“Bath salts” intoxication: a new recreational drug that presents with a familiar toxidrome

Abstract

It is important for emergency physicians to be aware of new psychoactive agents being used as recreational drugs. ''Bath salts,'' which include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, are the newest recreational stimulants to appear in Canada. There are currently more than 12 synthetic cathinones marketed as bath salts and used with increasing frequency recreationally. Although these drugs are now illegal in Canada, they are widely available online. We present a case report and discuss bath salts intoxication and its anticipated sympathomimetic toxidrome, treatment strategies, and toxicologic analysis, Treatment should not rely on laboratory confirmation. Since the laboratory identification of such drugs varies by institution and toxicologic assay, physicians should not misconstrue a negative toxicology screen as evidence of no exposure to synthetic cathinones. Illicit bath salts represent an increasing public health concern that involves risk to the user, prehospital personnel, and health care providers. RÉ SUMÉIl est important que les urgentologues connaissent les nouvelles substances psychoactives utilisé es comme drogues à usage ré cré atif. Les «sels de bain», qui contiennent de la 3,4-mé thylè nedioxypyrovalé rone (MDPV), de la mé phé -drone et de la mé thylone, sont les tout derniers stimulants à usage ré cré atif qui ont fait leur entré e au Canada. Il existe actuellement plus d'une douzaine de cathinones synthé -tiques, qui sont vendus comme des sels de bain et qui sont de plus en plus utilisé s à des fins ré cré atives. Bien que ces drogues soient maintenant illicites au Canada, on peut se les procurer facilement en ligne. Il y aura dans l'article un exposé de cas, suivi d'une discussion sur l'intoxication aux «sels de bain», le toxidrome sympathomimé tique pré visible, les straté gies de traitement et les analyses toxicologiques. Le traitement ne devrait pas reposer sur la confirmation des ré sultats des examens de laboratoire. Comme l'identification de ces drogues par les laboratoires varie d'un é tablissement à l'autre et selon les é preuves de dosage toxicologique, les mé decins ne devraient pas interpré ter à tort un test de dé pistage toxicologique né gatif comme un signe d'absence d'exposition à des cathinones synthé tiques. Les sels de bain illicites posent un problè me de santé publique, qui prend de l'ampleur et qui pré sente des risques pour l'utilisateur luimê me, pour le personnel pré hospitalier et pour les fournisseurs de soins de santé .

Quantitative structure–activity relationship analysis of the pharmacology of para‐substituted methcathinone analogues

“…Mephedrone (4‐CH 3 MCAT) is the para ‐methyl analogue of MCAT and was recently popularized in Europe and the United States as one of the primary components of bath salts (Spiller et al ., ; Vardakou et al ., ; Zuba and Byrska, ; Hall et al ., ). Because of its rapid rise to international notoriety as a designer drug of abuse, as well as its cocaine‐ and methamphetamine‐like discriminative stimulus effects, 4‐CH 3 MCAT was added to the list of controlled drugs in both the United States and the United Kingdom in 2010–2011 (Gatch et al ., ).…”

Neurocognitive dysfunction following repeated binge-like self-administration of the synthetic cathinone 3,4-methylenedioxypyrovalerone (MDPV)

“…Many synthetic cathinones, including mephedrone, MDPV, α-PVP, function as reinforcers in this paradigm and are readily self-administered via the intravenous route, as reviewed elsewhere (Watterson and Olive, 2014, Aarde and Taffe, 2017, Watterson and Olive, 2017). Yet most, if not all, of these prior studies in rodents were conducted under conditions of limited daily access (e.g, 1–6 hr/day), and it is clear from a myriad of case reports that human synthetic cathinones users often engage in binge-like patterns of intake spanning several consecutive days or even weeks (Winstock et al, 2011, Ross et al, 2012, Forrester, 2013, Gunderson et al, 2013, Miotto et al, 2013, Wright et al, 2013, Hall et al, 2014, Palamar et al, 2015, Barrio et al, 2016). It is therefore of great importance to implement rodent models of long term repeated binge-like self-administration patterns that are frequently observed in human synthetic cathinone users.…”

Comprehensive review of cardiovascular toxicity of drugs and related agents

“…The treatment of cathinone cardiotoxicity is similar to that of amphetamines or cocaine overdose. In cases of hyperthermia, extensive cooling is needed . Similar to synthetic cathinones, some piperazines possess significant, complex sympathomimetic activity and other effects on monoamine receptors, in particular those associated with serotonin.…”

“…In cases of hyperthermia, extensive cooling is needed. [73][74][75][76][77][78] Similar to synthetic cathinones, some piperazines possess significant, complex sympathomimetic activity and other effects on monoamine receptors, in particular those associated with serotonin. For this reason, they are labeled as "legal ecstasy" and sometimes sold instead of "ecstasy" (MDMA).…”