Toxicology Today

Author's note: In this article we will discuss some products that are legal and sold over the counter, and others that are illegal. We will comment upon their use by drug abusers, but in no way do we intend to imply that any of the legally sold products are bad, per se or as marked.

Today’s EMS providers are encountering a new set of drugs being abused, which can cause a variety of serious side effects. Here’s a primer on what’s on the streets.

Bath Salts

An ER physician described bath salts as having “potentially lethal side effects, which include extreme agitation, increased heart rate and blood pressure, hallucinations and paranoia,” and as being “tremendously addictive.”1

Up until now, bath salts have been sold legally in smoke shops, gas stations and other businesses. These substances can be smoked, snorted or swallowed, and produce similar effects to methamphetamine and cocaine.

Arizona and Louisiana have recently joined a number of other states in making the substances illegal to manufacture, possess or sell, but they are still readily available from multiple Internet sites, and not all states, nor the federal government, have yet made them illegal. However, on Sept. 11, 2011, the U.S. Drug Enforcement Administration (DEA) invoked its “emergency scheduling authority” to control mephedrone, methylone and methylenedioxypyrovalerone (MDPV), the three most common synthetic stimulants found in bath salts. However, chemists are always inventing new versions of the same chemicals and changing the ingredients, so there is no guarantee about what is actually in these substances. The buyer, in effect, has no idea what he is putting into his body, and responding EMS providers are just as clueless. This presents a nasty dilemma for rescuers—what measures to take to control the body’s responses to the substances.²

Bath salts are sold under a delightful variety of imaginative names, such as Blizzard, Snow Leopard, Bliss, Red Dove, Blue Silk, Cloud Nine, Scarface, White Lightning, Hurricane Charlie, Vanilla Sky and White Night, among many others which can be found by Googling “bath salts.”

Synthetic Marijuana

Bath salts are not the only drugs now popular with the party set. Synthetic marijuana is also finding a wide market. Sold under names like K2 and Spice, it is available at “head shops”³ and other places catering to drug users. It is also widely available through mail order Internet outlets.

These drugs seem to have first popped up around 2000 and were made of compounds which mimicked the effects of cannabis. Two of these compounds, JWH-018 and JWH-200, were both apparently invented by a scientist with the initials JWH, who worked at a major university. Others such as CP-47, 497 and cannabicyclohexanol were formulated by others. All were placed in Schedule I of the Controlled Substances Act as of March 11, 2011.⁴

However, the chemists manufacturing these so-called “designer drugs” are always searching for ways to thwart the laws by producing isomers of the substances that will be chemically similar to the original substances but different enough to pass legal muster. In the race between regulation and intoxication, intoxication usually finds a way to stay ahead.

It is virtually impossible for law enforcement authorities and toxicologists to keep up with these changes, since none of them are available for testing until they hit the street.

K2 and Spice show up in some areas of the country but not others. Drug fads tend to follow regional patterns. EMS providers are often the first to see folks who are trying something new, and they are always at a disadvantage because neither the patient nor the EMS providers really know what has been ingested.

Herbal Teas

Since the beginning of time, people have experimented with plants and plant extracts to produce both medicines and recreational drugs. Digitalis, originally extracted from the common foxglove plant (Digitalis purpurea), is one of the best examples of legitimate use of plants in medicine.