Television procedural crime dramas often have episodes when some new drug hits the streets with violent effects, killing people in waves or turning them into monsters. A familiar story happened in 2012, only this time it was in the real news. According to reports, a drug called bath salts were responsible for disturbing zombie-like behavior and some horrifying crimes. However, bath salts are loosely defined and don’t actually describe a specific chemical structure. Plus, some of the incidents in which bath salts were implicated couldn’t definitively be matched to any drug that fit that description.
So what are bath salts and what can they actually do to a person?
Bath salts are generally stimulants with hallucinogenic effects. They can cause powerful effects that make people run into the streets in a panic. Though it rarely causes violent outbursts like the ones in the 2012 stories, it could cause strange and disturbing behavior. This is why, after one incidence of cannibalism in Miami, an officer told reporters that the crime was consistent with bath salts before anyone ran a toxicology report.
Still, street drugs that go by the name bath salts are unpredictable and dangerous. Though they may not turn you into a zombie, they could put you in serious danger. If you have a substance use disorder involving illicit drugs like bath salts, learn more about what it is, the signs of addiction, and how it can be treated.
Bath salts don’t refer to a specific chemical substance but instead to a class of designer drugs that has stimulant effects and a constantly shifting chemical structure. Each time bath salts are seized, the substances in them are different. However, they typically contain a type of stimulant drug called synthetic cathinones, which are analogs of psychoactive substances found in the khat plant. As designer drugs, bath salts are designed to mimic the effects of illicit substances without being expressly illegal.
Cathinones are stimulants that mimic the effects of meth and cocaine. However, since those are expensive controlled substances, they are difficult to buy and sell on the black market. Dealers and clandestine drug manufacturers make synthetic versions of controlled substances that are not technically illegal. They are packaged as inert products like plant food and actual bath salts (hence the name) to get around FDA regulations that come with selling products for human consumption.
Synthetic cathinones aren’t exactly perfect copies of cocaine or meth. For instance, one common cathinone called 3,4-methylenedioxypyrovalerone (MDPV) affects the brain in a way that’s very similar to cocaine, but it’s much more powerful. Bath salts also cause some other effects in addition to the feeling of excitement and power that’s consistent with cocaine. Cathinones can cause paranoia, hallucinations, panic attacks, and the feeling that your body temperature is rising. In some cases, it can cause excited delirium which is agitated and violent behavior.
MDPV, like most cathinones found in bath salts, is a norepinephrine-dopamine reuptake inhibitor, just like cocaine and meth. Dopamine and norepinephrine are naturally-occurring “feel good” chemicals that have a variety of functions in the brain. They play a large role in mood and reward. When they are released and bind to their respective receptors in the brain, they activate feelings of motivation, arousal, excitement, and energy. When they are no longer needed, the neurotransmitter that sent them recycles them through a process called reuptake. MDPV blocks reuptake, leaving dopamine to bind to more sites, causing more potent effects.
Like other stimulants, bath salts can be addictive if you abuse it for long enough. However, the experience of using them is often intense and discourages frequent use. Drugs like cocaine cause euphoric sensations that often override negative feelings like paranoia and anxiety. Bath salts can cause strong feelings of panic and frightening hallucinations.
Addiction to powerful cathinones like bath salts is rare because of the drug’s unpleasant effects. Most users feel some euphoria, but it’s largely outweighed by anxiety, paranoia, and panic. Hallucinations can also be frightening, like a nightmare. Since addiction is typically caused by excessive and repeated use, most people don’t use bath salts consistently or in close enough succession to lead to addiction. However, since the drug causes receptors to be inundated with dopamine and dopamine is closely tied to reward, addiction is possible. Studies on rats showed that MDPV could cause reinforcing and rewarding effects that can lead to addiction.
Tolerance is typically the first sign that drug use in turning into a disorder. Tolerance is the feeling that a dose of the drug that used to be effective is now weaker. This is due to the fact that your brain is getting used to the drug. In some cases, tolerance can build up quickly. If you use stimulants that cause the release of dopamine or prevent its reuptake, the drug will have diminishing effects until your system has a chance to replenish dopamine.
Dependence is the next sign. This is when your brain starts to rely on the drug to maintain normal neurochemical processes. If you try to stop using or cut back on the drug you might feel uncomfortable withdrawal symptoms. Addiction occurs when the compulsions to use the drug are greater than your ability to resist. This is often characterized by the continued use of the drug even after it has caused serious consequences.
Addiction is a chronic disease that affects the reward center of the brain, and every person with the disease is different, requiring unique approaches to treatment. Though there is no one-size-fits-all addiction treatment plan, there are industry standards and therapies that are backed up by evidence. Treatment often starts with medical detox, 24-hour medically managed care. Medical detox can help manage uncomfortable bath salt withdrawal symptoms, which can include depression, anxiety, tremors, insomnia, and paranoia. Detox can also address other medical issues that you might have when you enter treatment.
Clinicians can help you find the next step in your recovery after detox. Depending on your specific needs, you will be placed in a level of care that can vary in intensiveness (they amount time you spend in treatment and the attention you get from professionals).
Addiction treatment can involve a variety of therapy options depending on your specific needs. When you enter treatment, you will go through an assessment with your therapist to create a treatment plan for your needs. Treatment often involves behavioral therapies that are designed to help increase your motivation and get to the root of your addiction. Cognitive-behavioral therapy is especially helpful in creating a relapse prevention plan.
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While the media hype around bath salts in 2012 may not be completely accurate, both cathinones have been linked to agitation and aggression, which could potentially cause violent outbursts. Bath salts cause paranoia, hyperstimulation, and frightening hallucinations. The combination of these effects sometimes leads people into harm’s way. Many other hallucinogens cause you to relax or act as depressants. Even during bad trips, people stay where they are. If you have a frightening hallucination while also highly energized, your fight or flight response takes effect.
People on bath salts are often observed pacing, moving around, or running, which can lead to accidents or injuries. The fight response can potentially lead to aggression toward the people around you. Many of the most famous cases attributed to bath salts turned out to be inconclusive in toxicology reports. Still, the threat of cathinones causing paranoia, erratic behavior, and even aggression is very real.
Cathinones can also cause raised heart rate, blood pressure, and chest pains. If bath salts cause a state of delirium you could become dehydrated or experience kidney failure. An overdose on cathinones can occur and become fatal.
CBS. (2012, May 31). Eugene's Friends Recall His Last Words To Them Before Causeway Attack. Retrieved from https://miami.cbslocal.com/2012/05/31/eugenes-friends-recall-his-last-words-to-them-before-causeway-attack/
National Institute on Drug Abuse. (2018, February). Synthetic Cathinones ("Bath Salts"). Retrieved from https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts
Petri, A. (2012, June 07). Zombie Apocalypse: Are bath salts to blame? Retrieved from https://www.washingtonpost.com/blogs/compost/post/zombie-apocalypse-are-bath-salts-to-blame/2012/06/07/gJQAsYL3LV_blog.html?utm_term=.51769c8d187a
Watterson, L. R., Kufahl, P. R., Nemirovsky, N. E., Sewalia, K., Grabenauer, M., Thomas, B. F., Olive, M. F. (2012, July 11). Potent rewarding and reinforcing effects of the synthetic cathinone 3,4‐methylenedioxypyrovalerone (MDPV). Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1369-1600.2012.00474.x