Bath Salts, Zombies, and Crossbows: An Update on a Popular Class of Designer Drugs

First up is an article on the explosion of designer drugs on the streets in the UK, followed by an article on the production and perils of "bath salts," mephedrone and other similar cathinones. These drugs are nasty, and the lack of any way for users to know exactly what they are getting and how low or high the dose is beyond alarming.

Here is a little bit from the Wikipedia article linked to above on mephedrone (emphasis added):

Mephedrone administration caused about a 500% increase in dopamine, and about a 950% increase in serotonin. They reached their peak concentrations at 40 minutes and 20 minutes, respectively, and returned to baseline by 120 minutes after injection. In comparison, MDMA caused a roughly 900% increase in serotonin at 40 minutes, with an insignificant increase in dopamine. Amphetamine administration resulted in about a 400% increase in dopamine, peaking at 40 minutes, with an insignificant increase in serotonin. Analysis of the ratio of the AUC for dopamine (DA) and serotonin (5-HT) indicated mephedrone was preferentially a serotonin releaser, with a ratio of 1.22:1 (serotonin vs. dopamine). Additionally, half-lives for the decrease in DA and 5-HT were calculated for each drug. Mephedrone had decay rates of 24.5 minutes and 25.5 minutes, respectively. MDMA had decay values of 302.5 minutes and 47.9 minutes, respectively, while amphetamine values were 51 minutes and 84.1 minutes, respectively. Taken together, these findings show mephedrone induces a massive increase in both DA and 5-HT, combined with rapid clearance. The rapid rise and subsequent fall of DA levels could explain some of the addictive properties mephedrone displays in some users.[95][96]

In the US, bath salts are more likely to be made with methylenedioxypyrovalerone (MDPV), a drug with different effects and toxicities. MDPV acts as a norepinephrine-dopamine reuptake inhibitor (NDRI)[1], a slightly different effect because of norepinephrine reuptake inhibitor creates high levels of adrenaline, similar to amphetamines, but also having effects of dopamine, making compulsive use (even after negative effects) highly common.

For own part, I always believe prohibition is the wrong choice (as the UK has found - mephedrone is more expensive and more popular now than when the ban was imposed). However, I am SO glad this stuff was not around when I was snorting, smoking, or swallowing anything I thought might get me high. I'd probably have a fried brain or be dead.

Why the war on drugs has been made redundant

For every 'designer drug' the authorities ban, clandestine labs are churning out a new version. No wonder the law can't keep up . . .

Vaughan Bell

The Observer, Saturday 15 June 2013

Mephedrone (aka meow, bubbles), one of the new generation of 'designer drugs'. 

Photograph: Foodography /Alamy

The term "designer drug" became popular with the acid house and ecstasy boom in the 1990s, but it was never really accurate. The main ingredient in ecstasy pills – MDMA – was first synthesised in 1912 and began its life as a recreational drug in 70s California, years before it became notorious on the rave scene. The drug was never created for the party crowd, but the "designer drug" label stuck as the perfect phrase both to glamorise and demonise the fashionable new high.

There have been some genuine attempts at designer drugs through the years – where people have attempted to create new recreational substances to evade drug laws – but most have been abject failures. In the most notorious example, chemistry student Barry Kidston tried to create a synthetic heroin-like high in 1976 and ended up creating MPTP, a substance so neurotoxic that it gave him Parkinson's disease days after he injected it. As a grim consolation, Kidston's only legacy was to create a drug that is still used today in lab experiments to try and understand this debilitating neurological disorder.

But something has changed on the street drug scene in recent years. For the first time, we can use the term "designer drug" with confidence because we are in the midst of an unnerving scientific revolution in the use and supply of mind-altering substances.

These drugs have hit the headlines under names such as Spice, K2, mephedrone and M-Cat, but there are hundreds more. They are sold euphemistically as "bath salts", "incense" or "research chemicals", and don't get regulated, at least not at first, because they are labelled as "not for human consumption". Unlike previous generations of legal highs that were about as recreational as a slap in the face, they actually work. They get you high.

The two most popular types are synthetic, cannabis-like drugs, sold as smokable plant material, and stimulants, similar to ecstasy and amphetamines. But what makes this a revolution, rather than simply a market innovation, is the scale and speed of drug development. The European Monitoring Centre for Drugs and Addiction reported 73 new substances last year, meaning new highs were hitting the market at a rate of more than one a week. This wave of new drugs only began five years ago and since then more than 200 previously unknown substances have been found in circulation.

This upsurge in new highs has some serious science behind it. It is worth noting that most traditional drugs of abuse – speed, cocaine, heroin, ecstasy and so on – can be synthesised fairly easily. You need someone with a bit of knowledge and the right ingredients, not always easy to find, but you can complete the process in a back room, basement or jungle. Not so with the new generation of synthetic highs. While most university chemists would sneer at the suggestion that the synthesis was difficult, it still needs a professional laboratory, more so for the constant production of new substances.

It is this constant innovation that is driving the market and making it possible to evade the law. Take the synthetic cannabis drugs, for example. All include variations of the tetrahydrocannabinol or THC molecule, the main active ingredient in cannabis. Hundreds of these variations were created for research purposes and described, often only once or twice, in the pages of obscure scientific journals. They were mostly created in the lab as an exercise in exploring the limits of the cannabinoid molecules but were never used commercially and never tested on humans.

When the legal highs market exploded in 2008, drug researchers started to analyse what was being sold. They found inert plant material, sprayed with obscure substances that were barely known outside the small world of cannabis neurochemistry. It was like finding the new iPhone worked on antimatter.

