Pubdate: Sun, 17 Jul 2011
Source: New York Times (NY)
Copyright: 2011 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Michael Stravato

AN ALARMING NEW STIMULANT, LEGAL IN MANY STATES

Dr. Jeffrey J. Narmi could not believe what he was seeing this spring 
in the emergency room at Schuylkill Medical Center in Pottsville, 
Pa.: people arriving so agitated, violent and psychotic that a small 
army of medical workers was needed to hold them down.

They had taken new stimulant drugs that people are calling "bath 
salts," and sometimes even large doses of sedatives failed to quiet them.

"There were some who were admitted overnight for treatment and 
subsequently admitted to the psych floor upstairs," Dr. Narmi said. 
"These people were completely disconnected from reality and in a very 
bad place."

Similar reports are emerging from hospitals around the country, as 
doctors scramble to figure out the best treatment for people high on 
bath salts. The drugs started turning up regularly in the United 
States last year and have proliferated in recent months, alarming 
doctors, who say they have unusually dangerous and long-lasting effects.

Though they come in powder and crystal form like traditional bath 
salts - hence their name - they differ in one crucial way: they are 
used as recreational drugs. People typically snort, inject or smoke them.

Poison control centers around the country received 3,470 calls about 
bath salts from January through June, according to the American 
Association of Poison Control Centers, up from 303 in all of 2010.

"Some of these folks aren't right for a long time," said Karen E. 
Simone, director of the Northern New England Poison Center. "If you 
gave me a list of drugs that I wouldn't want to touch, this would be 
at the top."

At least 28 states have banned bath salts, which are typically sold 
for $25 to $50 per 50-milligram packet at convenience stores and head 
shops under names like Aura, Ivory Wave, Loco-Motion and Vanilla Sky. 
Most of the bans are in the South and the Midwest, where the drugs 
have grown quickly in popularity. But states like Maine, New Jersey 
and New York have also outlawed them after seeing evidence that their 
use was spreading.

The cases are jarring and similar to those involving PCP in the 
1970s. Some of the recent incidents include a man in Indiana who 
climbed a roadside flagpole and jumped into traffic, a man in 
Pennsylvania who broke into a monastery and stabbed a priest, and a 
woman in West Virginia who scratched herself "to pieces" over several 
days because she thought there was something under her skin.

"She looked like she had been dragged through a briar bush for 
several miles," said Dr. Owen M. Lander, an emergency room doctor at 
Ruby Memorial Hospital in Morgantown, W.Va.

Bath salts contain manmade chemicals like mephedrone and 
methylenedioxypyrovalerone, or MDPV, also known as substituted 
cathinones. Both drugs are related to khat, an organic stimulant 
found in Arab and East African countries that is illegal in the United States.

They are similar to so-called synthetic marijuana, which has also 
caused a surge in medical emergencies and been banned in a number of 
states. In March, the Drug Enforcement Administration used emergency 
powers to temporarily ban five chemicals used in synthetic marijuana, 
which is sold in the same types of shops as bath salts.

Shortly afterward, Senator Bob Casey, Democrat of Pennsylvania, asked 
the agency to enact a similar ban on the chemicals in bath salts. It 
has not done so, although Gary Boggs, a special agent at D.E.A. 
headquarters in Washington, said the agency had started looking into 
whether to make MDPV and mephedrone controlled Schedule I drugs like 
heroin and ecstasy.

Mr. Casey said in a recent interview that he was frustrated by the 
lack of a temporary ban. "There has to be some authority that is not 
being exercised," he said. "I'm not fully convinced they can't take 
action in a way that's commensurate with the action taken at the state level."

Senator Charles E. Schumer, Democrat of New York, introduced federal 
legislation in February to classify bath salts as controlled Schedule 
I substances, but it remains in committee. Meanwhile, the drugs 
remain widely available on the Internet, and experts say the state 
bans can be thwarted by chemists who need change only one molecule in 
salts to make them legal again.

And while some states with bans have seen fewer episodes involving 
bath salts, others where they remain fully legal, like Arizona, are 
starting to see a surge of cases.

Dr. Frank LoVecchio, an emergency room doctor at Banner Good 
Samaritan Medical Center in Phoenix, said he had to administer 
general anesthesia in recent weeks to bath salt users so agitated 
that they did not respond to large doses of sedatives.

Dr. Justin Strittmatter, an emergency room doctor at the Gulf Coast 
Medical Center in Panama City, Fla., said he had treated one man 
whose temperature had shot up to 107.5 degrees after snorting bath 
salts. "You could fry an egg on his forehead," Dr. Strittmatter said.

Other doctors described dangerously elevated blood pressure and heart 
rates and people so agitated that their muscles started to break 
down, releasing chemicals that led to kidney failure.

Mark Ryan, the director of the Louisiana Poison Center, said some 
doctors had turned to powerful antipsychotics to calm users after 
sedatives failed. "If you take the worst attributes of meth, coke, 
PCP, LSD and ecstasy and put them together," he said, "that's what 
we're seeing sometimes."

Dr. Ryan added, "Some people who used it back in November or 
December, their family members say they're still experiencing 
noticeable paranoid tendencies that they did not have prior."

Before hitting this country, bath salts swept Britain, which banned 
them in April 2010. Experts say much of the supply is coming from 
China and India, where chemical manufacturers have less government oversight.

They are labeled "not for human consumption," which helps them skirt 
the federal Analog Act, under which any substance "substantially 
similar" to a banned drug is deemed illegal if it is intended for consumption.

Last month, the drug agency made its first arrests involving bath 
salts under the Analog Act through a special task force in New York. 
Undercover agents bought bath salts from stores in Manhattan and 
Brooklyn, where clerks discussed how to ingest them and boasted that 
they would not show up on a drug test.

"We were sending out a message that if you're going to sell these 
bath salts, it's a violation and we will be looking at you," said 
John P. Gilbride, special agent in charge of the New York field 
division of the D.E.A.

The authorities in Alton, Ill., are looking at the Analog Act as they 
prepare to file criminal charges in the death of a woman who 
overdosed on bath salts bought at a liquor store in April.

"We think we can prove that these folks were selling it across the 
counter for the purposes of humans getting high," said Chief David 
Hayes of the Alton police.

Chief Hayes and other law enforcement officials said they had been 
shocked by how quickly bath salts turned into a major problem. "I 
have never seen a drug that took off as fast as this one," Chief 
Hayes said. Others said some people on the drugs could not be subdued 
with pepper spray or even Tasers.

Chief Joseph H. Murton of the Pottsville police said the number of 
bath salt cases had dropped significantly since the city banned the 
drugs last month. But before the ban, he said, the episodes were 
overwhelming the police and two local hospitals.

"We had two instances in particular where they were acting out in a 
very violent manner and they were Tasered and it had no effect," he 
said. "One was only a small female, but it took four officers to hold 
her down, along with two orderlies. That's how out of control she was."
- ---
MAP posted-by: Jay Bergstrom