Bath salts (drug)
Bath salts is a term used to describe a number of designer drugs often containing substituted cathinones, which have effects similar to amphetamine and cocaine. The name derives from instances in which the drugs were being sold under the guise of being bath salts.  Their white crystals often resemble legal bathing products like epsom salts, but are chemically disparate from actual bath salts. The drug bath salts' packaging often states "not for human consumption" in an attempt to avoid the prohibition of drugs.
Synthetic cathinones such as mephedrone which are chemically similar to cathinone, naturally found in the plant Catha edulis (khat), were first synthesised in the 1920s. They remained obscure until the first decade of the 21st century, when they were rediscovered by underground chemists and began to be used in designer drugs, as the compounds were legal in many jurisdictions. In 2009 and 2010 there was a significant rise in the abuse of synthetic cathinones, initially in the United Kingdom and the rest of Europe, and subsequently in the US. Drugs marketed as "bath salts" first came to the attention of authorities in the US in 2010 after reports were made to US poison centres. In Europe, the drugs were predominantly purchased from drug dealers or from websites, but in the US they were mainly sold in small independent stores such as gas stations and head shops. Bath salts are sold in 50-milligram packets online and have their own brand names. Some of the brand names online are called "Purple Wave," "Zoom," and "Cloud Nine." In the US, this often made them easier to obtain than cigarettes and alcohol.
Hundreds of other designer drugs or "legal highs" have been reported, including artificial chemicals such as synthetic cannabis and semi-synthetic substances such as methylhexaneamine. These drugs are primarily developed to avoid being controlled by laws against illegal drugs, thus giving them the label of designer drugs.
The number of calls to poison centers concerning "bath salts" rose from 304 in 2010 to 6,138 in 2011, according to the American Association of Poison Control Centers. More than 1,000 calls had been made in 2012 by June.
Pharmacologically, bath salts usually contain a cathinone, typically methylenedioxypyrovalerone (MDPV), methylone or mephedrone; however, the chemical composition varies widely and products labeled with the same name may also contain derivatives of pyrovalerone or pipradrol. In Europe the main synthetic cathinone is mephedrone, whereas in the US MDPV is more common.
Very little is known about how bath salts interact with the brain and how they are metabolised by the body. Scientists are inclined to believe that bath salts have a powerful addictive potential and can increase users' tolerance. They are similar to amphetamines in that they cause stimulant effects by increasing the concentration of monoamines such as dopamine, serotonin, and norepinephrine in synapses. They are generally less able to cross the blood brain barrier than amphetamines due to the presence of a beta-keto group which increases the compound's polarity.
Users of bath salts have reported experiencing symptoms including headache, heart palpitations, nausea, and cold fingers. Hallucinations, paranoia, and panic attacks have also been reported, and news media have reported associations with violent behavior, heart attack, kidney failure, liver failure, suicide, an increased tolerance for pain, dehydration, and breakdown of skeletal muscle tissue.
Visual symptoms similar to those of stimulant overdoses include dilated pupils, involuntary muscle movement, rapid heartbeat and high blood pressure. Many documented users have also had a history of mental illness.
The effects of "bath salts" on a developing fetus are unknown. However, the use of cocaine and methamphetamine (which have effects similar to "bath salts") during pregnancy has been linked to an increased risk of miscarriage, premature delivery, and decreased birth weight. These newborns were also more likely to be irritable, malnourished, and suffer from sleep disturbances within the first few weeks after birth.
MDPV cannot be smelled by detection dogs and will not be found in typical urinalysis, although they can be detected in urine and hair analyses using gas chromatography-mass spectrometry. Distributors may disguise the drug as everyday substances such as fertilizer or insect repellent.
Little is known about how many people use bath salts. In the UK, mephedrone is the fourth most commonly used drug among nightclub goers after cannabis, MDMA and cocaine. Based on reports to the American Association of Poison Control Centers, use of bath salts in the US is thought to have increased significantly between 2010 and 2011. The increase in use is thought to be a result of their widespread availability and sensationalist media coverage.
