Bath Salts: What the EMS Provider Needs to Know

EMS providers must be prepared to protect the patient and themselves.


   There has been increasing law enforcement and media interest in a new product that is currently unregulated, but is causing significant medical issues for emergency providers. With this new group of drugs hitting the streets across the United States, there is a high level of alarm with law enforcement, poison control centers, lawmakers and physicians alike.

   The drugs, referred to as "bath salts," were never intended for the tub, and you won't find them at Bath and Body Works. These salts, with names like "Ivory Wave," "White Lightning" and "Vanilla Sky," seem harmless, though they are anything but, having been blamed for up to four deaths in the U.S. Unbelievably, this product is legally available and can be easily purchased at convenience stores, head shops and online for about $20-$40 per gram. It is sold as a powder in sealed envelopes and can be purchased by consumers of any age. There are no limitations on quantity and no need to register the purchases.

   In Louisiana, after the state poison center received more than 125 calls in the last three months of 2010 involving exposure to the chemicals, they alerted the appropriate authorities. In response, the state legislature issued a Declaration of Emergency and enacted a temporary order on January 6, 2011, banning the sale of bath salts and placing these toxic chemicals on the state's Controlled Dangerous Substances list. In addition to Louisiana, lawmakers in Texas, Mississippi, North Carolina and Kentucky are considering proposals to ban the sale of the powder. The DEA has weighed in recently, calling them a "drug of concern."

BATH SALTS: THE SCIENCE

   So what is this new drug? What are the active chemicals in it, and what effects do they have on the human body? How should you manage the patient who has ingested a bath salt?

   Bath salts contain the active ingredients methylenedioxypyrovalerone (MDPV) and mephedrone. MDPV is a synthetic psychoactive drug with stimulant properties that have been likened to ecstasy. Mephedrone is a synthetic stimulant with amphetamine-like or cocaine-like effects. These molecules are very similar to amphetamines, cocaine and other stimulants. The substances have been described as a white or off-white powder that can be smoked, snorted, injected, or wrapped in pieces of paper and ingested (bombed). Both are considered analogs of illegal substances that are prohibited by the Federal Analog Act, a section of the United States Controlled Substances Act. However, since this act only applies to drugs sold for human consumption, they can be sold legally in products labeled as "bath salts." The appearance is similar to cocaine and other illicit substances, so law enforcement may or may not be able to do field testing to identify them.

EFFECTS ON HUMANS

   The drugs have profound effects on the central nervous and cardiovascular systems, similar to other stimulants. To date, complications have been reported at three levels. With small quantities, users report feelings of euphoria, increased alertness and awareness, diminished need for food and sleep, and overall feeling of well-being.

   At higher doses, the substances can cause hallucinations, anxiety, agitation, paranoia and erratic behavior. In one case that was well-publicized in the national media, an abuser used his skinning knife to slice his face and stomach repeatedly. Effects on the cardiovascular system include tachycardia and hypertension, increasing the risk of stroke and acute myocardial infarction. Increased activity and metabolism common with use of the drugs can lead to renal failure secondary to rhabdomyolysis and hyperthermia. Rhabdomyolysis is the breakdown of muscle fibers that results in the release of myoglobin into the bloodstream, which damages kidneys and can result in renal failure.

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