For many of us, when we think of bath salts we think of a nice warm relaxing bath, but if you say bath salts to a teenager you might get a different response. The illegal drug “bath salts” hit the U.S. scene in 2010 after being a big hit in Europe. It’s called “bath salts” because it resembled Epsom salt, but shares no chemical properties with it.

Because it was called bath salt, it initially evaded the Food and Drug Administration, and was sold at gas stations and clubs marked “not for human consumption,” which earned it its name as the “legal high.” Bath salts are creatively packaged in containers that are colorful and attractive, and have aliases such as “plant food,” “Ivory Wave,” “Purple Wave,” “Bloom,” “Cloud Nine,” or “Vanilla Sky,” according to the National Institute on Drug Abuse.

Shortly after the drug’s debut, emergency departments were seeing several hundreds of people with amphetamine-like intoxication and “naked rages.” In 2012, when it became known that these substances were being use as illicit drugs, they were made illegal, but the problem now is there are many derivatives of this drug and their use is becoming more widespread.

Mephedrone is one of the possible active ingredients, and it is derived from the synthetic cathinone, similar to cathinone found naturally in the khat plant (Catha edulis). It stimulates the adrenergic receptors to release dopamine and norepinephrine, and block their reuptake, which makes them act like a stimulant on the nervous system. The result is agitation, hyperalertness, hypertension, tachycardia, diaphoresis, and elevated temperatures to 106˚ F. The term “naked rage” came into use because users would become overheated and angry, and would rip off their clothes as they raged.

Other synthetic canthinones being used as drugs of abuse include butylone, dimethylcathinone, ethcathinone, ethylone, 3- and 4-fluoromethcathinone, mephedrone, methedrone, methylenedioxypyrovalerone (MDPV), methylone, and pyrovalerone ( J. Med. Toxicol. 2012;8:33-42 ).

MDPV raises dopamine levels in the brain as does cocaine, but is at least 10 times as potent, according to the National Institute on Drug Abuse.

Bath salts can be administered by snorting, ingesting, smoking, or injecting. Necrotizing fasciitis has been associated with its use. Most patients present with elevated temperatures, hypertension, palpitations, and delirium. Hydration and sedation are usually required, and patients usually need to be restrained to prevent them from hurting themselves further. Psychiatric symptoms may include paranoia, hallucinations, and panic attacks. Several deaths have been reported in association with its use.

In the time since this drug was made illegal, several other designer drugs have presented, which are just modifications of the mephedrone. “Flakka” and “jewelry cleaner” are examples of the modified synthetic cathinone. They all cause amphetamine-like reactions and the risk of overdose is great.

The cost to manufacture the drug is about $8 per unit, but its retail price is $20-$40. Though it takes only 3-5 mg to be effective, packages are sold with 500 mg, making the risk for overdose even greater. It usually takes about 1.5 hours to reach peak rush and the entire experience can last 6-8 hours. There is little difference between the euphoric level and intoxication level, which is what makes the drug so dangerous.

Synthetic drugs are a great danger to all age groups, including toddlers, because of the misleading packaging. But they are especially dangerous because the ingredients vary, and overdose occurs quickly.

It is imperative that parents and teens are made aware of the dangers associated with these drugs and their street names; www.streetdrugs.org is a website designed to educate teachers, parents and students about these drugs and their dangers.

Dr. Pearce is a pediatrician in Frankfort, Ill. E-mail her at pdnews@frontlinemedcom.com .

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