Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Wednesday, June 13, 2012
Bubbles or Bath Salts
A number of months ago, I had a massage. It was very relaxing and my massage therapist suggested I take a bath with some special salts later that evening to "remove the toxins.
In the lull of the moment, I spent $18 on a paper bag full off bath salts. I used some once, but the truth is, I prefer bubbles. Recently, there's been a lot of talk about bath salts in the news, a staff member at the Hopkins Press asked if I could talk on "bath salts and cannibalism" and I must say, I was completely confused. I've finally figured out that "bath salts" have nothing to do with massages or baths tubs. As I'm sorting this out, I thought I would share with you what I'm learning.
So "Bath Salts" are the street name for a mostly legal drug (now banned in some states, Denmark, the Czech Republic, or Sweden) named Methylenedioxypyrovalerone --MDPV. MDPV can be purchased in gas stations and head shops.
On the website for the National Institute for Drug Abuse, director Nora Volkow, M.D. wrote last year:
These drugs are typically administered orally, by inhalation, or by injection, with the worst outcomes apparently associated with snorting or intravenous administration. Mephedrone is of particular concern because, according to the United Kingdom experience, it presents a high risk for overdose. These chemicals act in the brain like stimulant drugs (indeed they are sometimes touted as cocaine substitutes); thus they present a high abuse and addiction liability. Consistent with this notion, these products have been reported to trigger intense cravings not unlike those experienced by methamphetamine users, and clinical reports from other countries appear to corroborate their addictiveness. They can also confer a high risk for other medical adverse effects. Some of these may be linked to the fact that, beyond their known psychoactive ingredients, the contents of "bath salts" are largely unknown, which makes the practice of abusing them, by any route, that much more dangerous. Unfortunately, "bath salts" have already been linked to an alarming number of ER visits across the country. Doctors and clinicians at U.S. poison centers have indicated that ingesting or snorting "bath salts" containing synthetic stimulants can cause chest pains, increased blood pressure, increased heart rate, agitation, hallucinations, extreme paranoia, and delusions
The ingestion of bath salts is associated with raising body temperature, which may lead users to take their clothes off. It was speculated that the man who was found naked and eating the face of another man on a Florida highway may have been using bath salts, though the latest of Googled articles states that this was not the case.
In any case, the "bath salts" in the tub are different from the stuff in the news. Stick with the tub stuff, the MDPV variety seem to be doing nothing good and are very dangerous.
And yes, I'd love to hear your bath salt stories.
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We've had a number of drug-induced psychosis admits in the Midwest that are attributable to these. "Scarier than meth" per patient reports.
From what I've read, the drug is like MDMA (which also raises body temp) initially. However many people use it at higher doses, or multi-day binges and it acts like Ritalin (some use it for study aid) or amphetamines. Sleep deprivation becomes a problem. Anyway, I think this is a pretty good summary of one viewpoint of bath salts. http://jezebel.com/5914694/this-is-your-brain-on-bath-salts-what-its-like-to-do-the-scary-drug-du-jour
Hmmm, I'm not so sure about that post you linked to. It seems to say that Bath Salt aren't so bad, that it's over/repetitive use that causes problems and otherwise they are a good study aid which cause a mild euphoria. Yet all the stories presented are people overusing them. And we don't have statistics on how many people are taking them with no problems. So when you take a substance like this, you don't know if you're a person who will have a bad response, or if you're someone who will be driven to repeated use and getting lack of sleep.
If we're going to ban bath salts because they cause you to behave very very badly, then we must swiftly and completely ban alcohol.
I think it is unfortunate that a recreational drug with such potentially bad effects is so cheap and easy to get.
I thought the article that anonymous linked to seemed balanced and thoughtful. Many of the described people who used repeated doses were not described as being "driven" to use more, but choosing to use more. Having suffered a bad experience once, they might be able to use a single dose and no more. The described users seemed to be operating in the dark, not knowing what the outcome of repeated doses will be.
In college, one time, I drank to the point of vomiting, and I never did that again. You could say I was "driven" to drink that much, or one could say I learned my lesson from a bad experience and thus learned how to use alcohol responsibly.
In college, I drank to the point of vomiting. Before that, I did it in high school, and junior high before that. After college, I never drank to the point of vomiting because my tolerance increased and I got better at holding my liquor. Since college, I have puked a few times, usually not alcohol related especially since docs are willing to prescribe tranquilizers and it is harder to puke on those unless you mix with alcohol. No interest in bath salts. Really, Rob is not so off the mark.
The problem with this logic is that alcohol and cigarettes, two legal substances, are responsible for tremendous morbidity, mortality, and financial burden to our society. To say that we should make legal anything that is either equally or less addictive/destructive/or potentially harmful or fatal, would open the door to legalizing many substances. And maybe we shouldn't make substances illegal-- we're certainly not winning the War on Drugs with our current tactics.
I don't have answers here.
