DEA Moves to Make 'Bath Salts' Illegal as Overdoses Rise

Fran Lowry

Disclosures

September 07, 2011

September 7, 2011 ( UPDATED September 8, 2011 ) — In the wake of a growing number of overdose visits to emergency departments, the US Drug Enforcement Administration (DEA) has moved to make psychoactive "bath salts" (PABS) a controlled substance.

In a statement released today, the DEA announced it is using its emergency scheduling authority to temporarily control methylenedioxypyrovalerone and 2 other synthetic stimulants: mephedrone and methylone.

As of September 7, 2011, possessing and selling these chemicals or the products that contain them are both illegal in the United States for at least 1 year while the DEA and the US Department of Health and Human Services mull over whether the substances should be permanently controlled.

"This imminent action by the DEA demonstrates that there is no tolerance for those who manufacture, distribute, or sell these drugs anywhere in the country, and that those who do will be shut down, arrested, and prosecuted to the fullest extent of the law," DEA Administrator Michele M. Leonhart, said in a statement. "DEA has made it clear we will not hesitate to use our emergency scheduling authority to control these dangerous chemicals that pose a significant and growing threat to our nation."

In the last 6 months, the DEA has received increasing reports from poison centers, hospitals, and police involving one or more of the now-controlled substances.

Increasing Emergency Visits Related to Overdose

People who overdose on the bath salts are showing up in emergency departments with increasing frequency, concerned clinicians Edward A. Ross, MD, Mary Watson, MD, and Bruce Goldberger, PhD, from the University of Florida College of Medicine, Gainesville, write in a letter to the editor, that appears in the September 8 issue of the New England Journal of Medicine.

"Despite growing efforts to ban these products through legislation, [PABS] often skirt substance-control laws and are readily available at low cost," the authors write.

Until now easily obtained over the Internet, these bath salts, which have nothing to do with any hygiene product, go by such names as Ivory Wave and Vanilla Sky.

The main ingredient in PABS is methylenedioxypyrovalerone, which is structurally related to pyrovalerone and a-pyrrolidinophenone compounds that inhibit norepinephrine-dopamine reuptake and act as central nervous system stimulants.

Touted for giving a high similar to that of methamphetamine, PABS are also known as alertness enhancers or aphrodisiacs and are sometimes called "legal cocaine."

PABS are taken orally, intranasally, intravenously, or rectally, and doses as low as 3 to 5 mg will produce an effect. The average dose ranges from 5 to 20 mg, and the risk for overdose is high because packages can contain up to 500 mg. Taken orally, the bath salts are rapidly absorbed and produce a rush that peaks at 1.5 hours after ingestion and lasts for 3 to 4 hours.

The physical effects of PABS include tachycardia, hypertension, arrhythmias, hyperthermia, seizures, stroke, myocardial infarction, and even death. Behavioral and mental effects include panic attacks, anxiety, paranoia, hallucinations, psychosis, aggressive or violent behavior (such as self-mutilation, suicide attempts, and homicidal activity), insomnia, anorexia, and depression.

The consequences of a PABS overdose can be particularly nasty, and clinicians need to be aware of several issues, the authors warn.

Individuals who are experiencing symptoms of PABS overdose need to be cared for and monitored in the intensive care unit. In addition, routine drug screens are unable to detect bath salts. Bath salts also can be cut with other psychoactive substances, which can further confuse the clinical presentation, the authors write.

Overdose victims may also require physical restraints and high doses of sedatives to prevent harming themselves or others.

Treatment involves intravenous benzodiazepines to control seizures or for sedation and intravenous fluids for suspected rhabdomyolysis.

Disclosures for the authors are available at http://www.nejm.org .

N Engl J Med. 2011;365:967-968. Abstract

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