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Alert

DESIGNER DRUG “BATH SALTS” USE IN DELAWARE

A new group of designer drugs deceptively known as “bath salts” has become increasingly popular. Poison centers across the

U.S. have reported growing numbers of calls about the synthetic stimulant. Recent appearance of the drug in Delaware has prompted the

Delaware Controlled Substances Advisory Committee to hold an emergency meeting today, September 30 2011, to ban the drugs by placing them

on the Delaware’s list of Schedule 1 substances.

The following information is gleaned from the Federal Drug Enforcement Agency.

Introduction

Synthetic stimulants that are marketed as “bath salts” are often found in a number of retail products. MDPV

(methylenedioxypyrovalerone) is the drug most commonly found in “bath salt” products. Many of these products are sold over

the Internet, in convenience stores, and in “head shops.” They are sold in powder form in small plastic or foil packages

typically of 200 and 500 milligrams. MDPV is a designer drug of the phenethylamine class. MDPV is structurally related to cathinone, an

active alkaloid found in the khat plant, and is similar to methamphetamine and methylenedioxymethamphetamine (MDMA). MDPV is a central

nervous system (CNS) stimulant, first seized in Germany in 2007.

Street names

Bilss, Blue Silk, Cloud Nine, Drone, Energy-1, Ivory Wave, Lunar Wave, Meow Meow, Ocean Burst, Pure Ivory, Purple Wave, Red Dove, Snow

Leopard, Stardust, Vanilla Sky, Voodoo, White Dove, White Knight, White Lightning and many others.

Licit Uses

MDPV is not approved for medical use in the United States

Chemistry

MDPV (1-(1,3-benzodioxol-5-yl)-2-(1-pyrrolidinyl)- 1-pentanone; Chemical Abstract Service Number 687603- 66-3) is related in chemical

structure to schedule I hallucinogenic substances (MDMA, MDEA) and to schedule I stimulants (cathinone, methcathinone).

Pharmacology

MDPV is structurally related to MDMA and also to cathinone, with a ring-bearing substituent group. Cathinone derivatives, which bear

ring-group substituents, have been reported to induce subjective effects similar to those induced by cocaine, amphetamine, and MDMA in

humans. The subjective effects induced by ring-group substituted cathinones are feelings of empathy, stimulation, alertness, euphoria,

and awareness of senses.

It has been demonstrated that MDPV administered to mice increased the extracellular levels of dopamine levels 60 minutes after

administration of MDPV. Though MDPV increased dopamine levels, the effect was not as marked as the increases induced by methamphetamine

or MDMA.

The following information is provided courtesy of the Poison Control Center of Philadelphia.

Clinical Effects

MDPV may be ingested, snorted, smoked, or injected. Anecdotal reports from users suggest that they take 5 mg or less per dose, but

repetitive use may induce intense cravings. Typical symptoms reported by “bath salt” users seeking medical care include

anxiety, paranoia, restlessness, insomnia, anorexia, palpitations, bizarre behavior, and sometimes frank hallucinations. Signs of MDPV

intoxication include tachycardia, hypertension, dilated pupils, diaphoresis, and tremor. Seizure-like movements have been noticed in some

users. The duration of the subjective effects is about 3 to 4 hours and the side effects continuing to a total of 6 to 8 hours after

administration. Higher doses of MDPV have caused intense, prolonged panic attacks in stimulant-intolerant users. Users have reported

bouts of psychosis induced by sleep deprivation and becoming addicted after using higher doses or using at more frequent dosing

intervals. MDPV loses potency when it is put into solution.

Treatment

There is no specific antidote for intoxication with the stimulant drugs sold as “bath salts.” Intoxicated individuals should

be placed in a quiet room free from excessive stimuli until the drug effects wear off. Dehydration can be treated with oral or

intravenous fluids. Benzodiazepines have been used successfully to diminish anxiety and agitation, and will often reduce the sympathetic

effects of tachycardia, hypertension, and tremor. MDPV intoxication can exacerbate existing cardiovascular or neurological illness.

“Bath salts” are often abused along with other drugs including ethanol, marijuana, caffeine, amphetamines, and cocaine.

Standard urine drug screens for drugs of abuse will not detect the synthetic stimulants currently associated with “bath

salts” and aren’t usually needed to guide therapy. However, when necessary for diagnostic or epidemiological purposes, urine

can be analyzed for MDPV or mephedrone by some specialized laboratories.

For More Information

Clinicians seeking guidance in the care of patients using “bath salts” drugs are encouraged to utilize the regional poison

control center at 1-800-222-1222.

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