So Rob and Sunny:
Might you ever offer a loved one a beer?
Knowing the little we know about Bath Salts, would you offer your child/loved one some bath salts (in a limited quantity --as if we knew what that quantity might be-- that you'd picked up at the local gas station?
Rob, would you suggest to parents that it's fine if their kids experiment with bath salts because they are no more dangerous than alcohol when abused and we know that it's normal for teenagers to experiment with (and sometimes abuse) alcohol?
oh, I'm being provocative again...
I'm not sure if the "I'm being provocative again" is sarcastic or not, but your statements are pretty inline with anti-drug sentiment and not provocative.
I think if you had clicked through the links on the article, you would have seen that there were positive experiences, but what Jezebel was attempting to address, was specifically, the negative side-effects of the drug. The drug is being demonized in the press in dishonest sensationalist ways (OMG Naked Cannibals) and Jezebel, using the same anecdotal evidence as everyone else is trying to show what negative experiences people are having and they found a pattern is those negative experiences.
Now Jezebel is on the opposite side of the drug issue. They are pro marijuana, MDMA, LSD, etc, so from their perspective, if the drug is less harmful than MDMA (they linked to the study), why is this such a big deal? People use Ritalin for study aids too and abuse it. There are multitudes of things that alter perception that are legal and are abused. In 2010 psychotheraputics were the second highest abused illicit drug. Source
You are absolutely correct that we don't know the statistics about bath salts. And because of that, you will have the split of pro-drug/anti-drug responses and people will align themselves with their natural biases.
Would I offer a loved-one a beer?
Thanks for the hanging curveball! Not only would I make such an offer, I would be considered impolite, perhaps selfish and rude if I did not.
The difference between alcohol and so-called "dangerous drugs" is the social context.
It does not require a great stretch of imagination to perform a thought experiment in which bath salts are offered to loved ones as a matter of social etiquette, and bourbon is charged with the creation of wanton naked cannibals.
Dinah was hop,ing she was being provocative so don't burst her bubble.
You win! I do offer wine and beer to loved ones, though I drink very, very little myself.
I am anti-recreational drugs, not from a moral position, but a practical one and don't use recreational drugs myself. I would be horrified if a child of mine used bath salts or any other recreational drug. I do resent fictional media reports such as "Reefer Madness", though, because it makes genuine warnings meaningless.
So Rob, would you be okay with your children trying legal bath salts? Social context: I hear daddy isn't offering them to the kids, but if alcohol is the comparison, is it okay? condoned? encouraged? discouraged? punished?
Sunny: : )
I am a social drinker, but as someone who has never landed in either a hospital/a jail/ the principal or dean's office because of my alcohol use, I think we've come to accept that having alcohol be legal is the 'right' thing. For some people, it's not the best thing, and many people use it in a way that is not legal at all (underage drinking, driving while intoxicated).
I believe that there is nothing linking the Florida cannibal to bath salts in the latest rendition. In fact, it seems he spit out the victim's face and may not technically be a cannibal at all.
I am not a robot.
What is underage drinking? Where I am, it is under 18 or 19, depending on where. In the US, it seems to be under 21. There are a lot of states where it is illegal to serve alcohol to someone under 21 dining in restaurant with parents, but the same young adult can drink legally, at home, if the parents choose to provide the booze. It is so arbitrary to make drinking illegal in this way. It also drives drinking underground which is more dangerous. Adults should be allowed to drink. If you can vote, you should be able to drink. There are "kids" who will be attending med school in the fall who are still too young to drink!!
You know they're only using bath salts as a cover to hide the fact that the zombie apocalypse has begun... ;)
At the risk of sounding pedantic (for a change), what do you mean by "legal"? In what sense is Amoxicillin legal? No one can get it except through the intervention of an agent of the state, like me.
As to bath salts, legal or not, I would not be okay with my children trying them because the social context does not permit it. In a different place and time, maybe.
Social context is everything. Don't forget that opium was commonly used, socially-acceptable and perfectly legal
I'm not a huge fan of the War on Drugs since it hasn't done jack to reduce drug abuse, and it appears to have induced violent crimes (Drug cartels and drug lords). I'd prefer most recreational drugs be decriminalized or legal if they prove to have little physical harm. I'm all for harm reduction if someone feels that is what they need.
That said, some of these drugs being produced to by-pass drug laws appear more dangerous than some of our more "traditional" fare in that they can cause immediate risk of death. Some of the synthetic cannibinoids have landed a few people in the ER in my parts, as did MDPV. Alcohol does tend to cause more hospital visits, yes, but some of the new stuff has me a bit concerned. There are drugs that have little abuse potential and zero chance of overdose.
Oh, and Dinah - Bath salts for bath tubs are often scented Epsom Salt (or something similar). Mix Epsom salt with essential oil of your choice, let it hang out in a bag for a few days, and voila - pretty much the same thing you paid eighteen bucks for.
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