What Are Bath Salts?

In recent years, “bath salts” have emerged as frequently used and highly addictive substance that can be obtained legally in some areas as well as on online. Although they have nothing to do with the bath additives, “bath salts” is an informal name for synthetic cathinones—a central nervous system stimulant taken to produce effects similar to cocaine, methamphetamine, or MDMA (ecstasy or Molly).¹

A recreational dose of bath salts reportedly enhances mood and increase alertness. In higher doses, it can lead to dangerous neurologic and cardiovascular complications requiring emergency medical care.¹

Bath salts are usually found as a white or brown crystal-like powder that’s sold in small plastic or foil packages labeled “not for human consumption.” They may also be labeled as “bath salts,” “jewelry cleaner,” or “plant food.”² Other street names for bath salts are flakka, cloud nine, vanilla sky, or white lightning. Sometimes, the drugs can be seen in tablet or capsule form, but this is less common.³

Bath salts are usually self-administered by insufflation (“snorting”) but may be swallowed, smoked or injected. The intoxication lasts 6 to 8 hours and bath salts have a high addictive potential.¹

The psychoactive ingredient in bath salts, typically psychoactive “designer drug” methylenedioxypyrovalerone (MDPV) are a human-made derivative of a chemical related to cathinone, a stimulant found in the khat plant—a shrub grown in East Africa and southern Arabia.^1,3 Khat leaves are sometimes chewed for their mild stimulant effects.⁴ Man-made versions of cathinones are generally stronger and more dangerous.²

In 2011, the U.S. Drug Enforcement Agency (as well as agencies from other countries) banned MDPV and two of the other main chemicals that were prevalent in bath salts, mephedrone and methylone.⁵ But new cathinone derivatives that only slightly modify the original can be created fairly easily by chemists and have quickly replaced the drugs that are subject to regulatory control.¹

What are the Side Effects of Bath Salts?

Small amounts of synthetic cathinones can enhance mood and increase alertness, friendliness and sex drive.^1,2 

Mild side effects may include:^1,2

• Increased heart rate.
• Increased blood pressure (hypertension).
• Chest pain.
• Sweating.
• Panic attacks.
• Anxiety.
• Agitation.
• Hallucinations.
• Psychosis.

Severe, life-threatening side effects are experienced with larger doses and can lead to death. Physical effects that might be experienced when taking large doses of bath salts include:^1,2

• Irregular heartbeats.
• Dehydration.
• Swelling of the brain.
• Kidney failure.
• Breakdown of skeletal muscle tissue.
• Cardiovascular and respiratory collapse.
• Heart attack.
• Stroke.

High doses of bath salts can also induce a state of excited delirium, where the user becomes extremely paranoid and agitated, resulting in violent and aggressive behavior.² Suicidal ideation and self-mutilation may also occur.¹

Are Bath Salts Addictive?

In short, the answer is “yes.” Synthetic cathinones can be addictive. In animal studies, rats would self-administer the drugs, and individuals have reported strong cravings in association with synthetic cathinone use. Individuals may develop a tolerance, meaning that they require an increased dose of the drug to achieve the desired effect. With tolerance comes strong withdrawal symptoms that include:²

• Depression.
• Anxiety.
• Tremors.
• Trouble sleeping.
• Paranoia.

Getting Help

Individuals wishing to recover from abuse of synthetic cathinones may benefit from medical detox to ensure they remain safe and comfortable during the withdrawal process. Medically supervised withdrawal management 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) is often used to treat drug addiction. CBT 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.⁶
• Contingency Management 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.⁷
• Motivational Enhancement Therapy is a therapy program that aims to help clients achieve rapid changes in drug-related behaviors. 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.⁸

References

1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
2. National Institute on Drug Abuse. (2018). Drug Facts: Synthetic Cathinones (Bath Salts).
3. U.S. Dept. of Justice National Drug Intelligence Center. (2011). Synthetic Cathinones (Bath Salts): An Emerging Domestic Threat.
4. National Institute on Drug Abuse. (2014). Drugs of Abuse: Synthetic Cathinones (Bath Salts).
5. Drug Enforcement Administration. (2011). Schedules of controlled substances: Temporary placement of three synthetic cathinones in Schedule I. Final Order. Fed Regist, 76(204):65371–65375.
6. National Institute on Drug Abuse. (2018.) Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Cognitive-Behavioral Therapy.
7. National Institute on Drug Abuse. (2018.) Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Contingency Management Interventions/Motivational Incentives.
8. National Institute on Drug Abuse. (2018.) Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Motivational Enhancement Therapy.