salts hurled himself into traffic after scaling a roadside flagpole; a man in Pennsylvania stabbed a priest after forcing his way into a monastery; and a woman in West Virginia, convinced something was under her skin, shredded her flesh with her fingernails over several days [source: Goodnough and Zezima].
What are bath salts, and what do they in fact do? With this boogeyman of drugs, it can be difficult to separate fact from fiction. In part, this is because bath salts, like other substances in the growing synthetic drug scene, exist in several formulations. They sometimes come packed with "extras" like high doses of caffeine, and manufacturers often mix them with other drugs, with unpredictable consequences [sources: AP; Hiaasen and Green; Rahman].
A Dangerous Trip: You're Soaking in It
Bath salts are a recreational designer drug, like ecstasy (MDMA, or 3,4,-methylenedioxymethamphetamine) or meth (methamphetamine, also known as speed, crystal meth or crank). They come in packets of powders or crystals, naturally colored tan or white, but manufacturers often dye them to resemble real bath salts (the colorful, candy-like appearance has prompted critics to accuse pushers of marketing to children). Most of the American supply originates in Europe and China, although local sources also cook it up in their homes, much like crystal meth [sources: CNN; Haiken; Olives et al.].
Users commonly sniff, snort or inject bath salts, or swallow them wrapped in paper "bombs," although smoking is not unheard of. Snorting and shooting appear to produce the most severe effects. People who take bath salts -- including an alarming number of kids and teens, whose brains are still developing -- report highs akin to cocaine, LSD and meth; doctors describe the negative effects as combining the worst aspects of all three [sources: DEA; Goodnough and Zezima; Harris; Volkow].
Before an emergency measure by the U.S. Drug Enforcement Administration (DEA) made the drug's key ingredients illegal in the country, users could obtain bath salts at convenience stores, gas stations or head shops, buy them at dance clubs, raves and concerts, or acquire them from street pushers for about $25-$50 per 50 milligrams. And, of course, there's still the Internet [sources: DEA; Goodnough and Zezima; Haiken; Harris; Olives et al.].
Bath salts exemplify the challenges that synthetic drugs pose to lawmakers, police officers, emergency medical technicians (EMTs) and doctors, as well as the dangers they present to users. Because they were not initially developed as pharmaceuticals, the data describing their effects or interactions with other substances is still growing. Moreover, no general test can detect every synthetic drug, but tests have emerged that can screen for some of the most common compounds found in these synthetic stimulants [sources: Ameritox, AP; Fuentes; Hiaasen and Green].
The legalities surrounding synthetic drugs are similarly complicated. A chemical substance is not "born" illegal, so there's little to prevent its possession, distribution or use until the government institutes a ban. Synthetic marijuana (aka spice), which also brought numerous health crises into emergency rooms, was legal in America until the U.S. DEA used its emergency powers to ban five of its constituent chemicals [sources: DEA; Fuentes].
There are limits, of course. Even before the United Kingdom passed an act of Parliament outlawing key components of bath salts, its authorities could still have prosecuted people for peddling, providing or promoting the substances for human use, which is against the law under the 1968 Medicines Act. To get around this, producers labeled their packages as "plant food" and "not for human consumption," a practice that continues to this day [sources: BBC; Medicines Act; Reed].
So much for better living through chemistry.
Letting the Khat Out of the Bag
Like amphetamines, cocaine, LSD and ecstasy, bath salts act as a central nervous system stimulant, providing users a kick of energy, euphoria and sexual stimulation [sources: DEA; Olives et al.]. But bath salts also pack a psychoactive punch, meaning they can alter perceptions, emotions, thought processes and behavior [sources: Haiken; Merriam-Webster; U.K. Department of Health; Walsh].
These characteristics jibe with the known effects of bath salts' primary ingredients, namely mephedrone (4-methylmethcathinone, aka meph, MCAT, drone or meow meow), MDPV (3,4 methylenedioxypyrovalerone) and methylone (3,4-methylenedioxymethcathinone), all of which are synthetic versions of cathinones, the active ingredients in khat. Khat (Catha edulis), a leafy plant native to East Africa and the Arabian Peninsula, is chewed in Somalia, Ethiopia, Yemen and elsewhere for its mildly euphoric, inhibition-freeing and appetite-suppressing effects [sources: Bossong; DEA; Fuentes; Goodnough and Zezima; Olives et al.; Reed].
Based on the molecular structure of cathinones, which resembles that of amphetamines, researchers hypothesize that they might inhibit reuptake of dopamine, norepinephrine and serotonin transporters in the brain [source: Olives et al.].
