Bath Salts
The Drug Enforcement Administration
says it will temporarily outlaw possession and sale of three synthetic stimulants as dangerous chemicals that pose an imminent hazard to public health.
Sometimes packaged as bath salts or plant food and marketed under names such as “Purple Wave,” “Vanilla Sky” and “Bliss,”
the stimulants are especially popular among teens and young adults and are perceived as mimics of cocaine, LSD and methamphetamine.
The DEA says users have reported disorientation, extreme paranoia and violent episodes after ingesting the chemicals. They are sold on the Internet and in head shops and other retail outlets.
The ban will last at least a year, during which the government will determine whether it should permanently control the stimulants — Mephedrone, MDPV and Methylone.
An Alarming New Stimulant, Legal in Many States
By ABBY GOODNOUGH and KATIE ZEZIMA.
Dr. Jeffrey J. Narmi could not believe what he was seeing this spring in the emergency room at Schuylkill Medical Center in Pottsville, Pa.:
people arriving so agitated, violent and psychotic that a small army of medical workers was needed to hold them down.
Photo: Michael Stravato
They had taken new stimulant drugs that people are calling “bath salts,” and sometimes even large doses of sedatives failed to quiet them.
“There were some who were admitted overnight for treatment and subsequently admitted to the psych floor upstairs,” Dr. Narmi said. “These people were completely disconnected from reality and in a very bad place.”
Similar reports are emerging from hospitals around the country, as doctors scramble to figure out the best treatment for people high on bath salts. The drugs started turning up regularly in the United States last year and have proliferated in recent months, alarming doctors, who say they have unusually dangerous and long-lasting effects.
Though they come in powder and crystal form like traditional bath salts — hence their name — they differ in one crucial way: they are used as recreational drugs. People typically snort, inject or smoke them.
Poison control centers around the country received 3,470 calls about bath salts from January through June, according to the American Association of Poison Control Centers, up from 303 in all of 2010.
“Some of these folks aren’t right for a long time,” said Karen E. Simone, director of the Northern New England Poison Center. “If you gave me a list of drugs that I wouldn’t want to touch, this would be at the top.”
At least 28 states have banned bath salts, which are typically sold for $25 to $50 per 50-milligram packet at convenience stores and head shops under names like Aura, Ivory Wave, Loco-Motion and Vanilla Sky.
Most of the bans are in the South and the Midwest, where the drugs have grown quickly in popularity. But states like Maine, New Jersey and New York have also outlawed them after seeing evidence that their use was spreading.
The cases are jarring and similar to those involving PCP in the 1970s. Some of the recent incidents include a man in Indiana who climbed a roadside flagpole and jumped into traffic, a man in Pennsylvania who broke into a monastery and stabbed a priest, and a woman in West Virginia who scratched herself “to pieces” over several days because she thought there was something under her skin.
“She looked like she had been dragged through a briar bush for several miles,” said Dr. Owen M. Lander, an emergency room doctor at Ruby Memorial Hospital in Morgantown, W.Va.
Bath salts contain manmade chemicals like mephedrone and methylenedioxypyrovalerone, or MDPV, also known as substituted cathinones. Both drugs are related to khat, an organic stimulant found in Arab and East African countries that is illegal in the United States.
They are similar to so-called synthetic marijuana, which has also caused a surge in medical emergencies and been banned in a number of states. In March, the Drug Enforcement Administration used emergency powers to temporarily ban five chemicals used in synthetic marijuana, which is sold in the same types of shops as bath salts.
Shortly afterward, Senator Bob Casey, Democrat of Pennsylvania, asked the agency to enact a similar ban on the chemicals in bath salts. It has not done so, although Gary Boggs, a special agent at D.E.A. headquarters in Washington, said the agency had started looking into whether to make MDPV and mephedrone controlled Schedule I drugs like heroin and ecstasy.
