Understanding Bath Salts: Risks and Effects of Synthetic Stimulants

Bath Salts Drug Paper Drug Choice Paper Bath Salts Institution: University of Phoniex

Bath Salts Drug Paper Basic Information Synthetic cathinones, typically referred to as "bath salts," are potent central nervous system stimulants that effectively replicate the effects of cocaine, methamphetamine, and MDMA (ec- stasy). There is no doubt that bath salts go by multiple street names, such as bloom, cloud nine, flakka,etc. It is important to understand that "bath salts" are not just a harmless substance as the name may suggest. Instead, they are powerful and potentially harmful stimulant chemicals that should be approached with caution. Bath salts are a synthetic form of illicit drugs that are commonly sold in small plastic or foil sa- chets as a white or off-white powder. The drugs are frequently insufflated, or snorted, through the nasal cavity. Alternatively, they may be smoked, ingested orally, or dissolved in a liquid and in- jected with a syringe. It is important to note that these drugs are associated with significant health risks and may result in serious medical complications. As such, it is imperative that indi- viduals avoid the use of these drugs and seek appropriate professional assistance in cases of ad- diction or dependency. According to the Psychopharmacology article, it states the following on Bath salts, "Synthetic cathinones (Bath salts^) are among the most prevalent novel psychoactive substances (NPS), also known as designer drugs. They are psychostimulants related to the naturally occurring parent compound cathinone, a monoamine alkaloid found in the khat plant (Catha edulis). A growing body of literature refers that many cathinone NPS show significant abuse liability and potential for addiction (Watterson and Olive 2017). These designer drugs are a high-public risk because of their potency and dangerous effects on the central nervous system (CNS) or the cardiovascular

Bath Salts Drug Paper function, among others. The ability of cathinones to produce multiple organ system toxicities and death in humans is well-documented (Baumann and Volkow 2016; Watterson and Olive 2017). They are easy to buy over the internet, labeled under misleading descriptions such as Blegal drugs^ and Bnot for human consumption^. First-generation synthetic cathinones are the most used NPS and include 4-methylmethcathinone (mephedrone) (MEPH), 3,4-methylenedioxy-N- methylcathinone (methylone) (METH), and 4-methylenedioxypyrovalerone (MDPV). They are classified as Beuphoric stimulants^ because they act through the monoamine transporters (norep- inephrine, dopamine, or serotonin transporters) in two ways: either as monoamine uptake in- hibitors or as transporter substrates that increase the release of these neurotransmitters (Luethi and Liechti 2018). Based on their structural similarity and/or analogous mechanism of actions on neurotransmitters, MEPH and MDPV exert similar actions to methamphetamine and cocaine, re- spectively, while METH shows a pharmacological profile that more closely resembles 3,4- methylenedioxymethamphetamine (MDMA) (German et al. 2014; Weinstein et al. 2017). Syn- thetic cathinones and classical stimulants share some functional analogies regarding the main ef- fect on the dysregulation of monoamine systems, the behavioral effects (psychostimulant and hal- lucinogenic effects), and the abuse liability, but there is much less information about the synaptic, systemic, or behavioral mechanisms by which synthetic cathinones act in comparison with the classical psychostimulants. Cathinones present structural differences in their backbone and in the substitute groups that make them to be considered a unique family of drugs." (López-Rodríguez and Viveros) Biological Implications and Impact Despite being commonly used, the mechanism of action behind the physiological and behavioral effects elicited by synthetic cathinone derivatives still needs to be fully understood.

