Drug Information Rounds

Synthetic Cathinones (Bath Salts): Legal Status and Patterns of

Abuse

Jennifer A Fass, Andrea D Fass, and Angela S Garcia

Request
Should bath salts be permanently desig-
nated as Schedule I controlled substances
under federal law?
Response
BACKGROUND
Over the past 12 months, bath salts
abuse has increased across the US, lead-
ing to widespread public health con-
cerns.1 These products are also advertised
as bath crystals, plant food, and herbal in-
cense. They are available in small quanti-
ties (milligram or one-half gram packages)
and are not the same as legitimate com-
mercial bath products such as Calgon or
Aveeno for the bath. Common brand
names of these products marketed in all 50
US states and via the Internet include Blue
Silk, Charge+, Ivory Snow, Ivory Wave,
Ocean Burst, Pure Ivory, Purple Wave,
Snow Leopard, Stardust, Vanilla Sky,
White Knight, and White Lightening.1 The
most common active ingredients contained
in brand products consist of methylenedi-
oxypyrovalerone (MDPV) (3,4-methyl-
enedioxypyrovalerone) and/or mephe-
drone (4-methylmethcathinone). Bath salts
have been available for purchase at convenience stores, dis-
count tobacco outlets, gas stations, pawnshops, tattoo parlors,
and truck stops. The packaging of these products usually in-
cludes the disclaimer, “not for human consumption,” to
Author information provided at end of text.
OBJECTIVE: To review the current legal status and patterns of abuse of bath salts.
DATA SOURCES: A literature search was conducted through MEDLINE (1950-
December 2011), PubMed (1966-December 2011), EMBASE (1966-December
2011), and International Pharmaceutical Abstracts (1970-December 2011) using
the search terms bath salts, mephedrone, and methylenedioxypyrovalerone to
identify articles on the legal status of bath salts and on studies focusing on patterns
of abuse of bath salts. The GovTrack.us Web site was searched to determine the
status of federal bills regarding bath salts. The National Association of Boards of
Pharmacy and Drug Enforcement Administration Web sites and the Federal
Register were also examined to identify legislation on bath salts.
STUDY SELECTION AND DATA EXTRACTION: Case reports and studies regarding
bath salts were examined. Federal laws involving bath salts were also evaluated.
DATA SYNTHESIS: The Department of Justice issued a final order in the Federal
Register, temporarily placing the 3 synthetic stimulants, mephedrone, methylenedi-
oxypyrovalerone, and methylone, under Schedule I of the Controlled Substances
Act. Literature evaluated included case reports, retrospective studies, surveys,
toxicology data, and chemical analyses studies. Information in the literature
demonstrated that bath salts are highly abused, and common adverse effects
include hypertension, tachycardia, and psychiatric symptoms.
CONCLUSIONS: Psychoactive substances recently sold as bath salts have been
placed in Schedule I of the Controlled Substances Act. Pharmacists can play an
important role in raising awareness on the dangers of bath salts abuse through
patient counseling and community outreach programs. The evidence on legal
status and patterns of abuse clearly demonstrates that bath salts contain dangerous
substances that should be permanently controlled.
KEY WORDS: bath salts, MDPV, mephedrone, methylenedioxypyrovalerone,
synthetic cathinones.
Ann Pharmacother 2012;46:436-41.
Published Online, 28 Feb 2012, theannals.com, DOI 10.1345/aph.1Q628
evade the authorities and avoid regulation of these sub-
stances.1 The products are typically sold in 50-mg to 500-mg
packets, and the price ranges from $25 to $50 per 50-mg
packet. The typical age of individuals who abuse bath salts
ranges from teens to the 40s, and these individuals tend to
have an extensive history of drug abuse.1 Toxicology reports
and an autopsy report from the medical examiner’s office of

