Bath Salt Addiction
Addiction treatment centers across the nation are starting to see patients turning up with familiar addictive behaviors related to a new legal drug on the market that is being sold as bath salts. The Designer Drug, sold as bath salts are sold with names like Charge, Ivory Wave, White Knight and Sky Vanilla and all have labels stating they are not intended for human consumption. But it appears they are actually produced for exactly that, human consumption, with the “bath salts” description clearly being a sham and a clever, but insidious way to get around substance abuse laws.
The problem is that the laws do not cover many of the new substances showing up in mini-marts and gas stations around the country. Last year, many states scrambled to address a lack of laws on synthetic marijuana that people were smoking to get high. Lawmakers in several states moved quickly to ban the fake pot and now there are even more new variations of harder drugs showing up. The bath salts are sold in $20 packets about the size of a tea bag, available in corner stores, truck stops and on the Internet, which is clearly not enough “salt” for a real “bath” but evidently contains plenty of the potent, but unrestricted drug mephedrone, which is a stimulant and produces a high similar to cocaine or methamphetamine. This is supported by the finding that the most common ‘wrap size’ of mephedrone found in police seizures in the United Kingdom is close to 750 mg, enough for several succcessive doses. Because the packets come with the disclaimer, "not for human consumption" they are not subject to regulation even though they can contain a potpourri of dangerous chemicals. Bath salts are also sold in plastic containers in malls and convenience stores are not for use in a bathtub at all. Drug abusers smoke, inject, or snort the powdery substance inside. They are even mixed with water as a beverage. In a NJ study 48% are of age 20-29, mostly male. The substance has been implicated in a number of deaths of young people.
Exponential Growth in use
The problem is growing exponentially and there were 248 bath salts-linked 911 calls nationwide from at least 25 states in just the first two months of 2011. Poison centers nationwide report that in the first three months of 2011 they already had taken four times the number of calls on bath salts that they took all of last year (234 calls during the whole of 2010). Emergency room physicians are seeing an explosion of patients with severe and life-threatening toxic psychotic effects. The extreme psychotic hallucinations have caused people to slash themselves with knives, or barricade themselves in rooms waiting to “kill unseen monsters.”, another user vowed to remove their own liver with a mechanical pencil. ABC News reported bath salt drugs were found in the blood of a man who recently killed a sheriff's deputy in Tippah County, Mississippi.
Synthetic cathinones are related to the parent compound cathinone (Figure 1), one of the psychoactive principals in khat (found in the leaves of the shrub Catha edulis Forsk). Cathinone derivatives are the β-keto (βk) analogues of a corresponding phenethylamine. The group includes several substances that have been used as active pharmaceutical ingredients (API) of medicinal products, e.g. amfepramone (diethylpropion; Figure 2). Since the mid-2000s, unregulated ring-substituted cathinone derivatives have appeared in the European recreational drugs market. The most commonly available cathinones sold on the recreational market in the period up to 2010 appear to be mephedrone (Figure 3) and methylone (Figure 4). These products are usually encountered as highly pure white or brown powders. Ring-substituted cathinone derivatives are claimed to have effects similar to those of cocaine, amphetamine or MDMA (ecstasy), but little is known of their detailed pharmacology. Apart from cathinone (Figure 1), methcathinone (Figure 5) and two API’s amfepramone (Figure 2) and pyrovalerone, cathinone derivatives are not under international control. It appears that cathinone derivatives show similar sympathomimetic effects to amphetamine derivatives.
