How Do You Know If Someone Is on Bath Salts?

The National Institute on Drug Abuse (NIDA) and other organizations report that bath salts are actually many different substances that are forms of synthetic designer drugs. These drugs are manufactured in overseas laboratories in countries where there is very little supervision regarding the substances put into these drugs, such as China. They are then marketed to the United States as legal alternatives to drugs like ecstasy.

Some of the major psychoactive ingredients in these drugs include synthetic cathinones (e.g., MDPV or methylenedioxypyrovalerone, pyrovalerone, and mephedrone). Cathinones are natural occurring psychoactive substances found in the khat plant that is grown in Africa and the Middle East. Synthetic cathinones are extremely more potent than their natural counterparts, and their chronic use and even occasional use can be quite risky.

The United States Drug Enforcement Administration (DEA) has attempted to categorize most of these substances and their alternative chemical forms (minor changes to the substances that are made to allow them to be imported when the original forms are classified as illegal) as Schedule I controlled substances. This means that these drugs are illegal to possess by anyone, cannot be obtained with a prescription from a physician, and their use is considered to be extremely dangerous.

The drugs are often sold in party stores, head shops, and on the Internet, and they are often referred to as legal alternatives to cocaine or methamphetamine. Some of the more common street names for these drugs are vanilla sky, white lightning, and flakka. They are typically available in a powder or capsule form. They are most often snorted, but they can be injected, smoked, or swallowed.

Understanding the Effects of Bath Salts

A report in the New England Journal of Medicine listed the effects of bath salts. The drugs’ mechanisms of action lead to an increase in numerous neurotransmitters in the brain, particularly dopamine and norepinephrine. Taking them results in an increased rush of energy, feelings of euphoria, and hyperactivity. Some of the other signs associated with using these drugs include:

• Hyperactivity, rapid heartbeat, increased blood pressure, increased perspiration, and increased body temperature (hyperthermia)
• Dilated pupils, muscle tremors, muscle spasms, and labored breathing
• Insomnia and difficulty remaining at rest
• Problems with anxious behaviors, irritability, depression, and an increased potential for aggressiveness or hostility
• Feelings of invulnerability that can lead to risky behaviors, including self-mutilation and even potential suicidal behaviors
• Psychosis (the development of hallucinations and/or delusions)
• Physical effects that include the risk for heart attack, stroke, and seizures
• Delirium, which consists of severe confusion, disorientation, hyperactivity or hypoactivity, and psychosis
• Increased risk for swelling of the brain that can lead to injury or even death
• Other cognitive issues, such as severe problems with maintaining attention, rapid speech, memory problems, and severely irrational thinking
• Severe cravings, tolerance, and withdrawal (mostly psychological and emotional issues, such as depression, enhanced cravings, irritability, hopelessness, anxiety, etc.)

There are cases where individuals under the influence of these drugs have died due to the effects or as a result of their behavior while under the influence.

Because the chemicals in these substances are given a Schedule I controlled substance classification by the DEA, there is no statute for the recreational use of these drugs, and any use of these drugs should be considered a form of substance abuse.

Given the above symptom profile and the manner in which the drugs are most normally used, some of the signs that might indicate a person is abusing bath salts include:

• Finding empty packages or containers of these substances on the person, in their room, in their clothes, in their car, etc.
• Finding keys, rolled-up paper money, straws, etc., with a whitish powder on them
• Some form of nasal damage, such as a frequent bloody nose, frequent runny nose, perforated nasal septum, or raw or red nose
• Frequent periods of extreme energy, euphoria, and hyperactivity followed by periods of lethargy and low mood
• Significant appetite loss and weight loss
• Significant signs of being tense, such as displaying frequent jaw clenching or teeth grinding
• Acting invulnerable or becoming extremely aggressive and even hostile
• Periods of psychosis

Anyone exhibiting two or more of these signs should be under suspicion, particularly if empty containers of products that are sold as bath salts are found on the person or in their possessions.

When an individual is displaying issues with hostility or psychosis, it is best not to confront them. Instead, wait for the drugs to wear off and for the person to be experiencing the types of hangover effects that occur as a result of using these drugs. These effects typically involve periods of low motivation, lethargy, apathy, sleepiness, etc., and individuals are much more approachable at these times. While they are under the influence of the drug, it may be best to keep them isolated, reduce stimulation around them, and administer fluids to them if possible. If the person is aggressive or psychotic, call 911 immediately.

Individuals who abuse bath salts should be evaluated and treated by licensed mental health physicians and addiction treatment providers in conjunction with attending peer support groups and getting other forms of social support. It is imperative that the person does not discontinue use of the drug on their own in an attempt to go through a self-initiated program of recovery without receiving professional help, including an evaluation by a physician. This is due to potential issues that can occur during withdrawal and the neurological issues that may occur as a result of using bath salts.