436 n The Annals of Pharmacotherapy n 2012 March, Volume 46 theannals.com

Hillsborough County, Florida, revealed that a man died from
an overdose of bath salts on April 3, 2011.2 The individual
demonstrated abnormal behavior, including walking in traffic
and hitting cars. Additionally, he was misdiagnosed with viral
meningitis, as his body temperature increased to more than
41 ˚C when he died.2 A recent federal emergency ruling that
banned the use of the active ingredients within these bath
salts, along with actions taken by the state of Florida to place
bath salts in that state’s Schedule I list of controlled sub-
stances, prompted us to conduct this review of bath salts
abuse, which appears to be on the increase globally.3,4
PHARMACOLOGY
Mephedrone and MDPV are described as designer drugs
in the phenethylamine class, structurally similar to meth-
cathinone. Methcathinone is a Schedule I controlled sub-
stance.5-7 Cathinone is a natural, amphetamine-like alkaloid
found in the fresh leaves and stems of the African shrub
Catha edulis. These drugs are pharmacologically similar to
methamphetamine and methylenedioxymethamphetamine
(MDMA) and are known to produce similar adverse ef-
fects. Short-term adverse effects of bath salts include
tachycardia, sleep deprivation, agitation, appetite suppres-
sion, increased alertness and awareness, anxiety, delusions,
and nosebleeds. Serious adverse effects include muscle
spasms, hypertension, renal failure, seizures, hallucina-
tions, aggression, severe paranoia, panic attacks, and hy-
perthermia. The duration of effects is approximately 3- 4
hours, with adverse effects continuing for 6-8 hours after
consumption.5-7
LITERATURE REVIEW
A literature search was conducted through MEDLINE
(1950-February 2012), PubMed (1966-February 2012), EM-
BASE (1966-February 2012), and International Pharmaceu-
tical Abstracts (1970-February 2012), using the search terms
bath salts, mephedrone, and methylenedioxypyrovalerone to
identify legal studies. The GovTrack.us site was searched to
determine the status of the federal bill regarding these bath
salts. Also, the National Association of Boards of Pharmacy
Web site was searched for news updates on legal status
changes for bath salts. The Federal Register was also
searched to identify notices and proposed rules.
Legal Status
The Department of Justice/Drug Enforcement Adminis-
tration (DEA) issued a final ruling in the October 21, 2011,
Federal Register, temporarily placing the 3 synthetic stim-
ulants mephedrone, MDPV, and methylone under Sched-
ule I of the Controlled Substances Act, meaning that these
substances have no accepted medical use in the US and a
high potential for abuse.4,8 This order will control these
theannals.com The Annals of Pharmacotherapy
substances for at least 12 months, with the possibility of a
6-month extension, while the DEA and Department of
Health and Human Services determine whether the bath salts
chemicals should be permanently controlled.4 The following
are 8 factors that the Attorney General considers when
proposing to schedule a substance: “(1) its actual or relative
potential for abuse; (2) scientific evidence of its pharmaco-
logical effect, if known; (3) the state of current scientific
knowledge regarding the drug or other substance; (4) its his-
tory and current pattern of abuse; (5) the scope, duration, and
significance of abuse; (6) what, if any, risk there is to public
health; (7) its psychic or physiological dependence liability;
and (8) whether the substance is an immediate precursor of a
substance already controlled under this subchapter.”9 When
substances are temporarily scheduled, only factors 4-6 are
considered for threats to public safety.9
The UK banned mephedrone and other cathinone deriva-
tives on April 16, 2010, under the 1971 Misuse of Drugs Act,
followed by the Republic of Ireland.10 Mephedrone was first
recognized by the United Nations Office on Drug Crime in
December 2008 after the death of an 18-year-old Swedish
woman in whom this was the only substance detected
through toxicology testing. It has since been involved in ap-
proximately 25 deaths in the UK.11 As of September 15,
2011, at least 37 states in the US had instituted regulatory
controls or used emergency scheduling to place bath salts on
controlled substances lists.4 Since the DEA is placing these
bath salts substances under Schedule I, this action supersedes
states’ laws, thereby designating these substances as con-
trolled in all states.
Patterns of Abuse
Table 1 summarizes published studies that include sur-
veys and toxicology analyses that support the dangers of
bath salts.12-24
Case reports have revealed a variety of adverse effects
associated with the use of bath salts, including tachycardia,
hypertension, diabetic ketoacidosis, delusions, paranoid
psychosis, hyperthermia, dizziness, agitation, headaches,
hyponatremia, acute liver failure, suicide, and death.25-39
US poison centers first began receiving calls regarding
adverse effects of bath salts in December 2010.39 Adverse
effects included increased blood pressure, tachycardia, hal-
lucinations, paranoia, and delusions. Between 2010 and
January 31, 2012, US poison centers received 6670 calls
about human exposure to bath salts.40
PHARMACISTS’ ROLE
Pharmacists can play an active role in improving public
awareness and patient outcomes by increasing the aware-
ness, detection, and reporting of bath salts abuse or over-
dose. Pharmacists should inquire about bath salts abuse
when assessing patients for illegal drug use, especially in
n 2012 March, Volume 46 n 437
 Table 1. Summary of Selected Bath Salts Studies