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Bath Salts Drug Paper However, evidence indicates that bath salt cathinones interact confidently with plasma membrane transporters for dopamine (DAT), norepinephrine (NET), and serotonin (SERT). (Baumann et al., 2013) The scientific community remains divided on the precise nature of drug-transporter interactions for certain cathinone molecules. However, it is crucial to examine the mechanistic distinction be- tween drugs that target monoamine transporters, which are often classified as either substrates (such as amphetamine) or blockers (such as cocaine). This distinction is significant for two rea- sons: 1) Substrates, but not blockers, are transported into cells, where they disrupt vesicular storage and induce non-exocytotic neurotransmitter release by reversing the usual transporter flow direc- tion. 2) Substrates can cause long-term impairments in monoamine neurons, such as neurotransmitter depletion and loss of functioning transporters. (Baumann et al., 2013) Studies have conclusively shown that transporter substrates and blockers exhibit significant dif- ferences in their immediate and long-lasting effects. In light of this, it has been unequivocally es- tablished that both mephedrone and methylone function as transporter blockers by inhibiting the uptake of monoamine neurotransmitters in brain tissue and cells. (Baumann et al., 2013) According to Perspectives in Psychiatric Care , It says the following on the impact of bath salts, "Bath salts are an emerging street drug that contains one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant. Not to be confused with the legitimate product used

Bath Salts Drug Paper for bathing, bath salts are an addictive synthetic street drug used to increase alertness and eupho- ria. It has gained worldwide attention due to its increasing use and life-threatening outcomes as- sociated with psychosis (Kasick, McKnight, & Klisovic, 2012; Penders, 2012). Bath salt-induced psychosis is marked by extreme agitation and violence, is difficult to diagnose, is difficult to treat, and has significant negative consequences for patients, families, healthcare providers, and the public. Users who experience bath salt-induced psychosis exhibit extremely bizarre behavior that may lead them to harm themselves and/or others."(Stiles et al., 2015) Screening and or Assessment Tools During the evaluation phase, it is absolutely critical for healthcare workers to gather information from family or friends about the type of substances or drugs consumed by the patient . When there is no information available, nurses rely on symptom recognition. Advance practice nurses must have the ability to confidently identify the following symptoms in patients with bath salt- induced psychosis: delusions, extreme paranoia, hallucinations, intense agitation, suicidal ideation, uncontrolled violent behavior towards others, and accompanying physical problems related to stimulant use Early detection of these symptoms is vital to start therapy and help the patient achieve stability. Stiles et al. (2015) According to The Perspectives in Psychiatric Care, it says the following about the assessment screening, "One approach to providing adequate follow-up care is the Screening, Brief Intervention, and Referral to Treatment model (SBIRT; Young et al., 2014). SBIRT is a comprehensive, integrated public health approach to the delivery of early intervention and

Bath Salts Drug Paper treatment services for patients experiencing substance abuse that was designed for patients who are at high risk of not seeking treatment following discharge. The protocol of SBIRT is to utilize brief interventions for the patients, such as one-on-one counseling that provides information or advice, efforts to increase motivation to avoid substance use, or to teach behavior change skills with the aim of reducing substance use (Young et al., 2014). A strong evidence base supports that the use of the SBIRT model is beneficial in psychoactive substance abuse."(Stiles et al., 2015) Treatment According to National Library of Medicine it states the following about treatment for bath salts, “Routine toxicology screenings are unable to detect all of the chemical substances that constitute the various bath salt stimulant drugs. Although hundreds of bath salt compounds are available, toxicologists are able to identify no more than 40. As new tests are developed, basement chemists tweak existing compounds or introduce new ones to avoid detection. Physicians in EDs, urgent-care centers, and other settings might consider bath salts intoxication in persons without a psychiatric history who present with agitation, anxiety, and psychosis. Benzodiazepines, especially lorazepam (Ativan, Pfizer), are commonly used to treat the agitation and seizures associated with the use of bath salts. Restraints may be needed if the patient’s agita- tion cannot be controlled with these drugs. Because antipsychotic agents have the potential to lower the seizure threshold, they should be administered with caution in patients suspected of having used bath salts. If the patient or other sources indicate that a bath salts stimulant was taken, a urine toxicology sample may be tested for the more common substances found in these products.

