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An Alarming New Stimulant, Legal in Many States
nytimes.com 
Dr. Jeffrey J. Narmi could not believe what he was seeing this spring in the emergency room at Schuylkill Medical Center in Pottsville, Pa.: people arriving so agitated, violent and psychotic that a small army of medical workers was needed to hold them down.
They had taken new stimulant drugs that people are calling “bath salts,” and sometimes even large doses of sedatives failed to quiet them.
“There were some who were admitted overnight for treatment and subsequently admitted to the psych floor upstairs,” Dr. Narmi said. “These people were completely disconnected from reality and in a very bad place.”
Similar reports are emerging from hospitals around the country, as doctors scramble to figure out the best treatment for people high on bath salts. The drugs started turning up regularly in the United States last year and have proliferated in recent months, alarming doctors, who say they have unusually dangerous and long-lasting effects.
Though they come in powder and crystal form like traditional bath salts — hence their name — they differ in one crucial way: they are used as recreational drugs. People typically snort, inject or smoke them.
Poison control centers around the country received 3,470 calls about bath salts from January through June, according to the American Association of Poison Control Centers, up from 303 in all of 2010.
“Some of these folks aren’t right for a long time,” said Karen E. Simone, director of the Northern New England Poison Center. “If you gave me a list of drugs that I wouldn’t want to touch, this would be at the top.”
At least 28 states have banned bath salts, which are typically sold for $25 to $50 per 50-milligram packet at convenience stores and head shops under names like Aura, Ivory Wave, Loco-Motion and Vanilla Sky. Most of the bans are in the South and the Midwest, where the drugs have grown quickly in popularity. But states like Maine, New Jersey and New York have also outlawed them after seeing evidence that their use was spreading.
The cases are jarring and similar to those involving PCP in the 1970s. Some of the recent incidents include a man in Indiana who climbed a roadside flagpole and jumped into traffic, a man in Pennsylvania who broke into a monastery and stabbed a priest, and a woman in West Virginia who scratched herself “to pieces” over several days because she thought there was something under her skin.
“She looked like she had been dragged through a briar bush for several miles,” said Dr. Owen M. Lander, an emergency room doctor at Ruby Memorial Hospital in Morgantown, W.Va.
Bath salts contain manmade chemicals like mephedrone and methylenedioxypyrovalerone, or MDPV, also known as substituted cathinones. Both drugs are related to khat, an organic stimulant found in Arab and East African countries that is illegal in the United States.
They are similar to so-called synthetic marijuana, which has also caused a surge in medical emergencies and been banned in a number of states. In March, the Drug Enforcement Administration used emergency powers to temporarily ban five chemicals used in synthetic marijuana, which is sold in the same types of shops as bath salts.
Shortly afterward, Senator Bob Casey, Democrat of Pennsylvania, asked the agency to enact a similar ban on the chemicals in bath salts. It has not done so, although Gary Boggs, a special agent at D.E.A. headquarters in Washington, said the agency had started looking into whether to make MDPV and mephedrone controlled Schedule I drugs like heroin and ecstasy.
Mr. Casey said in a recent interview that he was frustrated by the lack of a temporary ban. “There has to be some authority that is not being exercised,” he said. “I’m not fully convinced they can’t take action in a way that’s commensurate with the action taken at the state level.”
Senator Charles E. Schumer, Democrat of New York, introduced federal legislation in February to classify bath salts as controlled Schedule I substances, but it remains in committee. Meanwhile, the drugs remain widely available on the Internet, and experts say the state bans can be thwarted by chemists who need change only one molecule in salts to make them legal again.
And while some states with bans have seen fewer episodes involving bath salts, others where they remain fully legal, like Arizona, are starting to see a surge of cases.
Dr. Frank LoVecchio, an emergency room doctor at Banner Good Samaritan Medical Center in Phoenix, said he had to administer general anesthesia in recent weeks to bath salt users so agitated that they did not respond to large doses of sedatives.
Dr. Justin Strittmatter, an emergency room doctor at the Gulf Coast Medical Center in Panama City, Fla., said he had treated one man whose temperature had shot up to 107.5 degrees after snorting bath salts. “You could fry an egg on his forehead,” Dr. Strittmatter said.
Other doctors described dangerously elevated blood pressure and heart rates and people so agitated that their muscles started to break down, releasing chemicals that led to kidney failure.
Mark Ryan, the director of the Louisiana Poison Center, said some doctors had turned to powerful antipsychotics to calm users after sedatives failed. “If you take the worst attributes of meth, coke, PCP, LSD and ecstasy and put them together,” he said, “that’s what we’re seeing sometimes.”
Dr. Ryan added, “Some people who used it back in November or December, their family members say they’re still experiencing noticeable paranoid tendencies that they did not have prior.”
Before hitting this country, bath salts swept Britain, which banned them in April 2010. Experts say much of the supply is coming from China and India, where chemical manufacturers have less government oversight.
They are labeled “not for human consumption,” which helps them skirt the federal Analog Act, under which any substance “substantially similar” to a banned drug is deemed illegal if it is intended for consumption.
Last month, the drug agency made its first arrests involving bath salts under the Analog Act through a special task force in New York. Undercover agents bought bath salts from stores in Manhattan and Brooklyn, where clerks discussed how to ingest them and boasted that they would not show up on a drug test.
“We were sending out a message that if you’re going to sell these bath salts, it’s a violation and we will be looking at you,” said John P. Gilbride, special agent in charge of the New York field division of the D.E.A.
The authorities in Alton, Ill., are looking at the Analog Act as they prepare to file criminal charges in the death of a woman who overdosed on bath salts bought at a liquor store in April.
“We think we can prove that these folks were selling it across the counter for the purposes of humans getting high,” said Chief David Hayes of the Alton police.
Chief Hayes and other law enforcement officials said they had been shocked by how quickly bath salts turned into a major problem. “I have never seen a drug that took off as fast as this one,” Chief Hayes said. Others said some people on the drugs could not be subdued with pepper spray or even Tasers.
Chief Joseph H. Murton of the Pottsville police said the number of bath salt cases had dropped significantly since the city banned the drugs last month. But before the ban, he said, the episodes were overwhelming the police and two local hospitals.
“We had two instances in particular where they were acting out in a very violent manner and they were Tasered and it had no effect,” he said. “One was only a small female, but it took four officers to hold her down, along with two orderlies. That’s how out of control she was.” |