When Germany identified the substances and banned them in early 2009, new cannabinoids, again never before seen outside the lab, had replaced them within weeks and this is what has been happening ever since. One gets banned and another novel substance takes its place almost immediately. Professional but clandestine labs are rifling the scientific literature for new psychoactive drugs and synthesising them as fast as the law changes. In one of the most interesting developments, a cannabinoid detected in 2012, named XLR-11, was not only new to the drug market but completely new to science. Several previously unknown substances have turned up since. The grey market labs are not only pushing new substances on to the drug market, they are actually innovating drug design. The human testers select themselves of course, unaware of what they're taking, sometimes leading to disastrous results. Information about the dangers of new substances is usually nonexistent.

The whole process has also been an unwitting experiment in drug policy. Despite the free availability of substances as pleasurable as already banned drugs, we have not seen a massive increase in problem users and drug mortality rates have been falling. Furthermore, even with the newly introduced "instant bans", drug laws are simply not able to keep up.

Currently, it is barely possible to detect new drugs at the rate they appear. It has long been clear that the drug war approach of criminalising possession rather than treating problem drug-users has been futile. The revolution in the recreational drug market is a stark reminder of this reality. The war on drugs has not been lost, it has been made obsolete.

* * * * *

This article comes from Pacific Standard, focusing specfically on mephedrone and bath salts.

Bath Salts, Zombies, and Crossbows: An Update

Scientists are working to study the make-up and effects of bath salts, while ER doctors are struggling to treat its victims

June 18, 2013 • By Lauren Kirchner

Theatrical release poster for Hannibal. (POSTER: UNIVERSAL PICTURES)

It’s been about a year since the dangerous new synthetic drug, packaged and disguised as “bath salts,” entered America’s mainstream consciousness. Last summer the drug was blamed for a series of bizarre, violent, and seemingly random attacks of cannibalism; it felt, for a few weeks there, like the beginning of a zombie apocalypse.

It should be noted that the drugged-out perpetrator of the first and most well known of these attacks, on a homeless man on a Miami highway overpass, later turned out to not actually have been on bath salts. But still: local news sites across the country are positively shrieking with reports of bath-salt-fueled violence. The drug has been shown to cause hallucinations, insomnia, and outbursts of anger. Here’s one from the past week, from Erie, Pennsylvania:

A Boggs Township man was behind bars Friday after police charged him with a series of brutal assaults on a woman that culminated with three days of alleged bath salts-fueled violence last week. 

Pennsylvania State Police at Rockview said Justin D. Hinds, 35, allegedly beat the woman with a crude weapon made by affixing a nail to a heavy flashlight, threw a cell phone at her face, breaking a tooth, and pointed a loaded shotgun at her.

What’s the appeal of this drug, exactly? Cathy Coonz, a behavioral specialist, explained the side effects in a recent presentation to one West Virginia community. From the West Virginia Inter Mountain:

Bath salts are appealing to users because they may induce euphoria, increased sociability and music appreciation, sexual arousal and pleasant hallucinations. However, users also frequently experience extremely unpleasant side effects such as paranoia, profuse sweating, delusions, intense thirst, vomiting, violent or psychotic behavior, and self-mutilation, Coontz said.

Not the best trade-off, eh? But despite the media attention the scariest bath salts fatalities have continued to receive, people are still experimenting with this stuff. Meanwhile, ER doctors, law enforcement agencies, and scientists have all struggled to keep up.

A research team from the University of Virginia, hoping to increase our collective understanding of the sinister salts, compiled data about its use and effects for the latest issue of the Journal of Addiction Medicine. The researchers, led by addiction medicine specialist Dr. Erik W. Gunderson, found that the drug’s effects are similar to those of cocaine and amphetamine, though the compound may be slightly different. Short-term “acute toxicity” has led to both suicides and homicides, and in the long term, the drug does appear to be addictive.

Since the drug is so new, and since manufacturers keep tweaking the recipe to circumvent each new ban on its ingredients, ER doctors and poison control centers don’t always know how to test for its presence in a patient’s body, or to respond to overdose situations. The UVA report recommended that, when in doubt, treatment for bath salt toxicity should resemble the treatment of other more familiar stimulants.According to Science Daily:

Substituted cathinone products are still new, so there are no formal guidelines for medical treatment of acute toxicity. Experience suggests that physical symptoms resolve after a few days, with supportive care. However, psychotic effects such as hallucinations may persist for a longer time. Intoxicated patients need close psychiatric observation and monitoring to keep them from harming themselves or others.

Another dangerous aspect of this drug is the propensity of its users to want to use other types of readily available drugs in combination, to calm themselves down or counteract the insomnia it causes. For instance, the UVA team found in a case study of one man’s three-week-long bath salts binge that his symptoms were exacerbated by his use of Benadryl to try to “come down” and sleep each night. He was hallucinating people in his yard. The drug’s interaction with the Benadryl only made things worse. An excerpt of the case study:

…the hallucinations had increased after taking diphenhydramine, which prompted him to climb onto his roof with a crossbow. He fired 2 arrows into the yard after giving the figures “the opportunity to identify themselves.” He had transient suicidal ideation later in the night, which occurred after the number of people increased from what were “always” there, 3 individuals dressed in white to 6 to 7 individuals. His plan was to use the crossbow.

Luckily, the cross-bow-wielder eventually made it to an emergency room and got help. It took about 24 hours after his last bath-salt ingestion (he was snorting the drug), until he seemed to be thinking clearly again and his heart rate was back to normal.

The UVA report ended with an extreme understatement: “a greater understanding of the behavioral pharmacology, health effects, and management of substituted cathinone use remains urgently needed.”