438
Pts., Baseline

n
Design N Demographics Results
JA Fass et al.

12
Retrospective 35 Age, 20-55 y 17 pts. hospitalized; 1 pt. dead on arrival (high levels of MDPV detected, along with marijuana and prescription drugs); 17 pts. with known drug test
Men (54%) results: 94% tested positive for other drugs (eg, marijuana, opiates, benzodiazepines, cocaine, amphetamines)
Women (46%) Administration method: injection (63%), snorting (26%), oral ingestion (11%)
Self-reported history of Adverse effects: neurologic (91%), cardiovascular (77%), psychological (49%)
abuse (69%)
Cross-sectional 2295; 947 Mean age, 23.8 y Mephedrone sixth most commonly abused drug:
online survey13 (41.3%) Male 69.3% used within past 12 months, n = 890; used in past month, n = 762; used at least weekly, n = 137 (15.1%); majority (69.7%) consumed monthly or
mephedrone less; 49.5% reported using between 0.5 g and 1 g per session
users Administration method: snorting (65.9%), intranasal use more likely among women (p < 0.01) than men; quantity used per session larger for snorting
vs oral ingestion (p < 0.001)
Adverse effects: palpitations more frequent with intranasal administration (p < 0.01)
Comparison with cocaine: majority of previous cocaine users reported mephedrone provided longer lasting (65.2%) and better (54.6%) high; snorters
more likely to rate mephedrone as more addictive (p < 0.02) and as carrying more risks (p < 0.02) than cocaine than individuals taking drug orally

The Annals of Pharmacotherapy

Cross-sectional 1506 Mean age, 26 y Began using mephedrone:

n
online survey14 Male, 84% prior to 2009, 20%
Reside in UK, 80% in 2009 or 2010, 80%
Typical quantity: 500 mg/session
Preferred route: intranasal (57%), oral (28%)
Ban impact: use mephedrone less (64%), stockpiled in anticipation of ban (30%)
Comparison of MDMA, cocaine, mephedrone:
reported mephedrone most similar to MDMA (49%), reported cocaine most similar (21%), do not prefer effects of mephedrone over MDMA (73%)
Adverse effects: experienced negative effects (20%); anxiety, panic, palpitations most common
Cross-sectional 150 Mean age, 24 y Postban: 95 (63%) continued use, 52 (55%) intended to continue using same quantity, 85 (57%) purchased from dealer; price doubled
online survey15

