The media has been abuzz in recent weeks about “bath salts” — but they’re not writing headlines about the scented crystals used for bathing or Epsom salts. Bath salts are the latest designer street drug to raise alarm bells across Europe and the United States. Marketed falsely under benign-sounding names that also include “research chemicals” or “plant food,” these substances are part of a dangerous new class of drugs called synthetic cathinones.

Synthetic cathinones are structurally and pharmacologically similar to methamphetamine, Ecstasy, and LSD, which are also considered designer drugs — that is, manufactured versions of controlled substances. Synthetic cathinones pose serious health risks and danger to the public. Side effects include chest pains, increased blood pressure, increased heart rate, agitation, hallucinations, extreme paranoia, and delusions. They are addictive and have been linked to deaths. A number of incidents of bizarre behavior have fueled recent media stories.

But what makes them particularly dangerous is their ease of access — bath salts are available legally via the internet or in drug paraphernalia stores. That’s because the so-called “chemists” who produce them make constant, minor alternations to the drugs’ chemical make-up, dodging Drug Enforcement Administration (DEA) Schedule 1 classification on a technicality — and leading many to claim the drugs provide a “legal high.” Further fueling their popularity, the outlets that sell bath salts often promise that urine drug screens will not detect their presence. Not so…

Ameritox, a uring drug testing company, announced recently the launch of a test for bath salts that not only detects three common synthetic cathinones that the DEA has categorized as controlled substances, but also tests for five other chemical components used commonly in bath salts products.

The battle to keep up with the latest formulations of these designer drugs is truly a game of “cat and mouse.” The DEA placed three specific synthetic cathinones into its Schedule 1 category of controlled substances in October 2011, citing the move as “necessary to avoid imminent hazard to the public safety” due to high abuse potential and lack of medical use.

But there are likely dozens of synthetic cathinones on the street today.

The public safety solution requires effort at multiple levels — with physicians, scientists, communities, law enforcement, and policy makers each playing a collaborative role. As the DEA works tirelessly to categorize these substances, other players are bringing their scientific expertise to bear on the problem.

Specialty laboratories work hard to stay ahead of the game in anticipating new formulations and launching new tests to detect these dangerous substances – and joining forces with the DEA, the physicians conducting these tests, and insurance companies could make our progress even stronger:

• Physicians need to be educated to identify patients suffering from the side effects of bath salts and be able to report increased use in their community. Using techniques like urine drug testing can help.
• Insurance companies need to be encouraged to cover drug screenings, so that data about drug use trends can be provided to the DEA and physicians to help reduce their use.
• The public needs to be educated about this dangerous and unregulated category of drugs, in particular that just because drugs are sometimes legal doesn’t mean they are safe.
• The DEA needs a faster way to outlaw these drugs by class, rather than by substance.

By working together, we can help reduce the threat of “bath salts” to individual’s health and to enhance public safety.

References

Rosenbaum CD, Carreiro SP, & Babu KM (2012). Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 8 (1), 15-32 PMID: 22271566

Prosser JM, & Nelson LS (2012). The toxicology of bath salts: a review of synthetic cathinones. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 8 (1), 33-42 PMID: 22108839

U.S. Department of Justice: Drug Enforcement Agency. Federal Register / Vol. 76, No. 204 / Friday, October 21, 2011 / Rules and Regulations.

European Monitoring Centre for Drugs and Drug Addiction. EMCDDA–Europol 2011 Annual Report on the implementation of Council Decision 2005/387/JHA. April 2012.

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