Mr. Casey said in a recent interview that he was frustrated by the lack of a temporary ban. “There has to be some authority that is not being exercised,” he said. “I’m not fully convinced they can’t take action in a way that’s commensurate with the action taken at the state level.”
Senator Charles E. Schumer, Democrat of New York, introduced federal legislation in February to classify bath salts as controlled Schedule I substances, but it remains in committee. Meanwhile, the drugs remain widely available on the Internet, and experts say the state bans can be thwarted by chemists who need change only one molecule in salts to make them legal again.
And while some states with bans have seen fewer episodes involving bath salts, others where they remain fully legal, like Arizona, are starting to see a surge of cases.
Dr. Frank LoVecchio, an emergency room doctor at Banner Good Samaritan Medical Center in Phoenix, said he had to administer general anesthesia in recent weeks to bath salt users so agitated that they did not respond to large doses of sedatives.
Dr. Justin Strittmatter, an emergency room doctor at the Gulf Coast Medical Center in Panama City, Fla., said he had treated one man whose temperature had shot up to 107.5 degrees after snorting bath salts. “You could fry an egg on his forehead,” Dr. Strittmatter said.
Other doctors described dangerously elevated blood pressure and heart rates and people so agitated that their muscles started to break down, releasing chemicals that led to kidney failure.
Mark Ryan, the director of the Louisiana Poison Center, said some doctors had turned to powerful antipsychotics to calm users after sedatives failed. “If you take the worst attributes of meth, coke, PCP, LSD and ecstasy and put them together,” he said, “that’s what we’re seeing sometimes.”
Dr. Ryan added, “Some people who used it back in November or December, their family members say they’re still experiencing noticeable paranoid tendencies that they did not have prior.”
Before hitting this country, bath salts swept Britain, which banned them in April 2010. Experts say much of the supply is coming from China and India, where chemical manufacturers have less government oversight.
They are labeled “not for human consumption,” which helps them skirt the federal Analog Act, under which any substance “substantially similar” to a banned drug is deemed illegal if it is intended for consumption.
Last month, the drug agency made its first arrests involving bath salts under the Analog Act through a special task force in New York. Undercover agents bought bath salts from stores in Manhattan and Brooklyn, where clerks discussed how to ingest them and boasted that they would not show up on a drug test.
“We were sending out a message that if you’re going to sell these bath salts, it’s a violation and we will be looking at you,” said John P. Gilbride, special agent in charge of the New York field division of the D.E.A.
The authorities in Alton, Ill., are looking at the Analog Act as they prepare to file criminal charges in the death of a woman who overdosed on bath salts bought at a liquor store in April.
“We think we can prove that these folks were selling it across the counter for the purposes of humans getting high,” said Chief David Hayes of the Alton police.
Chief Hayes and other law enforcement officials said they had been shocked by how quickly bath salts turned into a major problem. “I have never seen a drug that took off as fast as this one,” Chief Hayes said. Others said some people on the drugs could not be subdued with pepper spray or even Tasers.
Chief Joseph H. Murton of the Pottsville police said the number of bath salt cases had dropped significantly since the city banned the drugs last month. But before the ban, he said, the episodes were overwhelming the police and two local hospitals.
“We had two instances in particular where they were acting out in a very violent manner and they were Tasered and it had no effect,” he said. “One was only a small female, but it took four officers to hold her down, along with two orderlies. That’s how out of control she was.”
STATE OF MARYLAND
DHMH
Maryland Department of Health and Mental Hygiene
201 W. Preston Street • Baltimore, Maryland 21201
Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor – Joshua M. Sharfstein, M.D., Secretary
‘BATH SALTS’: New Synthetic Drugs of Abuse
Background
New drugs of abuse, known generically as ‘bath salts,’ have been introduced in many parts of the country, including Maryland. These ‘bath salts’ contain multiple substances and may pose significant health risks, including death. One death in Maryland has been confirmed and there have been reports of hospitalizations following exposure to these substances.
