Bath Salts – Medical Director Update

Dr. Allan Holmes & Dr. Erik Vu
Clinical Snapshot: Bath Salts
Subject: Synthetic cathinones
Street name: “Bath Salts”, “Plant Food”, “Cloud Nine”, “Rave”.

What are “Bath Salts”?

Psychoactive drugs containing MDPV1 have entered the recreational drug market, with a recent surge in the United States (US) and Canada. These products are often labeled as “bath salts” or “plant food,” and have been used legally for decades in parts of the US and Europe. These products are also available for online purchase and may be sold under such names as “Cloud Nine” or “Rave.”

What do “Bath Salts” look like?

MDPV and other analogues (e.g. Mephedrone) are often supplied as white powders. Users can snort or ingest these white or brown amorphous or crystalline powders, but since they are soluble in water, these substances can also be injected.

Bath Salts

What are the effects of “Bath Salts”?

MDPV has a chemical structure similar to MDMA2 or “Ecstasy”. The intended effects are improved attention, energy, and euphoria. Clinical features include altered mental status, agitation, delusions, hallucinations, psychosis, fast heart rate, high blood pressure, chest pain and elevated core body temperature, amongst others.

Why are “Bath Salts” dangerous?

MDPV is used as substitute for other stimulants such as amphetamines, cocaine or ecstasy because it can produce the same effects on the brain. MDPV toxicity can present as excited or agitated delirium. Mainstream media have reported bizarre suicides and homicides. Drug-induced psychosis and aggression appear to be more severe than with other amphetamine-like stimulants.

How do you manage patients high on “Bath Salts”?

Agitated patients require urgent medical assessment. Caution should be used when restraining these patients due to the potential of cardiac arrest in patients with excited delirium.

Summary of Key Points

  • MDPV (i.e. “Bath Salts”), has strong stimulant effects similar to cocaine and amphetamines. This compound can be considered an emerging designer drug of abuse.
  • The psychoactive profile of these drugs has gained popularity with widespread use of this compound as recreational drug, particularly among young people.
  • The marketing of MDPV as “bath salts” or “plants fertilizer” provided false assurances on the safety of this substance as drug of abuse.
  • Current case reports show the potential for severe cardiovascular and central nervous system toxicity.
  • Excited delirium is characterized by delirium with agitation, elevated temperature, elevated heart rate and breathing pattern, and can be followed by a period of “giving up,” or cessation of struggle, followed by cardiac arrest.
  • Use caution when engaging a patient exhibiting these signs or symptoms. Use caution if/when restraining these patients.
  • Considering the limited information about the clinical, pharmacological and toxicological effects of this substance in combination with the potential health risks, the alertness of the medical and law-enforcement community is of great importance in order to mitigate the downstream effects of MDPV use.

Best Regards,

Allan Holmes

Medical Director, Iridia

13,4-methylenedioxypyrovalerone, or MDPV
2methylenedioxymethamphetamine, or MDMA