Your brain cells communicate via special chemical messengers called neurotransmitters. Studies suggest that altering the balance of neurotransmitters affects mood and brain activity. For example, selective serotonin reuptake inhibitor antidepressants, better known as SSRIs, work by slowing down the reuptake (absorption) of serotonin, leaving more of the chemical messenger hanging around between nerve endings. This improves certain kinds of communication and boosts mood [sources: Mayo Clinic; Olives et al.].
The synthetic cathinones in bath salts slow absorption of serotonin, but they also interfere with reuptake of the following:
- Dopamine, which affects your brain's reward and pleasure centers, emotions, and tendency toward addiction and sensation-seeking
- Norepinephrine, which is related to stress response
Like cocaine, meth and ecstasy, this places bath salts squarely in the sympathomimetic toxidrome, a group of drugs that mimic the sympathetic response of the nervous system -- aka the fight-or-flight response [sources: CEPCP; NAMI; Olives et al.; Psychology Today].
The bodies of bath salts users experience a smorgasbord of stress effects, including rapid heart rate, high blood pressure, chest pains, fever, sweating, nausea, vomiting, nosebleeds, tremors, seizures and muscle agitation. These can lead to muscle damage, kidney failure, heart attack, stroke and death. Meanwhile, their brains board an emotional and perceptual roller coaster of agitation, irritability, dizziness and insomnia, ticking slowly up hills of anxiety and then diving into valleys of depression. Concentration can grow difficult, and thoughts might take a turn toward suicide or extreme paranoia, fueled by delusions and, in some cases, hallucinations -- all of which can culminate in panic attacks, hostility or aggression [sources: CNN; DEA; Fuentes; Haiken; Olives et al.; Volkow].
In other words, bath salts users often get more than they bargained for, which occasionally includes an episode akin to a psychotic break. The more severe effects possibly arise from mixing bath salts with other drugs, or from users overdosing as they try to keep the one- to two-hour high going and avoid the inevitable crash. Even after a bad trip, the drug's addictive pull remains strong, and users frequently require extensive rehabilitation; they might continue to experience cravings or symptoms for months afterward [sources: Goodnough and Zezima; Haiken; Olives et al.; Volkow].
On the Web and on the street, bath salts and mephedrone are labeled with more prosaic names, such as bath powder, herbal incense or plant food. Before governments specifically banned their ingredients, these names provided a way to get around legal restrictions having to do with the sale of substances for ingestion [source: Reed].
A Brief History of Bath Salts
Synthetic cathinones were first cooked up in France in the 1920s, after which the drug slumbered in obscurity until an underground chemist rediscovered it and published the recipe on the Web. The Web site was shut down in 2004, but not before khat-like substances entered the Israeli scene as the drug hagigat. No sooner had the Israeli government banned hagigat than manufacturers tweaked the formula and began peddling it under different names [source: Even; Haiken].
For those who struggle to understand, treat and contain synthetic drugs, such alterations constitute an all-too-familiar problem: Depending on a country's regulations, a small alteration in an illicit drug's chemical formula can suffice to break the law's hold over it [sources: Hayes; Rahman].
Mephedrone, the primary active ingredient in bath salts, entered the British club drug scene in early 2010 and soon rose to a popularity on par with cocaine, ecstasy and ketamine [sources: DEA; Goodnough and Zezima; Olives]. Users, who usually snorted the fine off-white powder, described its effects as a combination of cocaine and ecstasy, saying it made them feel more alert, confident and talkative. Its mental and physical effects closely resembled those of bath salts [sources: DEA; Reed].
Bath salts entered the British and American drugs scenes in 2010; by 2011, sales were booming. Poison control centers nationwide fielded 3,470 bath salts calls from January through June of that year, more than 10 times the previous year's total [source: Goodnough and Zezima]. The nightly news soon began reporting on frightening encounters with police, and hospitals and physicians were overwhelmed by troubling cases. By July 2011, 28 states had banned bath salts.
In October 2011, the U.S. Drug Enforcement Administration exercised its emergency authority to classify mephedrone, MDPV and methylone as controlled, schedule 1 substances, thereby making it illegal to sell them or anything made of them (sidebar). That same year, bath salts were associated with nearly 23,000 visits to U.S. emergency rooms (out of 2.5 million total that dealt with drug misuse/abuse. In July 2012, U.S. President Obama signed a federal ban on several synthetic drugs, and bath salts were one of them [sources: DEA; Harris; Hayes; Olives; Rahman,; Preidt].
