Bath Salts and New Drugs

Bath Salts and
the New Addictions
Laurence P. Karper, MD

Disclosures

• I am a full time employed physician at Lehigh
Valley Health Network
• I have received no funds from pharmaceutical
companies within the last year

Objectives
• Understanding the Rise of the New Drug Epidemic
• Characteristics of the “Bath Salt” Epidemic
Implications for diagnosis and treatment
Future directions and concerns

The Seventies:
Back to the Future?

Naturally Psychoactive
Hindu Soma

Tarahumara Peyote

Israelite Wine

Mayan Tobacco

Early Anglo-Saxon Medu

Andean Coca Leaf

Eastern Africa Khat

Khat (Qat)

African shrub which, when chewed, has a stimulant effect. Khat contains
the alkloid called cathinone, an amphetamine-like stimulant, which is said
to cause excitement, loss of appetite and euphoria.

Canned Heat Blues
(1928, Memphis)

Cryin' mama, mama, mama
Cryin' canned heat is killin' me
Canned heat don't kill me
Cryin', babe I never would die
I woked up a-this mo'nin
With canned heat on my mind

Tommy Johnson

Designer Drug Epidemic
•Ecstasy was the rage at Raves
•K2, Spice, and Synthetic Marijuana
•The rise of “bath salts”
•Mephedrone
•Methylmethcathinone or methylephedrone
•MDPV
•Methylenedioxypyrovalerone

Podcasts and Web Sites
• http://emcrit.org/podcasts/bath-salts/
• http://www.cnsproductions.com/drugeducati
onblog/uppers/1172/
• http://monitoringthefuture.org
• http://dawninfo.samhsa.gov/

Serious Jail Time

When Neil Brown got high on bath salts, he
took his skinning knife and slit his face and
stomach repeatedly. Brown survived, but
authorities say others haven't been so lucky
after snorting, injecting or smoking powders
with such innocuous-sounding names as Ivory
Snow, Red Dove and Vanilla Sky.

Sally B.
Last night I had to take my mom to the ER for a severe asthma attack, her second in two days. During the long, long night in the ER
while nurses monitored her vital signs over the space of 5 hours (before they finally decided she needed to be admitted for
observation because her breathing still wasn't very clear), twelve cases of "bath salts" overdose were brought into the ER. Twelve.
Obviously this drug has made its way into our normally fairly rural county, probably via truck stops along the highways nearby. I
found myself feeling extremely angry because the woman in the ER room next to my mom's, separated by a thin curtain, was in the
ER for the second night in a row from "bath salts" overdosing. I was actually glad to hear the nurses and the doctor on duty giving
reading this woman the riot act instead of just being nice to her. Worse still, I am willing to bet that if all 12 of these people have
medical insurance, it will probably cover their ER visits despite it being due to irresponsible drug abuse. Now, for those of us who, by
misfortune of working in taxpayer supported public sector jobs during this deep recession, find ourselves nearly uninsured due to
sharp cutbacks in our benefits, the idea of wasting taxpayer money on treating drug abusers - especially repeat ones like the woman
in the room next to my mom - seems a bit preposterous. It's stuff like this that gets my hackles up and makes me see red. "Bath
salts", indeed......June 11, 2011

Bath Salts or Designer Cathinones
•Synthetic stimulants that are marketed as “bath salts” are
often found in a number of retail products.
•The chemicals are synthetic derivatives of cathinone, a central
nervous system stimulant, which is an active chemical found
naturally in the khat plant.
•Mephedrone and MDPV (3-4 methylenedioxypyrovalerone)
are two of the designer cathinones most commonly found in
these “bath salt” products. Many of these products are sold
over the Internet, in convenience stores, and in “head shops.”
•“Bath salt” stimulant products are sold in powder form in small plastic or foil packages of 200 and 500
milligrams under various brand names. Mephedrone is a fine white, off-white, or slightly yellow-colored
powder. It can also be found in tablet and capsule form. MDPV is a fine white or off-white powder. They
typcially sell for 25 to 50 dollars.