2012 March, Volume 46

Prospective16 140 Used heroin (90%), Symptoms
marijuana (3%), or somatic: headache (75%), dizziness (46%), weight reduction (97%), cardiac disorders (74%), paresthesia (48%), myalgia (12%)
ketamine (1%) psychiatric: euphoria (92%), insomnia (95%), communication disorder (96%), psychomotor excitation (97%), auditory and visual hallucinations (25%),
paranoid thoughts (15%), paroxysmal anxiety (8%), depression (10%)
Treatment: benzodiazepines, valproate (75%), atypical antipsychotics (30%), heroin-addicted pts. continued methadone (75%) and suboxone (25%)
Symptom remission: developed cravings first week of detoxification treatment (30%)
Chemical Products, 129 Cathinones, 33% of samples; 85% of 20 products supplied in >1 month contained same compounds; mephedrone detected; MDPV detected in
analysis17 postlegislation samples
Semistructured 23 Age, 19-51 y; history Mephedrone doses consumed, 1-2 g; current users, 87%; stopped because of AEs (vomiting, paranoia), 3
interviews18 of substance abuse Abuse patterns: reported burning in nasal passages with sensation of “snorting razor blades”
Pre-ban behaviors: no respondents considered mephedrone safer prior to the ban; obtained through friends, dealers, Internet-based and street-
based “headshops”; no credit card purchases because of fear of being identified
Post-ban behavior: purchased through dealers; drug widely available first 10 weeks after ban
Chemical 4 fatalities Mephedrone present in 4 deaths; cause of death in 2 cases labeled mephedrone intoxication; concomitant drugs included diazepam,
analysis19 amphetamines, marijuana
Cross-sectional 1006 Attending Used mephedrone at least once, n = 205 (20.3%); used daily, 4.4%
survey20 college/university Method of obtaining drug: dealer (48.8%), Internet (10.7%), found mephedrone very easy to obtain, 66.6%
during study, 65% Adverse effects reported, 56%; bruxism (28.3%), paranoia (24.9%), sore nasal passages (24.4%), hot flushes (23.4%),
sore mouth/throat (22.9%), nose bleeds (22.4%)

theannals.com
 Cross-sectional 100 Age (mean), 25.1 y; Typical mephedrone consumption, 500 mg; average duration of use, 6.1 months; intranasal use, 79%
telephone used mephedrone at Reported at first session (n): consumed alcohol 89; used cocaine 17; MDMA 23; cannabis 34; ketamine 24
interview; least once in past 12 Adverse effects:
urine months acute: increased energy, euphoria, talkativeness
toxicologic Lifetime prevalence: withdrawal: tiredness, insomnia, nasal congestion, impaired concentration
analysis21 MDMA (96%), DSM-IV dependence symptoms and intention to use next month:

theannals.com
cocaine (92%) 3 or more symptoms, 29.5%
concerned about mephedrone use, 33.7%
intended to use in next month, 47%
provided urine sample, 55%
Mephedrone identified in all 14 urine samples
Chemical Mephedrone Ecstasy regular users, Ecstasy composition: <50% of tablets contained MDMA in first half of 2009
analysis of users, 70; 63 Drug Information and Monitoring System: 995 mephedrone tablets sold as ecstasy, representing 11.5% of ecstasy tablets in 2009
mephedrone ecstasy Quantity of mephedrone base (range): 96-155 mg/tablet
and ecstasy tablets, Acute adverse effects reported (mephedrone users, n = 70): increased alertness, 28; euphoria, 63; drug craving, 61; talkative, 51, hyperactivity, 56;
tablets and 12,331 distorted vision, 33; tachycardia, 44; abnormal sleep, 33; overall enjoyable experience, 58
retrospective
analysis of
mephedrone
adverse
effects22
Chemical Products, 17 6 weeks post-ban, majority of products contained mephedrone and MDPV
analysis23
Retrospective Cathinone Mephedrone used alone Adverse effects: tachycardia, palpitations, agitation, anxiety, mydriasis, tremor, fever, nausea, dizziness, headache, sweating, hypertension
analysis, exposure or in combination
National calls, 188; with alcohol and other
Poisons calls drugs
Information involving
Service via mephedrone,
TOXBASE24 157

AEs = adverse events; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; MDMA = 3,4-methylenedioxymethamphetamine; MDPV = 3,4-methylenedioxypyrovalerone.

