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Transcript of Bath Salts
Feburary 25 2011
Emergeny Medicine Resident Bibliography Sewell, A. (28 January 2011). "'Bath salts' latest drug to raise alarms". Los Angeles Times. http://www.latimes.com/news/nationworld/nation/la-na-bath-salts-20110128,0,6453748,full.story. Retrieved 2011-02-17. 2011 214 cases thus far Symptoms Extreme Paranoia
Delusions Street Names "The patients who were showing up with this, they were off the wall. Some of them looked like a true psychotic break" What's in it? Mephedrone Richard "Dickie" Sanders III, dead on the floor along with the .22-caliber rifle he had used to shoot himself in the head.
Intermittent psychotic episodes induced when he snorted a packet of "Cloud Nine' bath salts. During that period Dickie peered out the kitchen window in terror, counting police officers and helicopters that wern't there, and sliced his own throat with a kitchen knife. "This is like a pill that creates schizophrenia" Twitter a psychoactive drug with stimulant properties which acts as a norepinephrine-dopamine reuptake inhibitor (NDRI).
First reports in 2007 on the German illegal drug market. Physical Exam:
Increase in blood pressure
Sweating High doses have been observed to cause intense, prolonged panic attacks in stimulant-intolerant users, and there are anecdotal reports of psychosis from sleep withdrawal and addiction at higher doses or more frequent dosing intervals Withdrawl/Comedown= comedown syndrome similar to that of methamphetamine, characterized by depression, lethargy, headache, anxiety, postural hypotension (lightheadedness and weakness of the muscles), and in some cases severely bloodshot eyes, which usually subside within 4 to 8 hours. History:
Mephedrone was first synthesised in 1929 but did not become widely known until it was rediscovered in 2003 The compound remained an obscure product of academia until 2003, when it was "re-discovered" and publicised by an underground chemist on The Hive website, working under the pseudonym "Kinetic" The Psychonaut Research Project, an EU organisation that searches the internet for information regarding new drugs, first identified mephedrone in 2008. Their research suggests that the drug first became available to purchase on the internet in 2007, when it was also discussed on internet forums Posion control centers last year took 235 calls related to "bath salts" in 2010 Lousiana hit the hardest with 160 cases last year and three deaths. S-enantianomer more potent Metabolism I. demythelated to the primary amine (compounds 2,3 and 4)
II. ketone can be removed (3)
III. Tolyl group can be oxidized (5 and 6)
5 and 6 are metabolized by conjugation glucuronide and sulfate derivatives Methylenedioxypyrovalerone Many of these “designer drugs” are not scheduled / listed in the Controlled Substances Act
Federal Analogue Act - allows any chemical "substantially similar" to an illegal drug (in Schedule I or II) to be treated as if it were also in Schedule I or II, but only if it is intended for human consumption.
States introduced legistlation
Florida, Hawaii, Michigan, Louisiana, Kentucky, and North Dakota What the Doctor's Are Saying. - Mark Ryan, director of the Louisiana Poison Center. It's not a pill Cloud 9 Ivory Wave Ocean Charge Plus White Lightning Scarface Hurricane Charlie Red Dove White Dove it's a powder Where to Get it? Thus Far: MDPV Mephedrone MDMA KHAT Amphetamine MDPV Mental Exam:
Euphoria, increases in alertness & awareness
Decreased need for food and sleep leep. Came from a case report of "toxicity" of a 22-year old man that purchased and injected approximately 4g of mephedrone
First study capable to identify mephadrone in drug screen.
believed to have originated in 1996 in other forms Experiences:
"Doing/coming off of MDPV is like winning a Mercedes and being told at the last minute they got your name wrong. Uggh"
"It's like I have been on a giant amusement park ride made of sparkly energy and the ride has slowly ground to a halt. Show's over" It's plant food. "My creative writing skills are definitely enhanced, and I am sincerely enjoying the process of recording my thoughts to virtual paper!!! " It's the latest, the greatest, the newest drug. LEGAL Bath Salts Origins are unclear but reports suggest that it was being supplied by an Israeli legal-high seller called Neorganics in 2007 Fourth most popular drug amongst club-goers behind marijuana, cocaine, MDMA. Also known as: 4-MMC
"Bombing" wrapping mephedrone powder in cigarette papers and swallowing Injecting Study to determine the use and effects among dance drue users in the United Kingdom
Online cross-sectional survey (MixMag) Self Reported
Survery November 2009
2700 Respondents Symptoms Respondents indicated a better, longer, less adictive "high" Mental and physical stimulation
Euphoria, mood lift
Feelings of empathy, openness
Increase in sociability, desire to talk with others
Sense of being sped up
Strong desire to redose, craving to recapture initial euphoric rush
Uncomfortable changes in body temperature (sweating/chills)
Heart palpitations, sense of racing heart
Impaired short term memory
Tightened jaw muscles, grinding teeth (trismus and bruxia)
Dizziness, light headedness, vertigo
Negative Positive 4-Methylmethcathinone "We simply kept going until there was nothing left. This is, according to me, the biggest danger with this drug; one doesn't seem to realize or even notice when one has crossed the line, until it's too late" A very nice substance for me overall. My elocution was remarkably enhanced, communicative centers were gaping wide, very comfortable and relaxed stimulation, empathy was significant. PARANOIA 251 calls to poison control in 2011
15-year-old girl presents with AMS, nausea, vomiting.
Previous night consumed a "white powdery substance" with EtOH
GCS 11 on arrivial with dilated pupils
Lumbar puncture with elevated opening pressure.
Sodium 118 Believed that mephedrone stimulated release and inhibit reuptake of monoamine neurotransmitters.
Hyponatremia is from excessive sweating with electrolyte loss.
Possible secreation of ADH mediated by serotonin. Accidental death by combined use of mephedrone and heroin in a 22-year-old male found unresponsive at home.
Urine drug screen kids for amphetamines, cocaine, or ecstasy kits did not show positive for mephedrone.
Study was able to identify mephedrone via Gas chromatography
Study highlighted importance of clinical investigators to relay to the medical examiners pertinent information for forensic toxicology as this is a known ingestion 19-year-old male with central crushing chest pain 20 hours after ingestion of plant food.
Troponin 1.19 ug/l Where Are we Now? Of 150 respondents 63% still use
55% intend to use same amount - November 2010