Maine's Bath Salts Treatment Shared Nationwide

BANGOR — Police encountered a half-dressed man bleeding at the wrists last Sunday and quickly realized they were dealing with a bath salts user, Bangor police Lt. Tom Reagan said at a conference held Wednesday on the state’s growing problem with the synthetic drug.

When officers approached the man, he told them he had insects under his skin. Then they watched in horror as he gnawed on his own bloody wrists trying to get at them.

Bath salts users who come into contact with police or ambulance personnel are often in crisis and agitated, severely delusional and paranoid, thinking people are out to kill them, Reagan said.

Emergency room doctors and ambulance crews have tried a variety of ways to treat bath salts users in the eight months since it emerged on the streets of Maine and are sharing what they have learned with other doctors around the state and across the country, said Dr. Jonnathan Busko, an emergency room doctor at Eastern Maine Medical Center in Bangor.

At first, “none of the usual therapies we were using were working,” Karen Simone, a toxicologist and director of the Northern New England Poison Control Center in Portland, told attendees at the daylong conference, which was sponsored by the Bangor Police Department and The Acadia Hospital and held at Eastern Maine Community College.

With daily exposure to bath salts users, Bangor doctors have a lot of hands-on experience, said Busko, adding that colleagues from as far away as California are calling because “what we’re doing is way out ahead.”

Ambulance crews and doctors must make quick decisions about how to deal with drug users and treat them based on the severity of their reactions to the drug, said Dr. Anthony T. Ng, medical director of psychiatric emergency services at Acadia.

The first thing that must be done is restrain them, but physically restraining such people — who are severely agitated and in a state of excited delirium — can be harmful and even life-threatening because they usually have increased heart rates and high blood pressure, the conference attendees were told.

Restraining patients “increases their release of adrenalin and puts them at risk,” Busko said. “They can go into cardiac arrest.”

The Bangor area has experienced “probably two or three deaths from excited delirium,” the emergency room doctor said. “We’re probably seeing a patient every two or three days with those symptoms.”

The best restraint is to use chemicals to counteract the ones ingested, the conference presenters said.

For most patients, benzodiazepines are used to sedate the patient and then an anti-psychotic is added, and a third drug, a paralysing agent, also can be injected if needed, the doctors said.

“Once they’re down and sedated, that’s a wonderful thing,” Busko said.

The temperatures of suspected bath salts users are taken first to see if they are hyperthermic, and when they get to the hospital an EKG is used to look at the heart, he said. Kidney function also is examined. The patients are tested for other illegal or diverted drugs and a check is done for creatine kinaseare, an enzyme that can indicate a heart attack, Busko said.

All that information is used to shape treatment.

Bath salts, which still can be ordered online in some states, became illegal in Maine in July, and last week the Legislature made possession a misdemeanor and trafficking a felony.

The drug, which usually contains mephedrone or methylenedioxypyrovalerone, known as MDPV, will be outlawed by the federal government for one year starting on Friday.

Bangor police have initiated a zero tolerance policy regarding bath salts, so “if you’ve got the stuff, you’re going to jail,” Reagan said.

With negative stories about bath salts circulating around the country, they now are being marketed as cleaners for such things as jewelry or windows, Reagan said.