The Annals of Pharmacotherapy

n
2012 March, Volume 46
439 n
Synthetic Cathinones (Bath Salts): Legal Status and Patterns of Abuse
JA Fass et al.
patients with cardiovascular and psychiatric conditions.
Pharmacists can play a key role in patient education re-
garding the dangers of abuse through community outreach
programs, and they can counsel individuals on the adverse
effects of bath salts abuse. Additionally, pharmacists can
register to receive free email alerts from the Federal Regis-
ter at http://Listserv.access.gpo.gov/ to stay informed on
federal regulations on bath salts.
Discussion
Mephedrone has been the most widely studied bath salt
substance in the literature. Evidence suggests that most in-
dividuals consume between 500 mg and 2 g of mephedrone
per use session. Most study participants abused mephedrone
via the intranasal route and purchased the substance through
a dealer. Individuals continued purchasing mephedrone after
it was banned in the UK. The most common adverse effects
included nasal irritation, hypertension, tachycardia, and psy-
chiatric symptoms. Additionally, there has been a small num-
ber of mephedrone- or bath salts–related deaths reported. In
the case reports that documented deaths, most individuals
had a history of polysubstance abuse, resulting in difficulty
determining whether bath salts were the direct cause of the
adverse events or whether the effects were exacerbated by
other substances. Most of the literature consists of case re-
ports and cross-sectional studies, which are not the highest
level of evidence. However, current literature does demon-
strate the existence of a public health emergency. The US
poison center data should be further analyzed to determine
whether the emergency ban on bath salts and their placement
as Schedule I controlled substances correlate with a decrease
in the number of calls regarding abuse of bath salts.
Summary
The evidence on legal status and patterns of abuse clear-
ly demonstrate that bath salts should be permanently clas-
sified as Schedule I controlled substances under the Con-
trolled Substances Act. The DEA has recognized the need
to control these substances by temporarily placing them in
Schedule I. Pharmacists can play an important role in rais-
ing awareness of the dangers of bath salts abuse through
patient counseling and community outreach programs.
Jennifer A Fass PharmD CPh, Clinical Assistant Professor, De-
partment of Pharmacy Practice, College of Pharmacy, Nova South-
eastern University, Center for Consumer Health Informatics Re-
search, Ft. Lauderdale, FL
Andrea D Fass PharmD, Assistant Professor, Department of Phar-
macy Practice, Arnold & Marie Schwartz College of Pharmacy &
Health Sciences—Long Island University, Brooklyn, NY; Clinical
Pharmacy Manager, Ambulatory Care, Montefiore Medical Group,
Comprehensive Family Care Center, Bronx, NY
Angela S Garcia PharmD CPh, Assistant Professor, Department
of Pharmacy Practice, College of Pharmacy, Nova Southeastern
University, Center for Consumer Health Informatics Research
Correspondence: Dr. Fass, fass@nova.edu
440 n The Annals of Pharmacotherapy n 2012 March, Volume 46
Reprints/Online Access: www.theannals.com/cgi/reprint/aph.1Q628
Conflict of interest: Authors reported none
We thank William Wolowich PharmD, Chair, Department of Pharmacy Practice, Col-
lege of Pharmacy, Nova Southeastern University, for reviewing this article.