These ‘bath salts’ are sold over the internet and in various retail locations under multiple brand names. These ‘bath salts’ are distinguished by their packaging and retail locations from the preparations which are traditionally used as bath or soaking preparations, often used as foot soaks, for topical relief or local comfort.
The most common substances identified in these products are 3,4-methylenedioxypyrovalerone (MDPV), mephedrone and derivatives of cathinone, all of which produce stimulant-like effects.
These drugs can be inhaled, ingested, smoked or injected. Users may develop cardiac and circulatory disturbances, agitation, delirium, paranoia and psychosis. There have been several cases in which users have attempted to inflict injury on themselves or others. The agitation and delirium may persist for days to weeks.
Note
Anyone experiencing symptoms or observing a person with serious symptoms following use of “bath salts” should call 911. For more information about ‘bath salts,’ contact the Maryland Poison Center at 1-800-222-1222.
Toll Free 1-877-4MD-DHMH – TTY/Maryland Relay Service 1-800-735-2258
Web Site: www.dhmh.state.md.us
What DHMH is Doing
The Department of Health and Mental Hygiene (DHMH) is taking multiple steps in response to the introduction of this new substance of abuse in the State. These steps include:
1. Requesting that all State-funded drug treatment providers assess new patients for past use of ‘bath salts.’
2. Collaborating with the Maryland Poison Control Center to provide information to emergency room clinicians regarding the signs and symptoms and treatment of ‘bath salts’ intoxication and to gather call data related to ‘bath salt’ use.
3. Enhancing the investigational and laboratory screening procedures in the Office of the Medical Examiner in order to assess cases for possible ‘bath salts’ intoxication.
4. Enlisting the assistance of the State’s local health departments to assess the availability of ‘bath salts’ for sale in local jurisdictions.
5. Seeking comment from the public as to information, data, observations, concerns and suggestions regarding ‘bath salts.’
Request for Public Comment
There are various approaches available to DHMH in response to the introduction of ‘bath salts’ in Maryland.
These alternatives range from monitoring the prevalence and impact of ‘bath salts’ up to a determination by the Secretary to add the active compounds in ‘bath salts,’ 3,4-methylenedioxypyrovalerone (“MDPV”) and 4-methylmethcathinone (“mephedrone”), to the list of controlled dangerous substances on Schedule 1.
Such a determination, pursuant to section 5-202(b) of the Criminal Law Article of the Maryland Annotated Code, would render the possession, manufacture, distribution and sale of these drugs unlawful.
In determining a course of action with regard to ‘bath salts’ in Maryland,’ DHMH is requesting public comment on various aspects of the use and impact of ‘bath salts.’
To assist DHMH in making this determination, DHMH is seeking input from the public on the following issues:
(1) the actual or relative potential for abuse of MDPV and mephedrone;
(2) if known, scientific evidence of the pharmacological effect of the MDPV and mephedrone;
(3) the state of current scientific knowledge regarding the MDPV and mephedrone
(4) the history and current pattern of abuse of MDPV and mephedrone;
(5) the scope, duration, and significance of abuse of the MDPV and mephedrone;
(6) any risk that MDPV and mephedrone pose to the public health;
(7) the ability of MDPV and mephedrone to cause psychological or physiological dependence; and
(8) whether MDPV or mephedrone is an immediate precursor of a controlled dangerous substance.
Based on the comments received as well as the information available from other public sources noted above, DHMH will determine and make public its response to the introduction of these substances into Maryland.
Please submit comments by July 11, 2011. Comments may be submitted by mail to Michele Phinney, Director, DHMH Office of Regulation and Policy Coordination, 201 W. Preston Street, Room 512, Baltimore, Md. 21201, by email to regs@dhmh.state.md.us, or by fax to 410-767-6483.
Individuals may also call 410-767-6499, TTY: 800-735-2258.