Jaime Hastings, JD
August 16, 2012
There is a new “designer drug” that threatens the health of anyone using it. It goes by the harmless-sounding name of “bath salts.” Known by a variety of street names such as Bliss, Blue Silk and Vanilla Sky, these bath salts are not intended for use in the bath. They have no use other than to get high.
Psychoactive bath salts (PABS), like all psychoactive drugs, affect the brain, perception, and mood. They are central nervous system stimulants that can lead to serious, sometimes permanent or fatal reactions in users. There are many different types of bath salts, containing a wide variety of chemicals .
First appearing in the United States around 2010, PABS fast have become a widespread and alarming drug fad, especially among teenagers and young adults. PABS are easily available on the internet, as well as convenience stores and “head shops” . They come in small foil packets containing anywhere from 200 to 500 milligrams, or even more, and the dosage is not listed on the packaging . The packages are labeled with the warning “not intended for human consumption,” even though they have no purpose beyond recreational drug use . Online sellers may call them “bath salts” or they may use even more vague terms such as research chemicals, incense, herbs, plant food or “party powders” in an effort to evade state and federal legal control .
How are “Bath Salts” Used and What Will They Do to My Health?
As a new drug, most of what is known comes from clinical reports from physicians and anecdotal reports from users, and the reports are frightening . For example, the authors of a September 2011 article in The New England Journal of Medicine described PABS as “possessing the worst characteristics of lysergic acid diethylamide (LSD), phencyclidine (PCP, or “angel dust”), methylenedioxymethamphetamine (“ecstasy”), cocaine and methamphetamines” .
PABS usually are ingested by sniffing or snorting, but they also can be taken orally or put into a solution and injected intravenously . Although users can feel the effects of PABS from doses as low as 3-5 mg, the risk of overdose is extremely high because packages usually contain doses well above 200 mg . PABS are absorbed quickly by the body, and the extreme effects last at least 3 to 4 hours. As the effects wear off, the user begins to experience a very intense withdrawal similar to withdrawal from methamphetamines. Symptoms include fatigue, insomnia, irritability, an inability to concentrate, anxiety, seizures and psychotic behaviors [3, 5]. People who have taken PABS may show up at the hospital or doctor’s office with withdrawal symptoms so severe that physicians have to use physical restraints and extremely high doses of sedatives to control seizures and keep medical staff and the PABS user from getting hurt . PABS is addictive, and people who take them crave more after they come down, needing larger and larger doses over time to avoid the significant withdrawal symptoms and achieve the same high. They are often taken together with other drugs, such as GHB (gamma hydroxybutryic acid, a commonly-used date-rape drug), marijuana, opiates, benzodiazepines (such as Klonopin and Ativan), cocaine, methamphetamines, and ketamine . Mixing these drugs can be even more dangerous, possibly resulting in overdose and death.
Some of the physical effects include: (1) rapid heartbeat; (2) high blood pressure; (3) heart irregularities (arrhythmia); (4) hyperthermia (elevated body temperature); (5) sweating; (6) muscle tremors, spasms and seizures; (7) stroke; (8) heart attack and (9) death . PABS have been compared to cocaine, but PABS seem to trigger violent behavior rather than producing a sense of well-being or euphoria. After taking PABS, a person is likely to experience one or more of these symptoms: (1) panic attacks; (2) anxiety; (3) agitation; (4) paranoia; (5) hallucinations; (6) psychosis; (7) aggressive, violent, homicidal and/or self-destructive behavior; (8) self-mutilation; (9) anorexia and (10) suicidal ideation . These physical and behavioral effects are severe and in some cases may be permanent.
With those kinds of common effects, why does anyone take PABS? When first taking PABS, users have described an immediate “rush” similar to methamphetamines. A 2011 study published in Clinical Toxicology found that a large number of PABS users at hospital emergency rooms reported previous abuse of cocaine or methamphetamines and had tried PABS as a “legal” replacement for illegal drugs.  Despite the unpleasant effects, PABS users often develop intense cravings that keeps them on PABS to avoid “the most unpleasant drug withdrawal . . . ever experienced” rather than to achieve any kind of high .
The information available demonstrates the initial attraction of PABS and the reason for their continued use PABS are cheap, available and don’t show up in drug tests. Because the chemicals in PABS change frequently, current drug tests cannot detect PABS in users . The inability to test a person for PABS makes it difficult for doctors to determine if the patient is suffering from a mental health problem or a drug reaction. Not knowing the cause of symptoms or what chemicals exactly are in a person’s body also makes it hard for the doctor to treat the patient appropriately.
In 2010, the American Association of Poison Control Centers reported that its centers had received only 304 calls about PABS; by 2011, the number of PABS-related calls had skyrocketed to 6,138 . It is hoped that use will decrease in 2012 because of all the bad publicity.
What is the Legal Status of PABS?
