Bath Salts and New Drugs

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Bath Salts and New Drugs

  1. 1. Bath Salts andthe New Addictions Laurence P. Karper, MD
  2. 2. Disclosures• I am a full time employed physician at Lehigh Valley Health Network• I have received no funds from pharmaceutical companies within the last year
  3. 3. Objectives• Understanding the Rise of the New Drug Epidemic• Characteristics of the “Bath Salt” Epidemic Implications for diagnosis and treatment Future directions and concerns
  4. 4. The Seventies:Back to the Future?
  5. 5. Naturally Psychoactive Hindu Soma Tarahumara Peyote Israelite Wine Mayan TobaccoEarly Anglo-Saxon Medu Andean Coca Leaf Eastern Africa Khat
  6. 6. Khat (Qat)African shrub which, when chewed, has a stimulant effect. Khat containsthe alkloid called cathinone, an amphetamine-like stimulant, which is saidto cause excitement, loss of appetite and euphoria.
  7. 7. Canned Heat Blues (1928, Memphis)Cryin mama, mama, mamaCryin canned heat is killin meCanned heat dont kill meCryin, babe I never would dieI woked up a-this moninWith canned heat on my mindTommy Johnson
  8. 8. Designer Drug Epidemic•Ecstasy was the rage at Raves•K2, Spice, and Synthetic Marijuana•The rise of “bath salts” •Mephedrone •Methylmethcathinone or methylephedrone •MDPV •Methylenedioxypyrovalerone
  9. 9. Podcasts and Web Sites• http://emcrit.org/podcasts/bath-salts/• http://www.cnsproductions.com/drugeducati onblog/uppers/1172/• http://monitoringthefuture.org• http://dawninfo.samhsa.gov/
  10. 10. Serious Jail TimeWhen Neil Brown got high on bath salts, hetook his skinning knife and slit his face andstomach repeatedly. Brown survived, butauthorities say others havent been so luckyafter snorting, injecting or smoking powderswith such innocuous-sounding names as IvorySnow, Red Dove and Vanilla Sky.
  11. 11. Sally B.Last night I had to take my mom to the ER for a severe asthma attack, her second in two days. During the long, long night in the ERwhile nurses monitored her vital signs over the space of 5 hours (before they finally decided she needed to be admitted forobservation because her breathing still wasnt very clear), twelve cases of "bath salts" overdose were brought into the ER. Twelve.Obviously this drug has made its way into our normally fairly rural county, probably via truck stops along the highways nearby. Ifound myself feeling extremely angry because the woman in the ER room next to my moms, separated by a thin curtain, was in theER for the second night in a row from "bath salts" overdosing. I was actually glad to hear the nurses and the doctor on duty givingreading this woman the riot act instead of just being nice to her. Worse still, I am willing to bet that if all 12 of these people havemedical insurance, it will probably cover their ER visits despite it being due to irresponsible drug abuse. Now, for those of us who, bymisfortune of working in taxpayer supported public sector jobs during this deep recession, find ourselves nearly uninsured due tosharp cutbacks in our benefits, the idea of wasting taxpayer money on treating drug abusers - especially repeat ones like the womanin the room next to my mom - seems a bit preposterous. Its stuff like this that gets my hackles up and makes me see red. "Bathsalts", indeed......June 11, 2011
  12. 12. Bath Salts or Designer Cathinones•Synthetic stimulants that are marketed as “bath salts” areoften found in a number of retail products.•The chemicals are synthetic derivatives of cathinone, a centralnervous system stimulant, which is an active chemical foundnaturally in the khat plant.•Mephedrone and MDPV (3-4 methylenedioxypyrovalerone)are two of the designer cathinones most commonly found inthese “bath salt” products. Many of these products are soldover the Internet, in convenience stores, and in “head shops.” •“Bath salt” stimulant products are sold in powder form in small plastic or foil packages of 200 and 500 milligrams under various brand names. Mephedrone is a fine white, off-white, or slightly yellow-colored powder. It can also be found in tablet and capsule form. MDPV is a fine white or off-white powder. They typcially sell for 25 to 50 dollars.
  13. 13. Bath Salts: The Skinny• Routes of Administration • PO • Neurological Action: • Insufflation • NDRI • IV • Stimulant • Rectal • Similar to • Vaporization • Cocaine • Methylphenidate• Metabolism: Hepatic • Amphetamines • CYP 2C19 • CYP 2D6 • CYP 1A2• Excretion: Renal
  14. 14. The Face of Bath Salts Bangor woman showed By Meg Haskell, BDN Staff up at police stationLast modified Oct. 09, 2011, at 6:24 p.m bail check with drugs in her purse, authorities say
  15. 15. NEJM Sept 8 2011First Article toCover BathSalts in aProfessionalJournal
  16. 16. Medical Marijuana?January 13, 2010|By Veronica Torrejon OF THE MORNING CALL Dr. Laurence Karper, vice chairman of the Department of Psychiatry at Lehigh Valley Health Network, would welcome more money for addiction services. But legalizing medical marijuana is not something Karper necessarily favors. Karper found himself answering many questions on the topic of medical marijuana as the bill in New Jersey gathered speed. As a physician who works with the addicted, Karper is concerned that the drug is untested, its benefits unproved, and that it could lead to addiction. But as a humanitarian, Karper isnt so sure. "I think Im of two minds," he said. "Should we waste resources putting medically ill people in jail when thats the only thing that helps them? To me that would seem to be a waste of resources." From a medical perspective, he said marijuana is a potentially dangerous drug that can cause acute paranoia, anxiety and other problems. Without rigorous scientific testing and approval by the U.S. Food and Drug Administration, marijuana as a medical therapy is risky, Karper said. "People shouldnt kid themselves that this is something that is nontoxic and has no problems because its natural," he said. "Arsenic is natural. Many things that are natural are also toxic." As with anything else, he said, a healthy dose of caution is recommended. "Some people say it makes them feel better," he said. "However, that has to be balanced against the possible side effects."
  17. 17. Cocaine Use: Perceptions“Used no more than two or three times a week, cocaine creates no serious problems. In daily and fairly large amounts, it can produce minor psychological disturbances. Chronic cocaine abuse usually does not appear as a medical problem.”Kaplan, Freedman, & Sadock, Comprehensive Textbook of Psychiatry, 1980
  18. 18. Positive Perception? • Julie Holland, M.D. author of Ecstasy: The Complete Guide. • A mostly positive view of MDMA published 2001 • Psychiatrist at Bellevue Hospital • Contributor to the Bulletin of Multidisciplinary Association for Psychedelic Studies • “the books "scientific" authorship are precisely what makes the book dangerous in that it seems to promote drug abuse as safe, although when read closely the data does not appear to support this conclusion so clearly. Perhaps the jury is still out on long-term adverse effects of MDMA. When the drug in question has potential to alter and damage neural structures of todays youth, perhaps a more cautious approach is in order. A great read, but the authors presupposition of the drugs safety appears unfounded, even given information cited.”
  19. 19. Vital Statistics• Drug Overdoses Now Kill More Americans Than Traffic Accidents• The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices was 4 times larger in 2010 than in 1999• Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. This is more than 3 times the 4,000 people killed by these drugs in 1999.
  20. 20. Summary•Addiction is common and part of our ancestryso why not provide effective evidence-basedtreatment?•“Bath Salts” are the latest in a long series ofaddictive substances that are cheap and widelyavailable and very dangerous•The seeds for the next epidemic are within usand the fruit will be poisonous

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