Drug abuse with synthetic substances is not a new phenomenon, but it is interesting and can be challenging to health care providers. Patterns of abuse and the types of drugs being abused changes over time. There has been a dramatic increase in the use of synthetic drugs, including bath salts, which has poison control centers and emergency departments around the country on alert. In addition, the use of “Molly” has made its way to Missouri. “Molly”?! What’s that?! But first, let us discuss bath salts.
What are bath salts?
These are not the bath salts that you use in your tub. The bath salts are synthetic cathinones, which work in the same areas of the brain as methamphetamine. Methylenedioxypyrovalerone (MDPV) and methylone are two examples of synthetic cathinones that have been found in bath salts. Some of the newer bath salts have fluorinated cathinone substitutes that are very potent and may have prolonged action. How they work is not entirely clear, but it is believed that they increase the release AND reuptake of norepinephrine, dopamine and serotonin in the brain. Because of this, they create a stimulant effect and euphoria.
The packaged products are often sold as Bliss, Blizzard, Blue Silk, Charge+, Hurricane Charlie, Ivory Snow, Ivory Wave, Ocean Burst, Pure Ivory, Purple Wave, Red Dove, Star Dust, Vanilla Sky, White Dove, White Knight, White Rush, and White Lightening. The synthetic cathinones have been marketed as plant food/fertilizer, insect repellant, pond cleaner and vacuum fresheners. They come in powder, crystal and liquid forms. They are marketed less frequently as capsules or tablets. Abusers typically ingest, inhale, inject, smoke, or snort the synthetic cathinone products. When first introduced to the market several years ago, these products were easily purchased at gas stations, convenience stores and head shops. The DEA and law enforcement continue to work to extinguish this emerging trend of drug manufacturing and sale. Federal legislation and laws in Missouri have banned the legal sale of these substances including sales on the Internet, but newer synthetic variations may still allow traffickers the ability to stay ahead of law enforcement until it is shown that the new chemical produces effects similar to the known banned substances. So, for now we suspect that other variations of these chemicals can still be purchased on the Internet and on the illicit drug market.
The synthetic cathinones in bath salts can produce euphoria, increased sociability, and sex drive. However, too much of the drugs can cause very alarming symptoms, including extreme violent tendencies, paranoia, hallucinations, delusions, seizures, increased blood pressure, tachycardia, hyperthermia, nausea, vomiting, chest pain, and panic attacks. Deaths have been reported in several instances. The dangers of bath salts are compounded by the fact that these products may contain other unknown ingredients that have their own harmful effects.
How long do the effects of bath salts last?
The onset of effect is within 5 to 45 minutes. The duration of effect can be several hours. There have been reports of users experiencing effects from 2 to 48 hours, if not longer.
Are bath salts detected on drug screens?
Most routine drug testing screens do not detect the presence of synthetic cathinones. It is speculated that abusers are likely attracted to these drugs because they can evade positive results on most drug screens.
Treatment
The mainstay of treatment of a patient who has used bath salts is supportive care. Benzodiazepines can be used for seizures and agitation. Cardiac monitoring with EKG is recommended. Intravenous hydration is important, especially if the patient develops an elevated CK due to extreme (and potentially prolonged agitation). Control of hyperthermia is also critical as hyperthermia is a marker of severe toxicity and should be treated rapidly and aggressively to avoid complications. Monitor core temperature continuously. Cooling measures such as water spray mist and the use of fans to encourage evaporation, ice packs and other methods may be lifesaving. For more specific treatment information, please contact the Missouri Poison Center.
“Have you seen Molly?”
(Madonna at Miami’s Ultra Music Festival, March 2013)
“Molly”, slang for “molecular”, is the pure, crystalline form of the club drug, MDMA. In pill form, MDMA is known as ecstasy. Molly, usually purchased in capsules, has seen a surge interest in the past few years. It is celebrated frequently by popular music artists. In any form, MDMA produces energy and a euphoric high. It can also dangerously affect body temperature, cause confusion, depression, and sleep disturbances. In the December 2012 issue of Journal of Neurological Sciences, the authors reported on 3 healthy young patients who had intracranial hemorrhage of varying degrees after use of Molly. Angiography did not reveal any underlying aneurysms, arteriovenous malformations, or evidence of vasculitis.
Users often seek Molly to avoid the “adulterants” or substances that are commonly found in ecstasy pills. Some of the adulterants in ecstasy include caffeine and methamphetamine. Unfortunately, those who purchase Molly (or the “pure MDMA”) may be exposing themselves to the same risks. Hundreds of Molly capsules tested in two South Florida crime labs in 2012, for example, contained dangerous stimulants found in bath salts. Molly was linked to three deaths at Miami’s Ultra Music Festival in March, and it was ultimately found to contain methylone.
The bottom line with these synthetic drugs is that they are very powerful illegal drugs that have not been tested for safety. Users do not really know exactly what chemicals they are putting into their bodies. Treatment is limited to symptomatic and supportive care.
For more specific information on these synthetic drugs and treatment, please contact the Missouri Poison Center at 1-800-222-1222 or health care professionals can call 1-888-268-4195.