Will it matter? Britain's earlier ban on mephedrone appears to have done little to stem the tide, and might simply have forced users to turns to less reliable sources, such as street dealers or Internet peddlers. A survey conducted three months after the ban revealed that two-thirds of users continued using the drug [sources: Olives; Winstock].
Author's Note: How Bath Salts Work
When a new drug hits the clubs or the streets, especially one as hotly and sensationally reported as bath salts, I cannot help but be reminded of the outlandish picture "Reefer Madness"-era Hollywood painted of marijuana. Was bath salts, I wondered, an example of similarly baseless panic, or were we witnessing something truly chilling, like PCP?
It was no idle question. The popular backlash that such media campaigns often fuel can lead government agencies to overreach or overreact -- which might not sound like such a bad thing to non-drug users until they come after our coffee, cigarettes, antidepressants or cough medicine ...
Proportionality and principles aside, politically motivated bans also tend to sidestep the scientific process of determining effects and risks, as British medical journal The Lancet objected when the U.K. Parliament passed its emergency ban of mephedrone. In the case of bath salts, however, the stories rang with unnerving truth, in light of which the DEA's exercise of emergency powers seems justified.
Still, I found myself left with more questions than answers. How bad might synthetic designer drugs become? How can medical professionals deal with such extreme consequences to body and mind, and how can we control such chimeric chemistry?
- American Heritage Medical Dictionary. "Agonist." Saunders. 2007.
- AP. "Tests Find Only Marijuana In Face-Chewer's System." USA Today. June 27, 2012. (Sept. 9, 2012) http://www.usatoday.com/news/nation/story/2012-06-27/face-chewing-attack-marijuana/55874472/1
- Ameritox. "Bath Salts: Drug Testing for Synthetic Cathinones for Patients on Chronic Opioid Therapy." 2013. http://www.ameritox.com/bath-salts-drug-testing-for-synthetic-cathinones-for-patients-on-chronic-opioid-therapy/
- BBC. "Designer Drugs: Effect on Brain Chemistry 'Like Ecstasy.'" Dec. 14 2011. (Sept. 9, 2012) http://www.bbc.co.uk/news/health-16185373
- BBC. "Mephedrone Ban Comes Into Force in UK." April 16, 2010. (Sept. 9, 2012) http://news.bbc.co.uk/2/hi/uk_news/8623958.stm
- Bossong, Matthijs, J. Van Dijk and R. Niesink. "Methylone and mCPP, Two New Drugs of Abuse?" Addiction Biology. Vol. 10, no. 4. Page 321. December 2005. http://ewsd.wiv-isp.be/Publications%20on%20new%20psychoactive%20substances/Methylone/Bossong%20et%20al%202005%20proefprint%20AB.pdf
- Central East Prehospital Care Program. "Self-Study Package Summer 2008 -- Toxidromes: What's Your Poison?" (Sept. 9, 2012) http://www.cepcp.ca/main/paramedic/cme/Toxidromes%20Self%20Study%20Package.pdf
- CNN. "Security Video Shows Entire Miami 'Zombie' Attack." May 30, 2012. (Sept. 9, 2012)
- Even, Dan. "Hagigat Derivatives are Not All Fun and Games." Haaretz. Nov. 18, 2009. (Sept. 9, 2012) http://www.haaretz.com/print-edition/features/hagigat-derivatives-are-not-all-fun-and-games-1.3925
- Fuentes, Gidget. "Navy's Next Battle: Stopping 'Bath Salts'." Navy Times. June 10, 2012. (Sept. 9, 2012) http://www.navytimes.com/news/2012/06/navy-bath-salts-screening-061012/
- Goodnough, Abby and Katie Zezima. "An Alarming New Stimulant, Legal in Many States." The New York Times. July 16, 2011. (Sept. 9, 2012) http://www.nytimes.com/2011/07/17/us/17salts.html?pagewanted=all
- Haiken, Melanie. "'Bath Salts' a Deadly New Drug with a Deceptively Innocent Name." Forbes. June 4, 2012. (Sept. 9, 2012) http://www.forbes.com/sites/melaniehaiken/2012/06/04/bath-salts-a-deadly-new-drug-with-a-deceptively-innocent-name/
