Why 'bath salts' are dangerous, though not illegal in all states.
By Matt McMillen
Reviewed by Laura J. Martin, MD
"Ivory Wave," "Purple Wave," Vanilla Sky," and "Bliss" -- all are among the many street names of a so-called designer drug known as "bath salts," which has sparked thousands of calls to poison centers across the U.S. over the last year.
Citing an "imminent threat to public safety," the U.S. Drug Enforcement Administration (DEA) made illegal the possession and sale of three of the chemicals commonly used to make bath salts -- the synthetic stimulants mephedrone, MDPV, and methylone. The ban, issued in October 2011, is effective for at least a year. During that time, the agency will decide whether a permanent ban is warranted.
WebMD talked about bath salts and other designer drugs with Zane Horowitz, MD, an emergency room physician and medical director of the Oregon Poison Center.
First of all, what are bath salts?
"The presumption is that most bath salts are MDPV, or methylenedioxypyrovalerone, although newer pyrovalerone derivatives are being made by illegal street chemists. Nobody really knows, because there is no way to test for these substances," Horowitz says.
Why are they called bath salts?
"It's confusing. Is this what we put in our bathtubs, like Epsom salts? No. But by marketing them as bath salts and labeling them 'not for human consumption,' they have been able to avoid them being specifically enumerated as illegal," Horowitz says.
What do you experience when you take bath salts?
"Agitation, paranoia, hallucinations, chest pain, suicidality. It's a very scary stimulant that is out there. We get high blood pressure and increased pulse, but there's something more, something different that's causing these other extreme effects. But right now, there's no test to pick up this drug. The only way we know if someone has taken them is if they tell you they have.
The clinical presentation is similar to mephedrone [a chemical found in other designer drugs], with agitation, psychosis, and stimulatory effects. Both of these agents should be of concern, as severe agitated behavior, like an amphetamine overdose, has occurred.
A second concern is the ongoing suicidality in these patients, even after the stimulatory effects of the drugs have worn off. At least for MDPV, there have been a few highly publicized suicides a few days after their use," Horowitz says.
Are bath salts illegal?
"You can find them in mini-marts and smoke shops sold as Ivory Wave, Bolivian Bath, and other names," Horowitz says. "The people who make these things have skirted the laws that make these types of things illegal. While several states have banned the sale of bath salts, ultimately it will have to be a federal law that labels these as a schedule 1 drug, which means it has no medicinal value but a high potential for abuse, and declare them illegal."
Are bath salts addictive? How are they taken?
"We don't know if they are addictive. We have not had enough long-term experience with it. Acute toxicity is the main problem. But many stimulants do cause a craving. The people who take them are very creative. They snort it, shoot it, mix it with food and drink," Horowitz says.
In October 2011, the DEA used its authority to place several of the chemicals used to produce bath salts under their control, and it's likely that they will permanently illegalize the possession and sale of these chemicals and products that contain them. What impact will that have?
"Pretty much all of these chemicals will end up permanently banned," Horowitz says. "But it's easy to say, 'We've banned them.' It's something else to police them and make them go away. Cocaine, heroin, [and] marijuana are illegal, but they are all still out there. Designer drugs like bath salts never really go away. How people make them and how they sell them are the only things that change. People will abuse them until there's a crisis that brings attention to them, then they will disappear and a new drug will come along to fill the void."
Bath salts are the latest example of designer drugs. Where do you see this trend going?
"That's right. They are part of a long line of other pills and substances that we call designer drugs. And drug makers will keep creating new combinations at home and in illicit labs," Horowitz says. "It's almost impossible to keep up. And the motivation for buying them is always the same: Drugs like these are new and below the radar, unlike named illegal drugs."
Zane Horowitz, MD, emergency medicine specialist and medical director, Oregon Poison Center, Oregon Health & Science University.
News release, U.S. Drug Enforcement Administration.
American Association of Poison Control Centers: "Bath Salts Data."
Reviewed on March 23, 2012
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