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09-12-11 Bath Salts Again???

Question of the Week
September 12, 2011
Bath Salts Again ????
AAPCC News Release
For Immediate Release                                               For More Information, Contact:
Sept. 8, 2011                                                               Loreeta Canton, communications manager
canton@aapcc.org or 703-894-1863
Poison Control Centers Applaud DEA’s Ban of Bath Salts
ALEXANDRIA, VA – America’s 57 poison control centers are applauding the U.S. Drug Enforcement Administration’s recent ban of the chemicals used in synthetic drugs labeled as “bath salts,” according to Dr. Richard Dart, president of the American Association of Poison Control Centers and director of the Rocky Mountain Poison and Drug Center.
Poison centers first raised the alarm about bath salts in December 2010 after they started receiving calls about people having serious reactions to the chemicals, such as increased blood pressure and heart rate, agitation, hallucinations, extreme paranoia, and delusions. In 2010, poison centers received 303 calls about exposures to bath salts. That number rose dramatically in 2011; between January 1 and August 31, poison centers received 4,720 calls.
“Poison centers were instrumental in getting the word out to law enforcement, the medical community and the public about these extremely dangerous drugs,” Dart said. “We commend the DEA for banning the chemicals in bath salts, which have injured and killed too many people and destroyed too many lives.”
The products, which have nothing to do with bathing, have been sold on the Internet and at gas stations and head shops. They contain chemicals that seem to mimic cocaine, LSD, MDPV and methamphetamine. The substance creates a very severe paranoia that sometimes causes users to harm themselves or others.
“The psychosis seen in some users is truly remarkable, in a very scary way,” said Mark Ryan, director of the Louisiana Poison Center. “People high on these drugs have done some bizarre things to themselves and hurt others around them.”
People who use bath salts to get high range in age from teens to people in their 60s, according to poison centers. Packages of the powdered substance indicate that the products are “not for human consumption,” but people have snorted, smoked or even injected the chemicals.
“These products roared into the U.S. like a hurricane last year,” Ryan said. “They came ashore in Louisiana, gathered steam, flooded other states with cases and continue to leave heartache and devastation in their wake. The ban can’t come quickly enough for me. I’m ready to see bath salts washed down the drain.”  
For more information, the media may contact Loreeta Canton, communications manager, American Association of Poison Control Centers, at 703.894.1863 or canton@aapcc.org.
COMMENT:  There have been police raids at the convenience stores in certain counties in TN.  It will be interesting to see if this impacts the incidence of exposures.
Remember benzodiazepines are the mainstay of therapy for the treatment of bath salt psychosis.  I prefer a drip (midazolam 2 mg/h) as opposed to intermittent intravenous administration as it prevents the emergence reactions and then snowing the patient again.  Try not to intubate (unless you have EEG available) as these patients may have seizures. ds
Donna Seger, MD
Medical Director
Tennessee Poison Center
Poison Help Hotline: 1-800-222-1222