Microsoft word - bath salts what you need to know.docx

“Bath Salts” Abuse: What You Need to Know Part I
By Sullivan Smith, MD | April 3, 2012 | 3 Comments | Filed in Addiction, Drugs& Treatment
In the first half of a two-part column, Sullivan Smith, MD, Medical Director of the Cookeville
(Tennessee) Regional Medical Center, discusses the basics of “bath salts” and “plant food,” and
what substance abuse professionals need to know about these popular synthetic drugs. Today, he
talks about the history of bath salts, what they do to people who take them and why they are
probably significantly underreported.
Bath salts and plant food, while they have been in the news lately, are nothing new. They were
originally explored in attempt to find new and better antidepressants by universities and
pharmaceutical companies as long ago as the 1920’s. For whatever reason, they were not re-
discovered until recently.
The little that we know about these drugs comes mostly from European literature, where they
have been a problem for several years before they made their way to the United States. After
becoming illegal in the European Union, clandestine labs began to surface in order to supply
them. While the manufacture of these drugs is quite different than methamphetamine, the same
precursor is used to produce these drugs—pseudoephedrine.
The first important point is that they are not any sort of bath salt nor plant food. Both of these
terms come from some of the trade names when they were originally being marketed. These
drugs are various derivatives of methcathinone, also known as khat. As a derivative of a
Schedule I drug, the federal Controlled Substances Act would then designate these drugs as
schedule I “to the extent that they are intended for human consumption.”
These synthetic drugs are sold with the labeling “Not intended for human consumption,” clearly
circumventing the Controlled Substances Act. With this labeling, drug dealers can and do call
their products whatever they choose. Marketing websites report that these drugs are legal in all
50 states. The craze to use them was in part fueled by the fact that they were legally sold over the
counter in places like convenience stores and head shops.
Because they were sold legally, many people thought that these drugs had to be safe. There are
literally dozens and dozens of names used to market them, and the list continues to grow. Some
of the common names you may have heard are: Molly’s Plant Food, Super Molly’s, Ivory Snow,
Scarface, Jamaican Me Crazy, Charlie Sheen, Sprinkles, Sprinklezz, Lucky, Purple Monkey and
a whole host of others.
The second important point is what happens when people take these drugs. They represent a
class of chemicals with common chemical central structures, and they work at the serotonin
receptors in the brain. While there are nuances in the effects of these drugs when compared to
one another, the effects are similar and comparable to those of Ecstasy early after consumption.
Internet sites report the drugs produce a very euphoric feeling which is much better than Ecstasy,
and legal. As time goes by, the effects look more and more like methamphetamine. Common
effects are euphoria, a sense of well being, a sense of empathy, teeth grinding, jerking eye
movements, profuse sweating, high blood pressure, high body temperature, fast heart rate,
anorexia, diminished thirst, paranoia, hallucinations, seizures, significant violent outbursts, self injurious behaviors and suicidal thoughts and acts. Deaths have been reported as the direct result of the abuse of these drugs. The European literature and the early experience in the United States demonstrates a clear potential for addiction. The third important point is that this problem is probably significantly underreported. Most likely, it is because these drugs do not show up on standard toxicology tests. As such, many cases are suspected to be related to these drugs, yet are never scientifically proven. In my Center, it was once unusual to see patients who had taken bath salts; it is now an easily recognized and regular event.
Part 2:
“Bath Salts” Abuse: What You Need to Know Part II
By Sullivan Smith, MD | April 6, 2012 | Leave a comment | Filed in Drugs &Healthcare
In the second half of a two-part column, Sullivan Smith, MD, Medical Director of the Cookeville
(Tennessee) Regional Medical Center, talks to health care professionals about how to treat “bath
salts” patients, and what you can do to help address the growing problem of abuse.
Because bath salts are relatively new in the United States, many health care professionals are
grappling with how to treat these acutely intoxicated patients.
There are a few basic principles. First, provide for your own safety. These patients can become
explosively violent, phenomenally strong and do not feel pain. The potential for serious bodily
injury to you or your staff is very real. Always deal with these patients in groups and in the
calmest and quietest environment possible.
Treatment consists of intravenous fluids and sedation. It will often take very large amounts of
both in order to stabilize these patients. IV fluid volumes on the order of those used to treat
sepsis are a good idea. That’s a lot of fluid, but these patients are usually significantly volume
Even more startling is the amount of sedation required to control these patients. A
benzodiazepine such as midazolam (Versed) is an excellent choice. Very large amounts are often
required, to the point that many practitioners are very uncomfortable with the doses required.
On several occasions in our Center, doses of more than 100 mg of intravenous midazolam have
been required in order to resuscitate and control these patients. This high-dose benzodiazepine
and intravenous fluid therapy not only controls the delirium, it also corrects the high body
temperatures, high blood pressures, fast heart rates and seizures. Some patients will require
chemical paralysis and mechanical ventilation because of persistent violence or in order to
protect their airway because of very high-dose sedation. All of these patients will require
admission to an intensive care unit, sometimes for several days.
This is clearly a national problem. It is growing rapidly. It is costing our health care system
significant dollars. It is killing people. These designer drugs we call bath salts and plant food are
truly a health care crisis.
Currently, there are a couple of plans to address the bath salts problem. First, there is legislation in Congress to address the rapidly growing abuse of these drugs. The House bill, HR 1254 (the Synthetic Drug Control Act of 2011, sponsored by Representative Dent of Pennsylvania), passed out of the House last month and has now moved into the Senate, where the companion bill is currently stalled in the Senate Judiciary Committee. There are also three Senate bills that have passed and are now winding their way through the House: SB 409 (the Combating Dangerous Synthetic Stimulants Act of 2011, sponsored by Senator Schumer of New York), SB 605 (the Dangerous Synthetic Drug Act of 2011, sponsored by Senator Grassley of Iowa) and SB 839 (the Combating Designer Drugs Act of 2011, sponsored by Senator Klobuchar of Minnesota). I encourage you to contact your representative and senators and tell them to support this very important legislation. Sullivan Smith, MD, FACEP, is Medical Director of the Cookeville (Tennessee) Regional Medical Center; the Medical Director of Putnam County EMS and Clay County EMS; Chairman of the Tennessee Emergency Medical Services Board and Lieutenant of the Cookeville Police Department SWAT.



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