The term bath salts is simply an informal name for synthetic cathinones, which are illicit drugs. Though the name can be confusing, these drugs have nothing to do with traditional bath salts that are used for bathing purposes.
The National Institute of Drug Abuse describes synthetic cathinones as man-made drugs that are chemically related to cathinone, a stimulant in the khat plant, which is grown in eastern Africa and southern Arabia. The leaves of the khat plant are sometimes chewed by individuals for their simulant effects. Synthetic cathinones are chemically similar to other stimulants, such as amphetamines, cocaine, and ecstasy. The European Monitoring Centre for Drugs and Drug Addiction states that the high from synthetic cathinones, like that of cocaine, is often short-lived.
Man-made versions of cathinones are generally stronger and more dangerous. They are included in a family of “new psychoactive substances,” which are unregulated mind-altering drugs that are relatively new to the United States. They are sometimes made to mimic other illegal drugs or as a less expensive alternative to drugs like cocaine. At times, some drugs marketed as MDMA may actually contain synthetic cathinones rather than MDMA.
Synthetic cathinones are often seen as a crystal like powder, which may be white, off-white, or slightly yellow in color. They may be found in drug paraphernalia stores, head shops, or gas stations in foil packets, labeled as “plant food” or “jewelry cleaner.” They are generally marked that they are “not for human consumption.” This labeling is thought by the National Drug Intelligence Center to be used in an effort to escape regulation by the FDA and avoid drug prohibition laws. The drug also may be referred to by other names such as flakka, cloud nine, vanilla sky, or white lightning. Sometimes, the drugs can be seen in tablet or capsule form, but this is less common.
The DEA has listed synthetic cathinones as Schedule I drugs, meaning that they have no approved medical use in the United States, a lack of accepted safety for use, and a high potential for abuse. However, some prescription medications – such as Wellbutrin, Zyban, Tenuate, and Centroton – are legal forms of synthetic cathinones. The latter two medications are Schedule IV and Schedule V medications, respectively.
How Bath Salts Are Used
Synthetic cathinones can be used in a variety of ways, such as smoking, snorting, injecting, or orally ingesting the drugs. EMCDDA, however, states that they are most often not suitable for smoking; the DEA states that synthetic cathinones are most often snorted.
An article in the New England Journal of Medicine states that synthetic cathinones are metabolized by the body quickly, and that effects may peak at around 1.5 hours after ingested. The duration of the effects may last around 3-4 hours, after which individuals experience a crash.
The British Journal of Pharmacology published an article that determined that combining synthetic cathinones with alcohol increases the stimulant effects of the chemical mephedrone, also increasing the chances of adverse reactions.
Effects on the Body
The American Association of Poison Control Centers reported 520 cases of synthetic cathinone exposure in 2015, a number that has decreased since 2011’s reported 6,137. The age range of the reported exposures spans from individuals younger than 6 years of age to those older than 59.
There is little research on how, exactly, synthetic cathinones affect the body and brain, but some individuals have reported feeling agitation and an increase in energy. An article published by BBC states that some individuals consider the drugs’ effects to be similar to those associated with ecstasy. The drugs can raise both heart rate and blood pressure, and they can also produce:
- Altered mental status
- Chest pain
- Increased libido
- Nausea and vomiting
- Panic attacks
- Suicidal thoughts
- Excited delirium
The outcome of synthetic cathinone use can be worse if the drugs are injected or snorted, and can even include death.
As the National Center on Addiction and Substance Abuse points out, synthetic drugs such as cathinones are easily able to be sold in the United States because if they are banned, the manufacturers can make even slight changes to the chemistry of the cathinones, so they no longer fit the description of a banned drug. This increases the chance that individuals who use synthetic cathinones will experience adverse effects from the drug.
Overdoses on synthetic cathinones are possible regardless of the dose, as they are unregulated and uncontrolled substances, meaning that their effects are unknown. The New England Journal of Medicine states that the risk of overdose is also increased due to the fact that some of the packages contain well over the recommended dose. An overdose of synthetic cathinones can cause effects similar to those of other stimulants, including chest pain, sweating, nausea and vomiting, and rapid heart rate that may lead to stroke or heart attack. If an overdose is suspected, emergency services should be contacted immediately, as individuals may need intensive medical care. Users may need to be sedated in order to prevent them from harming themselves or others.
The BBC also reports that the long-term effects of synthetic cathinones are unknown, although research is being done to determine such effects.
Synthetic cathinones have been known to produce withdrawal symptoms, such as anxiety, depression, insomnia, paranoia, and tremors when their use is stopped. Individuals wishing to recover from abuse of synthetic cathinones may benefit from medical detox to ensure they remain safe and comfortable during the detox process. Medical detox also increases the likelihood that individuals will successfully complete detox, since support is available around the clock.
Treatment for an addiction to synthetic cathinones will include behavioral therapies, such as Cognitive Behavioral Therapy, Contingency Management, and Motivational Enhancement Therapy.
Cognitive Behavioral Therapy (CBT), as defined by NIDA, is a flexible type of therapy that is used very often to treat drug addiction. CBT is of shorter duration than other behavioral therapies, and it focuses on helping individuals identify drug-related behaviors and teaching them how to change those behaviors. Clients will learn to recognize situations that put them at high risk for using synthetic cathinones and how to avoid those situations. They will also learn how to cope with any cravings they may experience. Clients also acquire coping skills so they may learn to handle stressful situations appropriately without using synthetic cathinones.
National Institute on Alcohol Abuse and Alcoholism describes Contingency Management as a program that reinforces positive behaviors while in recovery. Clients earn rewards for recovery milestones, such as appointment attendance and positive drug test results. These rewards may include vouchers for items of different monetary values, such as movie or event tickets. If, however, clients relapse or miss an appointment, vouchers may be withheld, or clients may need to begin the program again. This program rewards behaviors that are essential to recovery, and it has been effective in preventing relapse.
Motivational Enhancement Therapy is a therapy program that aims to help clients achieve rapid changes in drug-related behaviors, according to NIDA. This therapy is shorter in duration than CBT, as it consists of an initial session followed by 2-4 therapy sessions. Individuals will also learn new coping skills that don’t involve substance abuse. In treatment sessions, the therapist will monitor the client’s changes in behaviors as well as encouraging the client’s commitment to the recovery process and sobriety. When combined with CBT, Motivational Enhancement Therapy is thought to be even more beneficial.
There are currently no medications approved to help with synthetic cathinone addiction, but research is ongoing to attempt to discover medications that may aid in recovery.