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Bath Salts Drug Paper After recovery, bath salts abusers should be referred for psychiatric consultation. Many of these individuals have a history of polysubstance abuse.” (Gershman, 2012) Individuals who have abused bath salts are treated similarly to those who have abused other sub- stances. They are typically diagnosed with a stimulant use disorder or another type of drug use problem. The therapy regimen generally comprises two main steps. Firstly, an initial evaluation is conducted at the beginning of therapy. A comprehensive assess- ment of the client's situation is undertaken, including a thorough physical examination, mental health diagnosis, and an evaluation of the individual's living conditions. This process helps to identify areas that require attention. Secondly, the individual is enrolled in a physician-assisted withdrawal management program. Al- though no drugs have been specifically designed to treat the withdrawal symptoms associated with bath salt abuse, benzodiazepines have been hypothesized to be effective. By following these steps, individuals who have abused bath salts can receive the necessary treat- ment and support to address their substance use disorder and achieve a successful recovery. Conclusion Although legislative efforts have been made to restrict the use of harmful chemicals, toxic bath salt stimulants continue to be legally available. It is imperative that federal laws permanently

Bath Salts Drug Paper prohibit their sale to prevent the addiction, damage, and death caused by these drugs. Physicians and pharmacists, as critical healthcare practitioners, must take the lead in raising awareness of this issue in their communities. Professional continuing education is a crucial step in achieving this goal.

Bath Salts Drug Paper References 1. López-Rodríguez, Ana Belén, and María-Paz Viveros. “Bath Salts and Polyconsumption: In Search of Drug-drug Interactions.” Psychopharmacology , vol. 236, no. 3, Springer Science+Business Media, Mar. 2019, pp. 1001–14. https://doi.org/10.1007/s00213-019- 05213-3. 2. Lajoie, Travis M., and Anne M. Rich. “‘Bath Salts’: A New Drug Epidemic-A Case Re- port.” American Journal on Addictions , vol. 21, no. 6, Wiley-Blackwell, Oct. 2012, pp. 572–73. https://doi.org/10.1111/j.1521-0391.2012.00286.x. (Lajoie and Rich) 3. Brandt, Simon D., et al. “The New Drug Phenomenon.” Drug Testing and Analysis , vol. 6, no. 7–8, Wiley, July 2014, pp. 587–97. https://doi.org/10.1002/dta.1686.(Brandt et al.) 4. Kasick, David, et al. “‘Bath Salt’ Ingestion Leading to Severe Intoxication Delirium: Two Cases and a Brief Review of the Emergence of Mephedrone Use.” American Journal of Drug and Alcohol Abuse , vol. 38, no. 2, Marcel Dekker, Jan. 2012, pp. 176–80. https://doi.org/10.3109/00952990.2011.643999. (Kasick et al.)

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Bath Salts Drug Paper 5. Penders, Thomas M. “How to Recognize a Patient Who’s High on ‘Bath Salts’.” PubMed , vol. 61, no. 4, National Institutes of Health, Apr. 2012, pp. 210–12. pubmed.ncbi.nlm.nih.gov/22482104.(Penders) 6. “Synthetic Cathinones (‘Bath Salts’) | National Institute on Drug Abuse.” National Insti- tute on Drug Abuse , 2 Aug. 2023, nida.nih.gov/research-topics/synthetic-cathinones-bath- salts. 7. Baumann, M. H., Partilla, J. S., & Lehner, K. R. (2013). Psychoactive “bath salts”: Not so soothing. European Journal of Pharmacology , 698 (1–3), 1–5. https://doi.org/10.1016/j.e - jphar.2012.11.020 8. Stiles, B. M., Fish, A. F., Cook, C. a. L., & Silva, V. (2015). Bath Salt-Induced Psychosis: Nursing Assessment, diagnosis, treatment, and Outcomes. Perspectives in Psychiatric Care , 52 (1), 68–78. https://doi.org/10.1111/ppc.12101 9. Gershman, J. A. (2012, October 1). Synthetic cathinones (‘Bath salts’): legal and health care challenges . PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474442/

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