Synthetic cathinones are man-made drugs that produce effects similar to those from illegal drugs such as MDMA or cocaine. Also known as bath salts, these drugs sparked a disturbing wave of addiction, death and alarming side effects in South Florida and other areas. A 2012 federal law banned chemical compounds found in two popular bath salts, but new, unregulated formulations have emerged since then. Poison control centers continue to report exposure to bath salts in the United States.
Bath salts belong to a group of drugs called synthetic cathinones, which are man-made substances that are chemically similar to a natural stimulant found in the khat plant. Native to East Africa and the Arabian Peninsula, khat produces mild stimulant effects when individuals chew its leaves.
Synthetic cathinones have been deceptively marketed as bath salts — harmless minerals such as Epsom salt that are commonly added to bath water — to avoid detection from law enforcement. Distributors of these drugs have also disguised them as other household products, such as plant food and jewelry cleaner, and the packaging often states the product is not for human consumption.
Bath salts are sold in a crystalized powder form that is white or brown. The packaging is often innocuous and may resemble that of candies such as Pop Rocks.
Bath salts have been sold under a variety of brand names, including:
Naturally occurring cathinone is mild and produces minimal effects. But synthetic cathinones are designed in laboratories to mimic the effects of illicit drugs such as cocaine, crystal meth and MDMA. The synthetic products can produce much stronger side effects, including paranoia, confusion and elevated heart rate.
In addition to a wide range of severe health risks associated with using bath salts, repeated use can lead to an addiction characterized by powerful cravings and strong withdrawal symptoms.
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Bath salts have a high addiction risk, and one 2013 study even suggests that certain synthetic cathinones are more addictive than methamphetamine.
People with synthetic cathinone use disorders experience intense and unexplainable cravings for the drugs. As they increase their usa of bath salts, their addiction becomes more severe.
Bath salts users develop a tolerance to the drugs over time. The increasing tolerance causes them to require higher doses of bath salts to achieve the effects they desire.
Madeleine Ludwig was a teen in Virginia when bath salts rose to prominence. She says they were easy to buy and to find. But the euphoric effects of bath salts are often followed by an uncomfortable comedown period.
“There was always a terrible crash at the end of a bath salts bender,” Ludwig told DrugRehab.com.
The crash often causes people to take more bath salts to avoid the unpleasant feelings of coming down. This exacerbates the side effects and the likelihood of developing a substance use disorder. Once people become addicted to bath salts, they experience withdrawals if they stop using the drugs.
Withdrawal symptoms of synthetic cathinones include:
Ludwig recalls a time at the height of her substance use disorder when she went on vacation and had to go without bath salts for a few days.
“I was forced to detox when I could not bring my stash of bath salts on a plane I was taking to a Florida family vacation,” she said. “I snorted all I had in an airport hotel bathroom. Later that day, we arrived in Sarasota. I was miserable the entire vacation, excessively tired and feeling sick.”
Ludwig says that addiction to bath salts is difficult to overcome without proper support.
Many people who develop synthetic cathinone use disorders also have a concurrent mental health disorder, which doctors call a co-occurring disorder.
Using bath salts places individuals at a greater risk of developing a co-occurring mental health disorder, and having a mental health disorder increases the chance of an individual developing an addiction to bath salts.
Ludwig experienced this first hand when she was actively using bath salts. She said the person she frequently used the drugs with had a history of schizophrenia in his family. He developed schizophrenia quickly after becoming addicted to bath salts.
“Before his addiction with bath salts started, he was not yet exhibiting symptoms,” said Ludwig. “However, the bath salts caused an early onset, making the mental side effects of this drug very severe for him. Even after he stopped using the drug, his delusions of grandeur, erratic behavior and aggression remained just as prominent as when he was in active addiction.”
Bath salts use disorders have also been linked to bipolar disorder, depression and anxiety disorders.
Flakka is one of the most notorious synthetic cathinones. Before law enforcement crackdowns on the drug in 2015, stories of flakka and its unpredictable effects appeared in local newspapers across the nation.
Also known as gravel, flakka is the brand name given to the compound alpha-PVP. Flakka is generally sold as a white or pink crystalized powder that can be snorted, eaten, injected or smoked. Its use has been linked to violent reactions, hallucinations, paranoia and death.
No area was hit harder by flakka and bath salts than South Florida. According to the Drug Enforcement Administration, 22 percent of flakka cases confirmed by drug labs nationwide came from Palm Beach, Broward and Miami-Dade counties in the first six months of 2014.
The following year, Broward County formed the Flakka Action Team, a collaborative effort involving law enforcement, drug counselors, educators and community leaders. The action team developed a comprehensive prevention plan to curb flakka’s harmful effects on the community.
Neighborhoods held nightly meetings to inform community members about the drug’s potential dangers. Law enforcement aggressively pursued flakka importers and dealers and coordinated with federal authorities to maximize the effectiveness of their efforts.
The action team also advocated for change. It pressed the media to spread awareness and show the world what was happening in Broward County.
