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Addiction Medicine FYI

Bath Salts

Not your average bath salts that you pour into the bathtub to soak in after a hard day to relax - these so-called bath salts are intended to be snorted, smoked or injected. "Bath salts" have hit the market and can be one or two drugs - Mephedrone or Methylenedioxypyrovalerone (MDPV). Below is a summary of each.

Methylenedioxypyrovalerone (MDPV)

MDVP is a psychoactive drug with stimulant properties. It is reported that it has four times the potency of Ritalin. It is not FDA approved and is only a controlled, scheduled drug in some states. It is also known as MDPK, Magic, Super Coke and PV.

In 2010, it was reportedly sold as a legal drug alternative and marketed in the United States as "bath salts" in gas stations and convenience stores, similar to the marketing for Spice and K2 as incense. MDPV was then going under the street names of Cloud 9, Ivory Wave, Ocean, Charge Plus, White Lightning, Scarface, Hurricane Charlie, Red Dove and White Dove.

The substance appears as a pure white to light-brown crumbly powder with a slight starchy odor. Acting like a stimulant, its acute effects include: rapid heartbeat, increase in blood pressure, sweating, euphoria, increase alertness, increased wakefulness, anxiety, agitation, and perception of a diminished requirement for food and sleep. Routes of use includes: oral consumption, insufflation, smoking, rectal administration and intravenously.

The effects have a duration of roughly three to four hours. The elevated heart rate and blood pressure can last for six to eight hours. High doses have been observed to cause intense, prolonged panic attacks in stimulant-intolerant users, and there are anecdotal reports of psychosis from sleep withdrawal and dependence at higher doses or more frequent dosing intervals.

Extended binges have caused significant withdrawal symptoms such as: depression, lethargy, headache, anxiety, lightheadedness, weakness, bruxism (teeth grinding, jaw clenching), kidney pain, abdominal pain and bloodshot eyes. The usual withdrawal can subside in four to eight hours.

Mephedrone

(From a summary of the 2010 Europol - European Monitoring Center for Drugs and Drug Addiction (EMCDDA) Joint Report on Mephedrone)

Mephedrone is the common name for 4-methylmethcathinone. Mephedrone is a psychoactive substance which is a cathinone derivative. Cathinone is a monoamine alkaloid found in the shrub Catha edulis(khat) and is chemically similar to ephedrine and some amphetamines. Cathinone derivatives are closely related to the phenethylamine family of psychostimulants. Cathinone and its analogs are considered illegal drugs in the United States.

Mephedrone is also known as MMC or 4-MMC (which is an abbreviation for 4 methyl - methcathinone), M-CAT or MMCAT.

Mephedrone hydrochloride salt is a white powder, while its free base is a yellowish liquid at ambient temperature. Mephedrone is sold as its stable, water-soluble, white or lightly colored hydrochloride salt.

Mephedrone is commercially available from chemical suppliers on the Internet where it can be purchased in bulk. The purity of mephedrone offered on the internet is very high - reportedly more than 99 percent.

Mephedrone has been identified in "ecstasy-like" tablets, but it is also sold as a "legal high" - a legal alternative to amphetamine and cocaine. On the Internet, mephedrone is advertised as a research chemical, bath salts, for botanical research, plant food, and plant feeder; often with a note indicating that it is not for human consumption in order to circumvent potential control mechanisms. There is often no indication of the presence of psychoactive substances in the list of ingredients of the marketed products. There are, however, online shops which are more explicit about the actual usage of mephedrone. Internet sites targeting recreational drug users offer mephedrone powder in retail quantities - for example - 1g, 5g, 10g up to 200g. Furthermore, it can also be bought in bulk from Asian-based chemical laboratories (China).

In March 2010, an Internet audit identified 78 online shops, of which 39 sold mephedrone in only retail quantities (less than 200 grams), while 38 sold it both in retail and bulk quantities.

There are no formal pharmacokinetic and pharmacodynamic studies on mephedrone. There are no published formal studies assessing the psychological or behavioral effects of mephedrone in humans. In addition, there are no animal studies on which to base an extrapolation of potential effects. Therefore psychological and behavioral effects related to mephedrone use are based on users reports and clinical reports of acute mephedrone toxicity. From the reported clinical effects seen in patients with mephedrone toxicity and effects reported on user discussion forums, it appears that mephedrone has similar effects to amphetamine derivatives.

The desired psychological and behavioral effects reported by users include:

  • euphoria
  • general stimulation
  • enhanced music appreciation
  • elevated mood
  • decreased hostility
  • improved mental function
  • mild sexual stimulation (reported in 60 percent of mephedrone users)

Overall, these effects are similar to those seen in other stimulant drug use (MDMA, amphetamines, cocaine).

Users report on Internet forums that desired effects are typically seen within 15 tp 45 minutes of oral ingestion. There are some reports of slower onset of action when mephedrone is taken orally on a full stomach. Following nasal insufflation, onset is reported within a few minutes and with peak effects within 30 minutes. Users report that the effects last approximately two to three hours and therefore that they may consume multiple doses during a session to prolong the duration of the desired effects. Reports from intravenous mephedrone users suggest that the high lasts approximately 10 to 15 minutes with an overall duration of desired effects of approximately 30 minutes.

Symptoms of use reported by users on Internet forums include: numbness, lack of tactile sensitivity, loss of appetite, insomnia, increased mean body temperature ("mephedrone sweat"), decrease in mean body temperature, bruxism, elevated heart rate and blood pressure, chest pain, nausea and vomiting, painful joints, discoloration of extremities/joints, abdominal pain, painful nasal drip with presence of blood, light headedness and dizziness, tremors, convulsions, headaches, cravings, nightmares, loss of concentration and memory loss, anxiety, depression, hallucinations, paranoia, fatigue and respiratory difficulties.

There are reports, particularly after intravenous use, of more severe psychological and behavioral effects. These include:

  • delusional parasitosis leading to scratching and gauging of the skin particularly of the face, neck and arms
  • Parkinson-like twitching of limbs
  • paranoia
  • suicidal ideation
  • severe insomnia

Data is available on 31 cases of acute toxicity associated with self-reported mephedrone use in London since January 2009. The most common clinical symptoms/signs on presentation were:

  • sixteen (51.6 percent) reported agitation
  • eight (25.8 percent) presented with palpitations
  • six (19.4 percent) presented with vomiting
  • three (9.7 percent) reported a self-limiting pre-hospital seizure
  • one (3.4 percent) presented with bruxism.
  • one (3.4 percent) presented with a headache.

Twenty-five (80.6 percent) patients were discharged either directly from the emergency department or the short-stay observation ward. These patients required either a period of observation prior to discharge and/or symptom control medications. Four (12.9 percent) patients required the use of benzodiazepines for the management of agitation on presentation to the hospital. Of the six patients who were admitted to hospital, four were admitted for observation/management on a general internal medicine ward and two (6.4 percent of all presentations) required admission to the intensive care unit. All patients survived to leave hospital with no long-term sequelae on discharge.

There has been only one confirmed death related solely to mephedrone. This case was in Sweden and was an 18 year old female who reported use of mephedrone and cannabis. Toxicological screening of blood and urine revealed the presence of mephedrone only (the mephedrone concentration was not reported), with no other drugs or alcohol detected.

2/2011

For more information see: Bath Salts Fact Sheet