Because many of my patients have been asking about bath salts, I thought it would be useful to start a series discussing issues concerning these, and other, designer drugs.

“Bath Salts,” not to be confused with scented crystals used in bathing, form a group of synthetic drugs which are all based around compounds called cathinones.  These cathinones (synthetic) were derived from naturally occurring cathinones found in the ‘khat’ plant, common in the countries of Lebanon and Yemen.  In those countries, khat leaves are often chewed to release a mild stimulant effect (although these leaves have been noted to produce cardiac problems similar to that of cocaine).

In an abused fashion, bath salts are most commonly snorted or ingested.  They initially produce effects of increased energy and euphoria similar to that of methamphetamines, phencyclidine (PCP), or ecstasy.  The adverse effects of bath salts include paranoia and psychosis with possibilities for kidney failure and cardiac arrest.  Extreme emergency room cases have been reported in which patients become violent and significantly impaired, endangering their own safety and that of hospital staff and police.

As these substances are quite new, they are not specifically characterized under the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).  The University of Colorado classifies these drugs as ‘other’ for research purposes.  A recent NPR story discussed the regulatory dilemma we currently face concerning bath salts.  Efforts to ban these substances have been slowed by the constantly evolving laboratory makeup of bath salts.  We also do not yet know if these drugs produce reinforcing effects similar to other drugs of abuse, as the adverse and impairing effects seem so prominent.

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