References
1. US Department of Justice. Drug alert watch: increasing abuse of bath
salts. www.justice.gov/ndic/pubs43/43474/sw0007p.pdf (accessed 2011
Nov 18).
2. ABC News. ‘Imitation cocaine’ killed Florida man, say authorities.
http://abcnews.go.com/Blotter/bath-salts-killed-florida-man-
authorities/story?id = 13746152 (accessed 2011 Nov 18).
3. The Florida Senate. Chapter 2011-90 Senate House Bill 1039 (2011).
http://Laws.flrules.org/files/Ch_2011-090.pdf (accessed 2011 Nov 18).
4. Department of Justice, Drug Enforcement Administration. 21 CFR Part
1308. Schedules of controlled substances: temporary placement of three
synthetic cathinones into schedule I. Fed Reg 2011;76:204. http://frweb-
gate1.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID = 3kZ7oe/1/2/
0&WAISaction = retrieve (accessed 2011 Nov 14).
5. Schifano F, Fergus S, Corazza O, et al. Mephedrone (4-methylmethcathi-
none; ‘meow meow’): chemical, pharmacological and clinical issues.
Psychopharmacology 2011;214:593-602.
6. Meyer MR, Maurer HH. Metabolism of designer drugs of abuse: an up-
dated review. Curr Drug Metab 2010;11:468-82.
7. Drug Enforcement Administration. Methylenedioxypyrovalerone
(MDPV). www.deadiversion.usdoj.gov/drugs_concern/mdpv.pdf (ac-
cessed 2011 Nov 18).
8. US Drug Enforcement Administration. Schedules of controlled sub-
stances. 21 U.S.C. 812 (1). www.deadiversion.usdoj.gov/21cfr/21usc/
812.htm (accessed 2011 Nov 17).
9. US Drug Enforcement Administration. 21 U.S.C. 811. Authority to con-
trol; standards and schedules. www.deadiversion.usdoj.gov/21cfr/21usc/
811.htm (accessed 2011 Nov 17).
10. The Misuse of Drugs Act 1971 (amendment) order 2010. No. 1207.
Dangerous drugs. www.legislation.gov.uk/uksi/2010/1207/pdfs/uksi_
20101207_en.pdf (accessed 2011 Nov 18).
11. Morris K. UK places generic ban on mephedrone drug family. Lancet
2010;375:1333-4.
12. Centers for Disease Control and Prevention. Emergency department visits
after use of a drug sold as bath salts—Michigan, November 13, 2010-
March 31, 2011. MMWR Morb Mortal Wkly Rep 2011;60:624-7. www.
cdc.gov/mmwr/preview/mmwrhtml/mm6019a6.htm (accessed 2011 Nov
18).
13. Winstock AR, Mitcheson LR, Deluca P, Davey Z, Corazza O, Schifano
F. Mephedrone, new kid for the chop? Addiction 2011;106:154-61.
14. Carhart-Harris RL, King LA, Nutt DJ. A Web-based survey on
mephedrone. Drug Alcohol Depend 2011;118:19-22.
15. Winstock A, Mitcheson L, Marsden J. Mephedrone: still available and
twice the price (letter). Lancet 2010;376:1537.
16. Simu MI, Hudita C, Rosca MC, et al. The mephedrone addiction phe-
nomenon (abstract). Int J Neuropsychopharmacol 2010;13:56.
17. Dargan PI, Davies S, Smith G, et al. A study assessing the content of le-
gal highs purchased from the internet (abstract). Clin Toxicol 2010;
48:604-67.
18. McErath K, O’Neill C. Experiences with mephedrone pre- and post-leg-
islative controls: perceptions of safety and sources of supply. Int J Drug
Policy 2011;22:120-7.
19. Torrance H. The detection of mephedrone (4-methylmethcathinone) in 4
fatalities in Scotland. Forensic Sci Int 2010;202:e62-3.
20. Dargan PI, Albert S, Wood DM. Mephedrone use and associatied ad-
verse effects in school and college/university students before the UK leg-
islation change. Q J Med 2010;103:875-9.
21. Winstock A, Mitcheson L, Ramsey J, et al. Mephedrone: use, subjective
effects and health risks. Addiction 2011;106:1991-6.
theannals.com

