Despite recent efforts to clamp down on “bath salts” and other designer drugs, their use (both legal and illegal) continues with many individuals winding up needing emergency treatment.
A previous law last December making many of the designer drugs illegal in Vermont was strengthened this month by new federal and state legislation. By slightly changing the content of the compounds, however, new products continue to be tweaked and, at least for a time, be sold legally.
Bath salts can contain mephedrone, methylone or methylenedioxypyrovalerone (MDPV), among other things. Similar to MDMA (Ecstasy) and methamphetamines, they bind to monoamine containing neurons and cause rapid increases in serotonin, norepinephrine, and dopamine. They are generally sold as a powder in smoke shops, often under a variety of odd sounding names such as “Mr Nice Guy” or “Vanilla Sky” and can be swallowed, injected, or inhaled. Use of the drugs can cause a number of symptoms and problems including psychosis (hallucinations and paranoia), aggressive and disorganized behavior, kidney failure, tachycardia, hypertension, hyperthermia, and seizures. Central Valley Medical Center in Barre has been especially busy with patients who present with bath salt toxicity. Treatment is largely supportive and can consist of IV benzodiazepines to control extreme agitation and lower seizure risk. The drugs often do not show up on routine drug screens.
We all need to be on the lookout for patients who are using and experimenting with these dangerous compounds. Adolescents when being interviewed can suddenly become remarkably skilled at very subtle language. If you ask, for example, if he or she uses any “other illicit drugs,” the answer from someone using bath salts might be a straight “no” based on a concrete response to your question. It can be worthwhile to examine about how we phrase our questions so that we minimize any wiggle room in the answers.