Flakka and most bath salts often entered the United States from laboratories in China. Around the same time that media coverage of the epidemic reached an all-time high, China took notice.
On Oct. 1, 2015, the Chinese government outlawed exports of alpha-PVP and 115 other chemicals used to make synthetic cathinones and other drugs.
Since then, flakka’s presence has virtually disappeared in South Florida and in other areas of the country, yet the drug still affects communities across the nation from time to time.
Countless synthetic cathinones can be found in products sold as bath salts. The link between various cathinones is that they create mind-altering effects similar to those of amphetamines such as crystal meth or cocaine.
Mephedrone and MDPV are two of the most common synthetic cathinones. Other synthetic cathinones include:
Any product that contains these substances can produce mind-altering effects when smoked, snorted or injected.
According to the National Conference of State Legislatures, all 50 states have banned synthetic cathinones as of 2011. In 2012, President Barack Obama signed the Synthetic Drug Abuse Prevention Act, which permanently banned a wide range of synthetic cannabis products and three formerly popular synthetic cathinones: mephedrone, methylone and MDPV.
Before the federal and state bans on these drugs, people could buy bath salts legally at a wide range of retail stores. Head shops, independently owned gas stations and skateboard shops became hotspots to buy bath salts.
The legality of bath salts made them easier to find and safer to purchase than hard drugs. They were a cheap and legal substitute to illicit stimulants, and they sometimes produced effects even more severe than the banned substances they imitated.
“It was a real epidemic where I was living,” Ludwig said. “As a 16-year-old, I would walk into head shops and people would just sell them to me.”
State and federal lawmakers responded to the bath salts epidemic by banning specific synthetic cathinones. Bath salts manufacturers countered this approach by slightly altering the chemical makeup of their products. They created new synthetic cathinones that produced similar effects but were not yet banned by law.
The ever-changing formulas of bath salts made them incredibly dangerous because the substances were unregulated and untested for human use. Their use caused widespread health problems, violent incidents and, in some cases, death.
In 2012, the Synthetic Drug Abuse Prevention Act banned three synthetic cathinones in the United States.
Today, many people purchase chemicals to make the drugs in household laboratories. From Jan. 1 to Aug. 31, 2016, United States poison centers reported 266 exposures to synthetic cathinones, according to the University of Maryland Center for Substance Abuse Research.
The effects of bath salts can be catastrophic to people who take them. People who use synthetic cathinones often seek a high characterized by euphoria, lowered inhibitions and increased energy. However, the side effects can also include paranoia and terrifying hallucinations.
Molly, the street name for MDMA, is a popular drug at clubs and music festivals. It comes in powder, pill or capsule form. Those who seek Molly often believe they are buying pure MDMA, but most pills or capsules are cut with other substances, such as cocaine, caffeine and bath salts.
Adding bath salts to MDMA is a cheap and easy way for dealers to make their supply last longer. Many people who take Molly are consuming dangerous synthetic cathinones without knowing it, making their reactions to the drugs unpredictable.
Some bath salts are 10 times stronger than cocaine.
Some synthetic cathinones have stronger effects than the illegal drugs they mimic. According to a study by the National Institute on Drug Abuse, the synthetic cathinone MDPV produces effects 10 times more powerful than cocaine.
“Bath Salts came with worse side effects than any other drug I have ever used,” Ludwig said. “Feelings of wakefulness and euphoria quickly turn to anxiety and hypersensitivity.”
People sometimes experience intense, impulsive bouts of psychosis that can lead to bursts of violence and dissociation from reality while using bath salts.
Bath salts side effects include:
Some side effects, such as nausea or vomiting, may disappear after a few hours or days. Other side effects, such as paranoia, may require counseling and therapy.
In rare cases, bath salts can cause extreme and unpredictable reactions that make anyone taking the drugs a danger to themselves and others.
The use of bath salts has been linked to a number of serious health problems. People who take them frequently report chest pain and cardiac issues. In many cases, people have died from respiratory or cardiac issues after using bath salts.
Bath salts users are also at risk for a rare condition called excited delirium. It is characterized by agitation, aggression, acute distress and hallucinations. Excited delirium frequently causes dehydration, breakdown of skeletal muscle tissue and kidney failure.
Nearly 10 percent of those with excited delirium die — often before emergency medical services can be administered — according to a report published in the FBI Law Enforcement Bulletin.
According to the National Institute on Drug Abuse, no medications are currently available to treat addiction to synthetic cathinones. However, there are a number of therapy techniques that can be used to rehabilitate people addicted to bath salts.
Cognitive behavioral therapy helps individuals learn how to identify and avoid destructive behaviors related to the use of synthetic cathinones. In therapy, people learn about the underlying cause of their substance abuse as well as what can trigger a bath salts binge. Therapy can also include motivational enhancement therapy and other behavioral approaches.
Substance use disorder treatment programs offer those struggling with bath salts a way out. These powerful synthetic drugs are dangerous and can easily ruin an individual’s life. Finding recovery is critical to ensure a bath salts user’s well-being and save them from a life of self-harm.