Mephedrone is a derivative substance similar to amphetamines and the stimulant side effects are about the same as physicians see with large does of amphetamines. User reports on Internet sites suggest that a typical dose of mephedrone is 100–250 mg. The resulting ‘high’ of mephedrone is short-lived. Consequently, users may consume several doses in succession, up to 1 g in a session. This causes increased heart rate and blood pressure, not sleeping, not eating and paranoia. Some experts have likened the bath salts to a combination of the worst effects of several different drugs, complete with hallucinogenic-delusional type properties, along with extreme agitation, superhuman strength and combativeness, as well as the hyper-addictive properties of cocaine and methamphetamine. The patient will be tachycardic, with rates up to 130, flushed sking, dilated pupils, and some even foam at the mouth. The drug is said to cause hallucinations, often visual, and suicidal thoughts. Some state they are coming out of their skin. Paranoia, and extreme anxiety is commonly found. The patient will feel like they cannot stop moving. In overdoses, the bath salts can cause extreme psychosis and have already been linked to many emergency hospitalizations as well as several suicides. Myalgia, from muscle breakdown and the associated pain has also been found. loss of appetite, anxiety, irritability, insomnia, hallucinations and panic attacks are common in even "lighter" presentations. Increasing alertness, talkativeness and feelings of empathy are noted. Other findings include Hypertension, tachypnea, chest pain, dyspnea, mania, and hyperthermia. Severe nosebleeds have been reported after snorting it. The most common clinical features reported by health professionals with mephedrone exposure were those typical for a sympathomimetic agent including tachycardia, palpitations, agitation, anxiety, mydriasis, tremor, fever or sweating and hypertension.
A quote from an internet site asking for help:
"last nite a buddy and i tryed some of the vanilla sky 500mg bath salts for the first time not thinking it was gonna really do anything we both used to do meth 6 years ago so not first timers but i did prob a half gram of this or less lastnite from 9pm to1am ive now missed work today with still no sleep i need to work tomorrow what can i do to make this shit go away please help "
Medical Treatment Acutely
The normal medical treatment for drug overdoses doesn’t seem to work in the case of bath salts. Patients experiencing acute toxic psychosis from a “normal” cocaine or methamphetamine overdose will respond to sedatives and gradually clam down after treatment. Bath salt overdoes cases do not seem to respond to normal sedatives like valium, at times even when administered in high doses. Some have the need to be sedated, intubated and placed on a respirator. Doctors have been dismayed to learn that when bath salt psychosis patients come off of the sedatives or antipsychotic medications, they simply revert back to the psychotic state and become uncontrollable again. In one case a patient was sedated for 12 days and the psychosis came right back as soon as the sedatives were stopped. More than half are admitted to the hospital.
Longer Term Effects
The effects of bath salts could be permanent because no one has ever studied the drug before. The effects of mephedrone have never been tested on humans and even though it bears a basic chemical similarity to some existing drug compounds, small changes in chemical composition can produce extremely different side effects. However, the worst and most frightening aspect of bath salts may be their extreme addictive property. When people take their first dose of bath salts, they instantly feel compelled to keep re-administering the drug. Despite the fact that the drug experience itself can be so hideously unpleasant, the drug creates such intense cravings that users often go back right to the drug as soon as they get out of the emergency room. Bath salts are so irresistibly addictive that many users seek professional help after only one month of abuse. The first toxicologically confirmed fatal case directly linked to mephedrone use was recorded in Sweden in 2008. Chronic abusers are at risk of developing personality disorders and of sustaining myocardial infarction. A study on mice showed a dose dependent course to sterility. significant weight loss is known.
Bath salts are highly addictive. Some say that they are even more addictive than heroin. Users have said the high is so addictive that they cannot stop doing it, regardless of the consequences and that they don’t want to be sober anymore, they just want to go out and get more because they can't live without it. The scariest thing is that no one really knows yet what the long-term ramifications of bath salt drugs will be. No one knows what damage the drug is doing to the brain, or how long the damage might last. It could easily turn out to be permanent.
State laws banning bath salts are difficult to enforce and researchers are still trying to determine the drug's composition to learn how to treat it. Users can be charged with public intoxication, but that’s about it since the salts are technically not illegal. Hospital and psychiatric workers confirm the use of the salts is spreading and if the problem is not addressed quickly, it could become an epidemic even greater than the scourge of meth. The FDA is looking at the problems but it may take years for schedule level enactment.
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