This is a presentation about the "bath salts" synthetic cathinone drugs of abuse given as part of an upper-level undergraduate psychology course at Temple University titled "Investigation of Addiction Disorders". I was invited to give this presentation by the course director, Dr. Rani Vasudeva. This class involved both an introductory and final discussion with questions listed in the second and final slide, which was both lively and enjoyable to be a part of. Special thanks for Dr. Vasudeva for the opportunity to teach in her course.

1. ““Bath Salts”Bath Salts”
The synthetic cathinoneThe synthetic cathinone
Drugs of abuseDrugs of abuse
Ryan Gregg
Doctoral Candidate, CSAR, TUSM
tud51613@temple.edu
Thursday, April 24th
2014

2. Give me your thoughts:Give me your thoughts:
For the first 5 minutes of class, give me your thoughts on
the following question:
What do you typically think of when you hear the term
“designer drugs”? What about the term “research
chemical”? Are they more or less dangerous? What type
of people abuse them? Can you become addicted to
designer drugs?

3. OutlineOutline
• Chemical classification
• History of synthetic cathinones
• Neurological and pharmacological effects of “Big 3”
• Prevalence/Legality
• Clinical observations
• Trends in new and emerging cathinones
• Discussion

4. Synthetic CathinonesSynthetic Cathinones
=

5. Synthetic Cathinones: Novel PsychostimulantsSynthetic Cathinones: Novel Psychostimulants
• New class of designer
psychostimulants known
on the streets as “plant
food” or “bath salts”
• Beta-ketone
amphetamines
• Popularized as “legal
high” alternatives in
head shops and Internet
sites
Mephedrone
MDPV
Methylone
Cathinone
Methcathinone
Amphetamine

6. History: CathinoneHistory: Cathinone
• Cathinone is the primary
psychoactive component of
the plant Catha edulis aka
khat
• Native to North Africa and
the Arabian peninsula
• Leaves are chewed for their
stimulant properties
Catha edulis
Yemenese man chewing khat leaves

7. History: Cathinone and MethcathinoneHistory: Cathinone and Methcathinone
• Cathinone produces
stimulant-like profile similar
to ephedrine
• Methcathinone, the alpha
methylated version of
cathinone, was synthesized
in the US in 1928 and
patented in the US in 1957 80 million yuan ($12.6 million US)
seized in China in 2011 from organized
crime selling methcathinone

8. Revival: Mephedrone, MDPV, MethyloneRevival: Mephedrone, MDPV, Methylone
• Mephedrone, MDPV, and
methylone were synthesized in the
1960s, but re-emerged in 2003
• Online designer drug communities
linked to rapid rise in use worldwide
• Commonly substituted for older
abused drugs by dealers
• Online drug markets offered
mephedrone, MDPV, and
methylone alone or in brand-name
formulations for cheap prices

9. Revival: Mephedrone, MDPV, MethyloneRevival: Mephedrone, MDPV, Methylone

10. MephedroneMephedrone
• Classified as a substrate-
type releaser
• Produces release of
dopamine (DA), serotonin
(5-HT) and norepinephrine
(NE)
• Order of potency:
– DA>NE>>5-HT

11. MDPVMDPV
• Potent monoamine
reuptake inhibitor at
monoamine transporters
• Order of potency:
– DA=NE>>>5-HT
• More potent than cocaine

12. MethyloneMethylone
• Classified as a
monoamine substrate-
type releaser
• Order of potency
– 5-HT>>>DA>NE
• More potent 5-HT release
than MDMA

13. Big 3 ComparisonBig 3 Comparison
Drug Mechanism Monoamine
Preference
Mephedrone Substrate releaser DA>NE>>5-HT
MDPV Reuptake inhibitor DA=NE>>>5-HT
Methylone Substrate releaser 5-HT>>>DA>NE

14. Synthetic Cathinones: Legality and PrevalenceSynthetic Cathinones: Legality and Prevalence
• Gradually made illegal in UK and
Europe from 2009-2010
• Mephedrone, MDPV and
methylone given emergency
Schedule I distinction in September
2011
– Permanent Schedule I status in
July 2012
• Federal Analog Act, an amendment
to the CSA, allows for any
compound “substantially similar” to
a Schedule I compound to be
labeled Schedule I
President Richard Nixon with AG John Mitchell
and first DEA president Jack Ingersoll signing
the Controlled Substance Act into law

15. Synthetic Cathinones: Legality and PrevalenceSynthetic Cathinones: Legality and Prevalence
• Mephedrone was reported as
the 6th
most commonly abused
drug in the UK in 2012
• Mephedrone is more popular
in UK, MDPV and methylone
more popular in the US
• Poison control centers report
over 9,800 exposures from
2011-2013 in US
• ~23,000 emergency room
visits in US in 2011

16. Reported Effects in Human AbusersReported Effects in Human Abusers
Positive effects
•Euphoria
•Pro-social/Empathogen
– Mephedrone/Methylone
•Increased alertness, arousal,
and concentration
– Mephedrone/MDPV
•Some reports of
hallucinations and sexual
stimulation
Negative effects
•Tachycardia and heart
palpatations
•Excited delirium and severe
psychosis
•Serotonin syndrome
•Severe hyperthermia
•Tissue necrosis (intranasal)
•Addiction/dependence
•Intense craving to redose
•Rhabdoymyolysis

17. Reported Effects in Human AbusersReported Effects in Human Abusers
• Users commonly go through “binge” periods of bath salt use
• High potential for overdose with heavy use
– Overdose- cardiac arrest following tachycardia or
overheating
• OD’s treated symptomatically with benzodiazepines,
activated charcoal, ice baths
• Several clinicians have reported abusers of synthetic
cathinones have met DSM-V criteria for dependence

18. Synthetic cathinone abuse liabilitySynthetic cathinone abuse liability

19. Synthetic Cathinone: At-risk populationsSynthetic Cathinone: At-risk populations
• Mephedrone and methylone are especially popular in
rave/nightclub cultures in the UK
– Especially prevalent 18-25 year white old males
• The novelty of designer cathinones prevents many
forensic labs and drug testing companies from
screening for it with blood/urinalysis
• Higher than normal population of abusers in following
groups:
– Active and retired military members
– Amateur and professional athletes

20. Bath Salts Zombie Theory: ExplainedBath Salts Zombie Theory: Explained
Symptomatology:
•Psychosis- Derived from
severe hyperthermia in brain
areas controlling cognition
•Tissue necrosis- Often found
with unpure products via
intranasal or intravenous
administration causing cell
death

21. Discussion: Drug Policy in the United StatesDiscussion: Drug Policy in the United States
Taken from NIDA presentation in
2004
Stats taken from Drug Policy
Alliance:
-Number of people arrested in
2012 in US for non-violent drug
charges: 1.55 million
-Number of people who died from
OD in 2010: 38,329