State and federal authorities in the United States are taking steps to ban these hazardous drugs. The Comprehensive Crime Control Act of 1984 allows the Drug Enforcement Administration (DEA) to temporarily “schedule,” (classify a substance as having no legitimate medical use) any abused, harmful, non-medical substance such as PABS in order to avoid an imminent threat to public safety . On October 21, 2011, the DEA exercised its emergency authority to make it illegal to possess or sell three of the known main components of PABS: MDVP (Mephedrone, 3, 4 methylenedioxypyrovalerone), and Methylone. . In July 2012, President Obama signed into law the Synthetic Drug Abuse Act of 2012 as part of the Food and Drug Administration Safety and Innovation Act []. The federal law added 31 chemicals used in PABS to its schedule of banned drugs under the Controlled Substances Act . However, this federal law leaves states free to also craft their own policies regarding PABS and the chemicals contained in these drugs. To date, at least 42 states have enacted legislation to ban at least some of the chemicals found in PABS .
PABS pose a serious danger to anyone who takes them. Their effects are extremely unpredictable because the chemicals used in them vary from one seller or place to another. If you or someone you know are using PABS, seek medical help immediately. PABS users can display unpredictable and violent behaviors, so take precautions for your safety and the safety of others when attempting to seek help. Talk to your doctor about how to stop taking PABS and how to avoid cravings and severe and unpleasant withdrawal symptoms.
For Further Information on PABS and Other Synthetic Drugs
American Association of Poison Control Centers. Available at: http://www.aapcc.org/dnn/PoisoningPrevention/SyntheticDrugs.aspx
National Institute on Drug Abuse. Available at: http://www.drugabuse.gov/drugs-abuse/emerging-drugs.
United States Drug Enforcement Administration. Available at: http://www.justice.gov/dea/images_bath-salts.html and http://www.pdfdownload.org/pdf2html/view_online.php?url=http%3A%2F%2Fwww.justice.gov%2Fdea%2Fpubs%2Fabuse%2Fdrug_data_sheets%2FBath_Salts.pdf
White House, Office of National Drug Control Policy. Available at: http://www.whitehouse.gov/ondcp/ondcp-fact-sheets/synthetic-drugs-k2-spice-bath-salts.
1. Volkow, N.D. ‘Bath Salts’ – Emerging and Dangerous Products. National Institute on Drug Abuse. February 2011. Available at: http://www.drugabuse.gov/about-nida/directors-page/messages-director/2011/02/bath-salts-emerging-dangerous-products. Accessed July 26, 2012.
2. Drug Enforcement Administration. Drug Fact Sheet: Bath Salts or Designer Cathinones (Synthetic Stimulants). Available at: http://www.justice.gov/dea/pubs/abuse/drug_data_sheets/Bath_Salts.pdf. Accessed July 20, 2012.
3. Winder, G.S., Stern, N., Hosanager, A. (2012). Are ‘Bath Salts’ the Next Generation of Stimulant Abuse? Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2012.02.003, 1-4.
4. Hadlock, G. C., Webb, K. M., McFadden, L. M., Chu, P. W., Ellis, J. D., Allen, S. C., Andrenyak, D. M., et al. (2011). 4-Methylmethcathinone (Mephedrone): Neuropharmacological Effects of a Designer Stimulant of Abuse. Journal of Pharmacology and Experimental Therapeutics, 339(2), 530 -536.
5. Ross, E.A., Watson, M., Goldberger, B. (2011). “Bath Salts” Intoxication. The New England Journal of Medicine, (365): 967-968.
 Henry A. Spiller, Mark L. Ryan, Robert G. Weston, Joanne Jansen. Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States. Clinical Toxicology. 2011;49:499-505.
7. American Association of Poison Control Centers. Bath Salts Data: Updated July 6, 2012. Available at: http://www.pdfdownload.org/pdf2html/view_online.php?url=http%3A%2F%2Fwww.aapcc.org%2Fdnn%2FPortals%2F0%2FBath%20Salts%20Data%20for%20Website%207.06.2012.pdf. Accessed July 31, 2012.
8. Drug Enforcement Administration. Chemicals Used in “Bath Salts” Now Under Federal Control and Regulation. October 21, 2011. Available at: http://www.justice.gov/dea/pubs/pressrel/pr102111.html. Accessed July 31, 2012.
9. American Association of Poison Control Centers. AAPCC Issues Statement on the Synthetic Drug Abuse Prevention Act. July 11, 2011. Available at: http://www.pdfdownload.org/pdf2html/view_online.php?url=http%3A%2F%2Fwww.aapcc.org%2Fdnn%2FPortals%2F0%2FStatement%2520on%2520Signing%2520of%2520Synthetic%2520Drug%2520Act%25207.2012.pdf. Accessed July 31, 2012.
10. S. 1387: Food and Drug Administration Safety and Innovation Act, Title IX, Subpart D (2012). Available at: http://www.govtrack.us/congress/bills/112/s3187/text. Accessed July 31, 2012.
11. National Conference of State Legislators. Substituted Cathinones (a.k.a. “Bath Salts”) Enactments. July 11, 2012. Available at: http://www.ncsl.org/issues-research/justice/substituted-cathinones-enactments.aspx. Accessed July 31, 2012.