01-31-11 Are bath salts for more than bathing?

Question of the Week
January 31, 2011
Are bath salts for more than bathing?
Apparently so.  Recently there has been much media attention about packets labeled as “ bath salts” which are sold in convenience stores.  Although the packets include the warning “not for human consumption”, they are actually designed for insufflation (snorting).  The packets reportedly contain drugs such as ephedrone (methcathinone), mephedrone (4-methylmethcathinone), or MDPV (3,4-methylenedioxyprovalerone).  Ephedrone (also known as “Bathtub speed” “Gaggers” “Cadillac Express”) and mephedrone are synthetic cathinone derivatives which are chemically similar to a psychoactive stimulant in the khat plant. They probably cause the release of dopamine, norepimephrine, and serotonin. MDPV, also known as “Magic” or Super Coke”, is a designer drug sold as a stimulant for recreational use.  All three of these drugs are powerful stimulants.  The bath powders are sold as “Ivory Wave”  “Charge Plus” “White Lightning” “Scarface” etc.  You get the picture.
Clinically, one would expect to see stimulant effects from these drugs.  What have been reported is strong psychoactive effects such as hallucinations and paranoia. As a result, there have been reports of violent behavior and suicides. 
There is nothing unique about treatment of patients with this exposure.  Assessment and treatment of complications from stimulants (hyperthermia, rhabdomyolysis, hepatic and renal failure, etc.) is warranted although supportive care will be the mainstay.  None of these drugs will be found on a routine urine drug screen.  
This question prepared by: Donna Seger, MD  Medical Toxicologist

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