Users tend to range from ages 15–55 with the average being age 28.
The drug policy of Canada is that during the fall of 2012, methylenedioxypyrovalerone (MDPV) will be categorised as a schedule I substance under the Controlled Drugs and Substances Act, placing it in the same category as heroin and cocaine. Mephedrone and methylone are already illegal in Canada.
In the United Kingdom, all substituted cathinones were made illegal in April 2010, under the Misuse of Drugs Act 1971, but other designer drugs such as naphyrone appeared soon after and some products described as legal contained illegal compounds. To avoid being controlled by the Medicines Act, designer drugs such as mephedrone have been described as "bath salts", or other misnomers such as "plant food" despite the compounds having no history of being used for these purposes.
The Federal drug policy of the United States reflects the fact that "bath salts" are illegal in at least 41 states, with pending legislation in others. Prior to the compounds being made illegal, mephedrone, methylone and MDPV had all been marketed as bath salts. Combined with labelling that they are "not for human consumption", these descriptions are an attempt to skirt the Federal Analog Act, which forbids drugs that are substantially similar to already classified drugs to be sold for human use. In July 2012, President Barack Obama signed a bill that amended the Federal drug policy of the United States to ban "bath salts". New York State banned the sale and distribution of the drug on May 23, 2011.
- DEA: Chemicals Used in "Bath Salts” Now Under Federal Control and Regulation
- "Situation Report. Synthetic Cathinones (Bath Salts): An Emerging Domestic Threat". United States Department of Justice: National Drug Intelligence Center. Retrieved 1 June 2013.
- Black, Matthew (25 June 2012). "What are 'bath salts'? A look at Canada's newest illegal drug". CBC News (Canadian Broadcasting Corporation).
- Spiller HA, Ryan ML, Weston RG, Jansen J (2011). "Clinical experience with and analytical confirmation of "bath salts" and "legal highs" (synthetic cathinones) in the United States". Clinical Toxicology 49 (6): 499–505. doi:10.3109/15563650.2011.590812. PMID 21824061.
- Coppola M, Mondola R (2012). "Synthetic cathinones: Chemistry, pharmacology and toxicology of a new class of designer drugs of abuse marketed as "bath salts" or "plant food"". Toxicology Letters 211 (2): 144–149. doi:10.1016/j.toxlet.2012.03.009. PMID 22459606.
- Morris, H. (5 April 2010). "Hamilton’s Pharmacopeia. Mephedrone: the phantom menace". Vice Magazine. Retrieved 2010-07-04.
- Dolak, Kevin. "'Bath Salts': Use of Dangerous Drug Increasing Across U.S.". ABC News: Good Morning America.
- McElrath K, O'Neill C (March 2011). "Experiences with mephedrone pre- and post-legislative controls: perceptions of safety and sources of supply". Int. J. Drug Policy 22 (2): 120–7. doi:10.1016/j.drugpo.2010.11.001. PMID 21242082.(subscription required)
- Kevin Dolak (June 5, 2012). "'Bath Salts': Use of Dangerous Drug Increasing Across U.S.". abc News. Retrieved 2012-07-22.
- Prosser JM, Nelson LS (2011). "The Toxicology of Bath Salts: A Review of Synthetic Cathinones". Journal of Medical Toxicology 8 (1): 33–42. doi:10.1007/s13181-011-0193-z. PMID 22108839.
- Ross, M.D., Edward. "“Bath Salts” Intoxication". The New England Journal of Medicine. Retrieved 20 March 2013.
- Kehr, J.; Ichinose, F.; Yoshitake, S.; Goiny, M.; Sievertsson, T.; Nyberg, F.; Yoshitake, T. (April 2011). "Mephedrone, compared to MDMA (ecstasy) and amphetamine, rapidly increases both dopamine and serotonin levels in nucleus accumbens of awake rats". British Journal of Pharmacology 164 (8): 1949–58. doi:10.1111/j.1476-5381.2011.01499.x. PMC 3246659. PMID 21615721.
