Abused Drug ‘Bath Salts’ Mimic Methamphetamine and Cocaine, Physicians Say

   The use of “bath salts” as recreational drugs has greatly escalated in recent years. Jeremy Moad, MD, and Gary Kinasewitz, MD, of the University of Oklahoma Health Sciences Center in Oklahoma City, presented the case of a man experiencing significant agitation, paranoia, and hallucinations who also exhibited violent behavior upon his ED arrival.

   They described the man at CHEST 2011, the 77th annual meeting of the American College of Chest Physicians, in Honolulu. New novel drugs have appeared in recent years to circumvent improved routine drug screening. A class of drugs known as bath salts has emerged and has a high abuse potential but leaves no identifiable markers in routine drug screens.

    The inexpensive powdery substances with benign names can produce a high along with increased blood pressure and heart rate as well as agitation, hallucinations, extreme paranoia, and delusions. A previously healthy 21-year-old male was brought in his wife with a two-week history of agitation and paranoia. He was having visual and auditory hallucinations, as well as exhibiting violent behavior. He had poor hygiene and had been running barefoot throughout the house and yard for the previous several days. He had run into his eight-month-old’s crib, broken it, fallen through a window, and become unconscious. He regained consciousness in the ED, and was very violent and agitated, requiring heavy sedation. 

    His vitals were stable and physical exam was unremarkable. There were no track marks or signs of intravenous drug abuse. His labs, including a drug screen, were unremarkable. After an extensive work-up, the etiology of his agitation remained unknown until his wife and mother returned to the ED with a bag of a substance called "Red Dove." This was further identified to be what is known as bath salts, and his wife and mother report that he had been snorting the drug for approximately two weeks. He was kept sedated to allow time for the drug to wear off, and discharged the following day.

   According to Drs. Moad and Kinasewitz, the drugs are sold for as little as $10 in grocery stores, smoke shops, truck stops, and online, marketed as bath salts or sometimes plant food. They possess a high abuse potential and are similar to methamphetamine and cocaine. The powdery substances contain synthetic stimulants including MDPV (3,4-methylenedioxypyrovalerone) and mephedrone, neither detectable on drug screens. 

   The authors concluded that the drugs “should be considered in the differential of patients presenting to the emergency department with symptoms of methamphetamine and cocaine abuse, but with negative drug screens.”