By Michael Craig Miller M.D.
Harvard Medical School
Parents are rightfully asking questions about a relatively new group of drugs called "bath salts." These are potent stimulants that are nothing like the Epsom salts people may put in a hot bath to relieve aches and pains.
Anyone with a teenager should understand what bath salts are. The good news is that teens seem to be aware that these are dangerous substances: Use of bath salts is trending down, not up.
What Are Bath Salts?
Bath salts come in powder form. People can take them by mouth. But often they snort or inject them, which is associated with greater risk.
Bath salts are designed by drug suppliers and users specifically to get around laws that govern controlled or illegal drugs.
The active chemicals in these salts — mephedrone, pyrovalerone or MDPV (methylenedioxypyrovalerone) — are stimulants. They are chemically different from drugs such as amphetamine, cocaine or ecstasy, yet have similar effects on the brain. They are thus likely to be highly addictive.
People have been able to buy bath salts at "head shops" where drug paraphernalia is sold, at some convenience stores and gas stations, and on the Internet. The products go by names such as White Rush, Cloud Nine, Ivory Wave, Ocean Snow, Charge Plus, White Lightning, Scarface, Hurricane Charlie, Red Dove, Blue Silk, Zoom, Bloom and Sextasy. The category even has alternative names, such as "plant food," "pond cleaner" and "insect repellent." Internet sellers label their products as "not intended for human consumption" to avoid prosecution.
Bath salts came to the attention of public health researchers and officials around 2010. The drugs quickly became a worrisome fad among both young and middle-aged people. For example, the U.S. Centers for Disease Control and Prevention reported a dramatic increase in use of bath salts from 2010 to 2011. In 2010, U.S. poison control centers logged 302 calls about bath salts. By 2011, they logged 6,136 calls. As a result, the National Institute on Drug Abuse began to survey bath-salt use in 2012.
Fortunately, a growing number of teens seem to be aware that these are risky drugs.
- The number of calls to poison centers regarding bath salts decreased in 2012.
- In 2013, almost 60% of 8th, 10th and 12th graders thought trying bath salts even once or twice would be harmful.
- By 2014, the use of bath salts and other synthetic drugs had begun to decline.
What Are the Risks?
Since bath salts are such a recent phenomenon, we have relatively limited information about their short- and long-term effects. But people who use these drugs do risk serious side effects — even death.
Emergency room data indicate that bath salts cause symptoms similar to those that occur with stimulant intoxication. Stimulants increase alertness, attention and energy. They also cause neurological symptoms, such as:
- Dilated pupils and involuntary muscle movements
- High blood pressure and rapid heartbeat
- Delusions, hallucinations and paranoia
As with other stimulants, people who are intoxicated with bath salts may become aggressive or violent.
Men and women appear to abuse bath salts in nearly equal numbers. Nearly 70% of users report having abused other drugs in the past. Many users also report having some type of mental disorder, such as bipolar disorder, depression or schizophrenia.
People who have a dangerous reaction to bath salts can recover — as long as they reach an emergency room as soon as possible.
Since they are relatively new substances, bath salts usually are not detected by standard drug screens in emergency rooms. Specialized labs may need to test for them. An emergency room doctor can only make the diagnosis by taking a history and observing the symptoms.
Treatment is usually the same as for stimulant intoxication — a benzodiazepine, such as lorazepam (Ativan), to counter the effects of the stimulant, along with an antipsychotic drug if necessary.
How To Stay Ahead of the Threat
Law enforcement officials at both the state and national levels have been clamping down on bath salts. But the drugs are still available through various channels. It is therefore wise to assume your teenage children or other loved ones could get them if they want.
Teenagers and young adults often discount the risks of drug use. And, especially in the heat of the moment, if they are offered a drug, it may be very difficult to resist the invitation to join the party. So it's worth getting information to them about the dangers of bath salts. Given the more recent decline in bath salt use, maybe they are finding safer ways to have fun.
You can find more information on the NIDA for Teens website, a project of the National Institute on Drug Abuse and the National Institutes of Health.
Michael Craig Miller, M.D., is the former editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 30 years