Bath Salts: The Skinny
• Routes of
Administration
• PO
• Neurological Action:
• Insufflation
• NDRI
• IV
• Stimulant
• Rectal
• Similar to
• Vaporization
• Cocaine
• Methylphenidate
• Metabolism: Hepatic • Amphetamines
• CYP 2C19
• CYP 2D6
• CYP 1A2
• Excretion: Renal

The Face of Bath Salts

Bangor woman showed
By Meg Haskell, BDN Staff
up at police station
Last modified Oct. 09, 2011, at 6:24 p.m bail check with drugs
in her purse,
authorities say

NEJM Sept 8 2011
First Article to
Cover Bath
Salts in a
Professional
Journal

Medical Marijuana?
January 13, 2010|By Veronica Torrejon OF THE MORNING CALL
Dr. Laurence Karper, vice chairman of the Department of Psychiatry at Lehigh Valley
Health Network, would welcome more money for addiction services. But legalizing
medical marijuana is not something Karper necessarily favors.
Karper found himself answering many questions on the topic of medical marijuana as
the bill in New Jersey gathered speed.
As a physician who works with the addicted, Karper is concerned that the drug is
untested, its benefits unproved, and that it could lead to addiction. But as a
humanitarian, Karper isn't so sure.
"I think I'm of two minds," he said. "Should we waste resources putting medically ill
people in jail when that's the only thing that helps them? To me that would seem to be
a waste of resources."
From a medical perspective, he said marijuana is a potentially dangerous drug that can
cause acute paranoia, anxiety and other problems. Without rigorous scientific testing
and approval by the U.S. Food and Drug Administration, marijuana as a medical therapy
is risky, Karper said.
"People shouldn't kid themselves that this is something that is nontoxic and has no
problems because it's natural," he said. "Arsenic is natural. Many things that are natural
are also toxic."
As with anything else, he said, a healthy dose of caution is recommended.
"Some people say it makes them feel better," he said. "However, that has to be
balanced against the possible side effects."

Cocaine Use: Perceptions
“Used no more than two or three times a week,
cocaine creates no serious problems. In daily
and fairly large amounts, it can produce
minor psychological disturbances. Chronic
cocaine abuse usually does not appear as a
medical problem.”

Kaplan, Freedman, & Sadock, Comprehensive
Textbook of Psychiatry, 1980

Positive Perception?
• Julie Holland, M.D. author of
Ecstasy: The Complete Guide.
• A mostly positive view of MDMA
published 2001
• Psychiatrist at Bellevue Hospital
• Contributor to the Bulletin of
Multidisciplinary Association for
Psychedelic Studies
• “the book's "scientific" authorship are precisely
what makes the book dangerous in that it seems
to promote drug abuse as safe, although when
read closely the data does not appear to
support this conclusion so clearly. Perhaps the
jury is still out on long-term adverse effects of
MDMA. When the drug in question has potential
to alter and damage neural structures of today's
youth, perhaps a more cautious approach is in
order. A great read, but the authors'
presupposition of the drug's safety appears
unfounded, even given information cited.”

Vital Statistics

• Drug Overdoses Now Kill More Americans
Than Traffic Accidents
• The quantity of prescription painkillers sold to
pharmacies, hospitals, and doctors’ offices
was 4 times larger in 2010 than in 1999
• Prescription painkiller overdoses killed nearly
15,000 people in the US in 2008. This is more
than 3 times the 4,000 people killed by these
drugs in 1999.

Summary
•Addiction is common and part of our ancestry
so why not provide effective evidence-based
treatment?
•“Bath Salts” are the latest in a long series of
addictive substances that are cheap and widely
available and very dangerous
•The seeds for the next epidemic are within us
and the fruit will be poisonous

Bath Salts and New Drugs

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