22. Brunt TM, Poortman A, Niesink RJM, et al. Instability of the ecstasy mar-
ket and a new kid on the block: mephedrone. J Psychopharmacol 2011;25:
1543-7.
23. Brandt SD, Sumnall HR, Measham F, et al. Second generation mephedrone:
the confusing case of NRG-1 (letter). BMJ 2010;341:c3564.
24. James D, Adams RD, Spears R, et al. Clinical characteristics of
mephedrone toxicity reported to the UK National Poisons Information
Service. Emerg Med J 2011;28:686-9.
25. Wong ML, Holt RIG. The potential dangers of mephedrone in people
with diabetes: a case report. Drug Test Anal 2011;3:464-5.
26. Antonowicz JL, Metzger AK, Ramanujam SL. Paranoid psychosis in-
duced by consumption of methylenedioxypyrovalerone: two cases. Gen
Hosp Psychiatry 2011;33:640.e5-6
27. Smith C, Cardile AP, Miller M. Bath salts as a “legal high.” Am J Med
2011;124:e7-8.
28. Durham M. Ivory wave: the next mephedrone? Emerg Med J 2011;
28:1059-60.
29. Regan L, Mitchelson M, Macdonald C. Mephedrone toxicity in a Scot-
tish emergency department. Emerg Med J 2011;28:1055-8.
30. Lusthof KJ, Oosting R, Maes A, et al. A case of extreme agitation and
death after the use of mephedrone in the Netherlands. Forensic Sci Int
2011;206:e93-5.
31. Wood DM, Davies S, Greene SL, et al. Case series of individuals with
analytically confirmed acute mephedrone toxicity. Clin Toxicol 2010;
48:924-7.
32. Nicholson PJ, Quinn MJ, Dodd JD. Headache heartache: acute
mephedrone ‘meow’ myocarditis. Heart 2010;96:2051-2.
33. Sammler EM, Foley PL, Lauder GD, et al. A harmless high? Lancet
2010;376:742.
34. Frohlich S, Lambe E, O’Dea J. Acute liver failure following recreational use
of psychotropic “head shop” compounds. Ir J Med Sci 2011;180:263-4.
35. Dickson AJ, Vorce SP, Levine B, et al. Multiple-drug toxicity caused by
the coadministration of 4-methylmethcathinone (mephedrone) and hero-
in. J Anal Toxicol 2010;34:162-8.
36. Maskell PD, Paoli GD, Seneviratne C, et al. Mephedrone (4-methyl-
methcathinone)-related deaths. J Anal Toxicol 2011;35:188-91.
37. Mackay K, Taylor M, Bajaj N. The adverse consequences of mephe-
drone use: a case series. Psychiatrist 2011;35:203-5.
38. Penders TM, Gestring R. Hallucinatory delirium following use of
MDPV: “bath salts.” Gen Hosp Psychiatry 2011;33:525-6.
39. Murray BL, Murphy CM, Beuhler MC. Death following recreational use
of designer drug “bath salts” containing 3,4-methylenedioxypy-
rovalerone (MDPV). J Med Toxicol 2012. Epub 20 Jan 2012.
DOI 10.1007/S13181-011-0196-9
40. American Association of Poison Control Centers. Bath salts data. Updat-
ed February 8, 2012. www.aapcc.org/dnn/Portals/0/Bath%20Salts%20
Data%20for%20Website%202.8.2012.pdf (accessed 2012 Feb 17).
Estado Legal y Patrones de Abuso de las Catinonas Sintéticas
(“Sales de Baño”)
JA Fass, AD Fass, y AS Garcia
Ann Pharmacother 2012;46:436- 41.
EXTRACTO
FUENTES DE DATOS: Una búsqueda de la literatura se llevó a cabo mediante
MEDLINE (1950-febrero 2012), PubMed (1966-febrero 2012),
EMBASE (1966-febrero 2012), y Extractos Farmacéuticos
Internacionales (1970-febrero 2012) usando los términos de búsqueda
“sales de baño”, mefedrona, metilenodioxipirovalerona para identificar
artículos y estudios legales enfocados en patrones de abuso. Se buscó en
el sitio GovTrack.us para determinar el estado de los proyectos de ley
theannals.com The Annals of Pharmacotherapy
Synthetic Cathinones (Bath Salts): Legal Status and Patterns of Abuse
federales sobre las “sales de baño”. Los sitios web de la Asociación
Nacional de Juntas de Farmacia y la Administración de Control de