- "Europol–EMCDDA Joint Report on a new psychoactive substance: 4-methylmethcathinone (mephedrone)". European Monitoring Centre for Drugs and Drug Addiction. 27 May 2010. Retrieved 2011-01-29.
- Reed, Jim (13 January 2010). "Clubbers are 'turning to new legal high mephedrone'". BBC News. Retrieved 2010-07-04.
- Dolak, Kevin (June 5, 2012). "'Bath Salts': Use of Dangerous Drug Increasing Across U.S.". ABC News. Retrieved June 28, 2012.
- "DrugFacts: Synthetic Cathinones ('Bath Salts')", on DrugAbuse.gov. National Institute on Drug Abuse, n.d. Web. 19 Mar. 2013
- Miller, Michael C. “Ask the Doctor: Bath salts—a new way to get high?”, Harvard Mental Health Letter. 2011. Retrieved 18 Aug 2012, additional text
- "'Bath salts'", Health Canada website, n.d. Web. 20 March 2013
- Winder GS, Stern N, Hosanagar A (March 2012). "Are "Bath Salts" the next generation of stimulant abuse?". J Subst Abuse Treat. doi:10.1016/j.jsat.2012.02.003. PMID 22445773.
- R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 9th edition, Biomedical Publications, Seal Beach, CA, 2011, pp. 992–993
- Rust KY, Baumgartner MR, Dally AM, Kraemer T (2012). "Prevalence of new psychoactive substances: A retrospective study in hair". Drug Testing and Analysis 4 (6): 402–408. doi:10.1002/dta.1338. PMID 22522922.
- 'Bath salts,' synthetic drugs targeted in Schneiderman lawsuits
- "BBC – Democracy Live – MPs move to ban mephedrone". BBC News. 7 April 2010. Retrieved 2010-04-08.
- "The Misuse of Drugs (Amendment) (England, Wales and Scotland) Regulations 2010 No. 1144". Office of Public Sector Information. 16 April 2010. Archived from the original on 2011-02-10. Retrieved 2010-04-08.
- "NRG-1 'legal high' drug is banned". BBC News. 12 July 2010. Retrieved 2010-08-23.
- Brandt SD, Sumnall HR, Measham F, Cole J (2010). "Second generation mephedrone. The confusing case of NRG-1". BMJ 341: c3564. doi:10.1136/bmj.c3564. PMID 20605894.
- "Consideration of the cathinones". Advisory Council on the Misuse of Drugs. 31 March 2010. p. 25. Retrieved 1 April 2010.
- "Police warning over 'bubble' drug". BBC News. 20 November 2009. Retrieved 2009-11-27.
- National Conference of State Legislatures
- Abby Goodnough and Katie Zezima (2011-07-16). "An Alarming New Stimulant, Legal in Many States". New York Times. Retrieved 2012-01-15.
- Victoria Cumbow (2011-02-06). "Synthetic form of cocaine and methamphetamine being packaged as bath salts". The Huntsville Times. Retrieved 2011-02-10.
- "Reports: Miami 'zombie' attacker may have been using 'bath salts'". CNN. May 29, 2012.
- Obama Signs Federal Ban on ‘Bath Salt’ Drugs
- "New York State Health Commissioner Bans Sale and Distribution of Dangerous Substances Marketed as Bath Salts" (Press release). New York State Department of Health. May 23, 2011. Retrieved December 26, 2012. "New York State Commissioner of Health Nirav R. Shah, M.D. today issued a Commissioner's Order to ban the sale and distribution of dangerous amphetamine-type substances marketed as "bath salts" that are sold over-the-counter and have resulted in hundreds of hospitalizations nationwide."