- Harris, Elizabeth. "D.E.A. Bans Chemicals Used in 'Bath Salts.'" New York Times. Oct. 22, 2011. (Sept. 9, 2012) http://query.nytimes.com/gst/fullpage.html?res=9405E2D91E3BF931A15753C1A9679D8B63
- Hayes, Ashely. "Miami 'Zombie Face Eating' Attack Explanation? Former Bath Salts Addict Says Drug 'Felt So Evil.'" June 4, 2012. (Sept. 9, 2012) http://www.abcactionnews.com/dpp/news/national/miami-zombie-face-eating-attack-explanation-former-bath-salts-addict-says-drug-felt-so-evil
- Hiaasen, Scott and Nadege Green. "No Bath Salts Detected: Causeway Attacker Rudy Eugene had Only Pot in His System, Medical Examiner Reports." Miami Herald. June 27, 2012. (Sept. 9, 2012) http://www.miamiherald.com/2012/06/27/2871098/mes-report-eugene-had-no-drugs.html
- Mayo Clinic. "Selective Serotonin Reuptake Inhibitors (SSRIs)." Dec. 9, 2010. (Sept. 9, 2012) http://www.mayoclinic.com/health/ssris/MH00066
- Merriam-Webster Dictionary. "Psychoactive." Merriam Webster. July 2004. (Sept. 9, 2012) http://www.merriam-webster.com/medical/psychoactive
- National Alliance on Mental Illness. "Depression: Medication." (Sept. 9, 2012) http://www.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=88724
- Olives, Travis, Benjamin Orozco and Samuel Stellpflug. "Bath Salts: The Ivory Wave of Trouble." Western Journal of Emergency Medicine. Vol. 13, no. 1. Page 58. February 2012. http://escholarship.org/uc/item/0mn1n5nj
- Pemberton, Max. "I Took Mephedrone and I Liked It." The Telegraph (UK). March 20, 2010. (Sept. 9, 2012) http://www.telegraph.co.uk/health/7481469/I-took-mephedrone-and-I-liked-it.html
- Preidt, Robert. "'Bath Salts' Led to 23,000 ER Visits in One Year." WebMD News from HealthDay. (Sept. 20, 2013) http://www.webmd.com/mental-health/news/20130917/bath-salts-drugs-led-to-23000-er-visits-in-one-year-us-report
- Psychology Today. "What is Dopamine?" (Sept. 9, 2012) http://www.psychologytoday.com/basics/dopamine
- Rahman, Rema. "Bath Salt' Drugs Called Emerging Threat in Colo." Aurora Sentinel. June 4, 2012. (Sept. 9, 2012) http://www.aurorasentinel.com/news/bath-salt-drugs-called-emerging-threat-in-colo/
- Reed, Jim. "What is Legal High Mephedrone?" BBC Newsbeat. Jan. 13, 2010. (Sept. 9, 2012) http://www.bbc.co.uk/newsbeat/10004383
- United Kingdom Department of Health. "Psychoactive Drug." (Sept. 9, 2012) http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4868774
- United Kingdom. "Medicines Act 1968." Oct. 25, 1968. (Sept. 9, 2012) http://www.legislation.gov.uk/ukpga/1968/67
- U.S. Drug Enforcement Administration. "Controlled Substance Schedules." Office of Diversion Control. http://www.deadiversion.usdoj.gov/schedules/index.html
- U.S. Drug Enforcement Administration. "DEA Moves to Emergency Control Synthetic Marijuana." Nov. 24, 2010. (Sept. 9, 2012) http://www.justice.gov/dea/pubs/pressrel/pr112410.html
- U.S. Drug Enforcement Administration. "Drug Fact Sheets: Bath Salts or Designer Cathinones (Synthetic Stimulants)." (Sept. 9, 2012) http://www.justice.gov/dea/pubs/abuse/drug_data_sheets/Bath_Salts.pdf
- U.S. Drug Enforcement Administration. "Khat." (Sept. 9, 2012) http://www.justice.gov/dea/concern/khat.html
- Volkow, Nora. "'Bath Salts' -- Emerging and Dangerous Products." National Institute on Drug Abuse. February 2011. (Sept. 9, 2012) http://www.drugabuse.gov/about-nida/directors-page/messages-director/2011/02/bath-salts-emerging-dangerous-products
- Walsh, Linda, Associate Professor of Psychology at University of Northern Iowa. "Basic Pharmacology Slides for PSYCH 3102/5102: Drugs & Individual Behavior." Aug. 7, 2012. (Sept. 9, 2012) http://www.uni.edu/walsh/pharm.pdf
- Winstock, A, L. Mitcheson and J. Marsden. "Mephedrone: Still Available and Twice the Price." Lancet. Vol. 376, no. 9752. Page 1537. Nov. 6, 2010. (Sept. 9, 2012) http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673610620211.pdf
- X-rate. "Historical Conversion Rates." (Sept. 9, 2012) http://www.x-rates.com/historical/?from=GBP&amount=10&date=2010-01-01