Drogas, y el Registro Federal también fueron examinados para identificar
legislación sobre “sales de baño”.
SELECCIÓN DE ESTUDIOS Y EXTRACCIÓN DE DATOS: Los informes y estudios
de casos sobre “sales de baño” fueron examinados. Las leyes que
involucran las “sales de baño” también fueron evaluadas.
SÍNTESIS DE DATOS: El Departamento de Justicia emitió una orden final en
el Registro Federal colocando temporalmente los tres estimulantes
sintéticos mefedrona, metilenodioxipirovalerona, y metilona bajo la
Clasificación I de la Ley de Sustancias Controladas. La literatura
evaluada incluyó informes de casos, estudios retrospectivos, encuestas,
datos de toxicología, y estudios de análisis químicos. La literatura
demostró que las “sales de baño” son altamente abusadas y los efectos
adversos comunes incluyen hipertensión, taquicardia, y síntomas
siquiátricos.
CONCLUSIONES: Las sustancias psicoactivas recientemente vendidas
como “sales de baño” han sido colocadas en la Clasificación I de la Ley
de Sustancias Controladas. Los farmacéuticos pueden jugar un papel
importante al levantar conciencia sobre los peligros del abuso de las
“sales de baño” mediante la consejería al paciente y programas de
extensión comunitaria. La evidencia sobre el estado legal y patrones de
abuso demuestra claramente que las “sales de baño” contienen
sustancias peligrosas que deben ser controladas permanentemente.
Traducido por Ana E Vélez
Cathinones Synthétiques (Sels de Bain): Cadre Réglementaire et
Profils d’Abus
JA Fass, AD Fass, et AS Garcia
Ann Pharmacother 2012;46:436-41.
RÉSUMÉ
OBJECTIFS: Revoir le cadre réglementaire et le profil d’abus des
cathinones.
SOURCES DE L’INFORMATION: Les bases de données MedLIne (1950-
février 2012), PubMed (1966-février 2012), EMBASE (1966-février
2012), et International Pharmaceutique Résumé (1970-février 2012) ont
été questionnées en utilisant les mots-clés: bath salts, mephedrone ,
methylenedioxypyrovalerone pour identifier les articles légaux et les
rapports d’essais portant sur le profil d’abus. Le site GovTrack.us a aussi
été consulté pour connaitre le statut réglementaire des cathinones. Les
sites de la National Association of Boards of Pharmacy et la Drug
Enforcement Administration et le Federal Register ont aussi été
consultés à cette même fin.
SÉLECTION DES ÉTUDES ET EXTRACTION DE L’INFORMATION: Les rapports de
cas et les essais portant sur les cathinones ont été examinés de même que
les lois fédérales.
SYNTHESE DE L’INFORMATION: Le Département de la Justice a émis un
décret inscrivant les trois cathinones synthétiques stimulantes:
méphédrone, méthylènedioxypyrovalérone, et la méthylone à l’annexe I
de la loi sur les substances contrôlées. Les publications étaient
principalement constituées de rapport de cas, d’essais rétrospectifs, de
sondages, de données toxicologiques et des analyses chimiques. Ces
publications démontrent que les cathinones sont utilisés comme produits
d’abus et dont les effets indésirables les plus fréquents sont
l’hypertension, la tachycardie et des symptômes psychiatriques.
CONCLUSIONS: Les substances psychoactives que sont les cathinones sont
maintenant inscrites à l’annexe I de la loi sur les substances contrôlées.
Les pharmaciens peuvent jouer un rôle important pour sensibiliser aux
dangers de ces substances, soit par des conseils aux patients ou par des
formations de groupe. Le profil d’abus et le statut légal supportent la
conclusion que ces produits sont des substances dangereuses et qu’elles
doivent demeurer sous contrôle constant.
Traduit par Marc Parent
n 2012 March, Volume 46 n 441