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Bath Salts < Back

By Joshua Edgar

History

The term “bath salt” is used to describe a class of synthetic drugs that are chemically related to the naturally occurring substance cathinone. Cathinone is a mild stimulant found in the khat shrub (Catha edulis) that is native to the Horn of Africa and the southern end of the Arabian Peninsula. Although naturally occurring cathinone has been used for generations, abuse of the synthetic cathinones mephedrone and methylone started in Europe in the mid-2000s. The United States government started investigating synthetic cathinones in 2010 once the American Association of Poison Control Centers (AAPCC) issued a warning on the rise of their use. In 2010, the AAPCC reported 302 calls related to bath salt use, this number increased to 2,237 calls in 2011. The most commonly abused synthetic cathinone in the United States is 3,4-methylenedioxypyrovalerone (MDPV). MDPV was banned in all 50 states when it was labeled as a Schedule I drug in May 2011. Due to the Federal Analog Act of 1986 (FAA), all chemically similar drugs meant for human use were also classified as Schedule I drugs, with the exception of legal pharmaceuticals like bupropion. Although loopholes in the law exist, the AAPCC reports that calls related to bath-salts have been in decline since 2011.



How It’s Used

Bath salts are white or brown crystals that can be ingested, smoked, snorted (insufflated), or injected to produce an effect. These compounds are not in any way related to Epsom salts, a common household product sold under the same name and used to enhance the experience of bathing. These compounds can typically be differentiated by the quantity in which they are sold (synthetic cathinones are sold in small packets), by the store that is selling them, and by their names (synthetic cathinones are often given evocative names like “Cloud Nine” or “Purple Wave”). Due to legal restrictions, distributers have started lacing plant matter with novel synthetic cathinones and labeling the packages “not for human consumption” to subvert the FAA’s clause that regulates drugs being sold intentionally for human use.


How It Works

Synthetic cathinones produce effects that are similar to those of amphetamines. These molecules affect the actions of monoamine transporters in the nervous system, allowing a buildup of dopamine, norepinephrine and serotonin in the spaces between neurons known as the synaptic cleft. Normally, the transporters reduce monoamines concentrations outside the neuron by shuttling the chemicals inward. The synthetic cathinone MDPV blocks this transporter, preventing it from reducing monoamine concentrations outside of the cell. On the other hand, mephedrone and methylone cause the transporters to act in reverse, allowing monoamines to rush out of the neuron. This causes an overall excitatory response in the nervous system and contributes to addiction. In-vivo microdialysis studies in rats reveal that synthetic cathinones cause an increase in extracellular dopamine in the brain’s reward pathway. The physiological effects of bath salts can include; nose bleeds, hyperthermia, sweating, nausea, dehydration, breakdown of skeletal muscles (rhabdomyolysis), and kidney failure. Psychological effects of bath salt use include; paranoia, hallucinations, increased sexual drive, panic attacks, and excited delirium.

Treatment

At this moment, there are no medications given Food and Drug Administration (FDA) approval for the treatment of bath salt addiction. The National Institute on Drug Abuse reports that cognitive-behavioral therapy, motivational incentives, motivational enhancement, and behavioral treatments geared to teens can possibly help those struggling with bath salt abuse. Cognitive behavioral therapy attempts to help individuals understand how their thoughts, feelings and behaviors interact to produce maladaptive responses to different stimuli. Motivational incentives and motivational enhancement both try to increase patient’s engagement during treatment either by rewarding them or via talk therapy, respectively. Attempts to target teenagers are used since 0.8-0.9% of teens from 8th to 12th grades have used bath salts within the last year in 2016.


References

NIDA. (2016, January 6). Synthetic Cathinones ("Bath Salts"). Retrieved from https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts on 2017, May 3.

EMCDDA. (2015, January 8). Synthetic cathinones drug profile. Retrieved from http://www.emcdda.europa.eu/publications/drug-profiles/synthetic-cathinones on 2017 on 2017, May 3.

United States. Department of Justice. National Drug Intelligence Center. (2011, July). Synthetic Cathinones (Bath Salts): An Emerging Domestic Threat. Retrieved from https://www.justice.gov/archive/ndic/pubs44/44571/44571p.pdf on 2017, May 3.

Baumann MH. Awash in a sea of “bath salts”: implications for biomedical research and public health. Addiction (Abingdon, England). 2014;109(10):1577-1579. doi:10.1111/add.12601.

Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2017). Monitoring the Future national survey results on drug use, 1975-2016: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan, 113 pp.