Sunday, May 22, 2011

Let's Panic About Bath Salts!

by Matt Curtis

This week the U.S. Centers for Disease Control and Prevention (CDC) reported that in the first 4 months of 2011, emergency department visits associated with stimulant drugs sold as “bath salts,” “plant food” or other outwardly innocuous household products have already surpassed the number logged in 2010.  Although testing of such drugs appears to be limited, police labs have detected methylenedioxypyrovalerone (MDPV) and mephedrone, both fairly potent stimulants similar in effect to amphetamines (MDPV is a norepinephrine-dopamine reuptake inhibitor and mephedrone is related to methcathinone). The drugs have been sold under a variety of names including White Rush, Cloud Nine, Ivory Wave, Ocean Snow, Scarface, and Hurricane Charlie, all labeled as "not intended for human consumption."  
In part, this is yet another example of drug suppliers getting ahead of law enforcement and regulators. In the U.S. neither MDPV or mephedrone are scheduled at the federal level. MDPV is scheduled at the state level only in Florida, Kentucky and Louisiana. Control isn't a totally straightforward issue. As the CDC notes, the drugs are closely related to stimulants used in medicine, and federal and many state laws require that a substance be intended for human consumption in order to be eligible for scheduling; notwithstanding the obviously bogus packaging of White Rush and friends, moves to legally control the drugs have proceeded slowly.

That is starting to change with the familiar aid of scandalized outrage and panic: the CDC report adds a layer of legitimacy to several months of increasingly high temperature news about the new drugs. Media reports have tended toward gloating over the depravity of anyone crazy or White Trash enough to use the drugs without adding much in the way of actual information. Public officials have not done much better. Here’s a representative statement, from an NPR interview with Mark Ryan, Director of the Louisiana Poison Control Center:
“For lack of a better term, they're flipped out. It's almost like a psychotic break. They're extremely anxious and combative, they think there's stuff trying to get them, they're paranoid, they're having hallucinations. So, the encounters are not pleasant," Ryan says. "And we were finding that some of these guys couldn't be sedated with the normal drugs that we would use with other stimulants.”
So, a strange new drug causes users to transform into enraged, hallucinating monsters that are impossible to subdue. If that sounds familiar, you may be hearing an echo of the original Drug War World Series, the “crack epidemic” of the ‘80s and ‘90s.  State governments, most recently New York’s this past Friday, have begun to jump to the beat by using public health orders to ban retailers from selling the drugs.

Hysterics aside, is there something to all this?  Let’s go back to the CDC bulletin. In addition to a brief national overview, the report focuses in on 35 emergency department cases from Michigan. Of those, a majority involved agitation or tachycardia. Less than half were reported to have experienced delusions or hallucinations, and 20% paranoia. Most patients were under 30 years of age, and two-thirds had injected the drug. Seventeen people were admitted and one was dead on arrival. Of 17 people administered a drug test, all but one was positive for other drugs, which included marijuana, opiates, cocaine, amphetamine, and benzodiazepines. Toxicology from the single death found “a high level” of MDPV along with marijuana and “prescription drugs,” according to CDC.

MDPV and similar drugs can, for sure, be dangerous if taken in high doses, especially for people with cardiovascular disease or associated risk factors like heavy smoking.  But the CDC report is hardly a slam dunk indictment of these drugs as America’s great new scourge. The Michigan investigation involved a tiny sample of people presenting at emergency departments, itself presumably a small fraction of people who had taken the drugs. More than half of cases were treated and released from the ED, most suffering from unpleasant, but relatively mild, symptoms. The effects of “bath salts” in those admitted to hospital is impossible to disentangle from the fact that practically cases all involved other drug use.

Ultimately, the CDC report ought to leave us with conclusions more or less opposite to the panicky, politicized reactions now appearing in state government offices and news accounts.  Getting a grip on the supply of these drugs of unknown origin and questionable manufacture will be good for public health. Hyperbolic statements about their danger, on the other hand, will lead to fewer people getting information or other help they need to protect their health, ramped up law enforcement, and disproportionately severe prosecutions of users and petty dealers. What we need is support from health departments to get the facts to users, clinicians, and to other officials, and a clear-eyed approach to treating these drugs as they are.

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