What's new about "Bath Salts"

One of the most popular posts on CPDDBLOG reported on the Bath Salts Symposium presented at the College on Problems of Drug Dependence (CPDD) Annual Meeting in June 2012.  At that time, most published scientific studies on the effects of bath salts in humans were case reports describing outcomes in individual users or in small groups of users.   More recent studies in larger cohorts surveyed national Poison Control Center data and report on the demographics and medical consequences of bath salts abuse.

The demographics of bath salts cases reported to Poison Control Centers nationwide during the period January 2009 – April 2012 (7467 cases) indicates that the epidemic began in 2010 and was centered in Ohio and other Midwestern states.  Large numbers of cases also were reported in North Carolina and several Southeastern states.  Poison Control Center data from 9 Midwestern states (1633 cases) indicates that bath salts abuse peaked in mid-2011 and began to decline later that year after bath salts preparations were placed on Schedule I by the Drug Enforcement Administration, meaning that they became controlled (and effectively banned) substances.

Data Source: Warrick et al., Annals Emergency Medicine, in press.

The most common symptoms associated with bath salts cases were agitation (62%), racing heart (55%), and hallucinations (33%), with nearly 75% of cases associated with moderate or major medical effects (Figure).  These medical consequence statistics are in line with those described in an earlier report from a smaller cohort (236 cases) based on Louisiana and Kentucky regional Poison Control Center data, including agitation (82%), racing heart (56%), and hallucinations (40%). 

It is worth bearing in mind that statistics based on Poison Control Center data, while representative of the national epidemic, do not provide any details on unreported cases (likely a majority of cases), so these statistics do not fully capture the scope of the bath salts epidemic.   Further, while it appears that bath salts abuse is on the wane, which is good given the serious side effects frequently experienced by bath salts abusers, other synthetic drugs capable of inducing similar behavioral effects and dangerous side effects, such as synthetic cannabinoids (e.g., K2 or spice), may take their place. 

CPDDBLOG welcomes CPDD member’s thoughts on this issue. 

Ominous news about anabolic androgenic steroid use and midlife memory dysfunction

A recent study published in Drug and Alcohol Dependence reported finding an association between spatial memory problems and lifetime cumulative exposure to anabolic androgenic steroids in middle-aged men. CPDDBLOG interviewed the senior author of the study, Harrison G. Pope, Jr., M.D., to learn more.

CPDDBLOG: We've been hearing a lot lately about many different forms of substance abuse including nicotine dependence, alcohol abuse, and prescription painkiller abuse, but we don't hear as much about anabolic androgenic steroid abuse. What substances are considered anabolic androgenic steroids?

Dr. Pope: Anabolic-androgenic steroids, usually abbreviated as “AAS,” are the family of hormones that comprises testosterone (the natural male hormone), together with dozens of synthetic derivatives of testosterone that have been created by chemists over the last 75 years. AAS should NOT be confused with corticosteroids, such as cortisol and its synthetic derivatives such as prednisone. Although these latter substances are often also called “steroids,” they have no muscle-building properties and are almost never abused.

CPDDBLOG: Why do people abuse these substances?

Dr. Pope: AAS allow individuals to gain large amounts of muscle mass and to lose body fat (i.e., to become very lean). If used in large doses, AAS allow individuals to reach levels of leanness and muscularity far beyond what can be attained by natural means.

CPDDBLOG: What are the major biological effects of anabolic androgenic steroids?

Dr. Pope: AAS have 1) anabolic effects, namely stimulating muscle growth; 2) androgenic (masculinizing) effects such as beard growth, male secondary sexual characteristics, and aggression; and 3) at least some hedonic effects, as illustrated by the fact that male hamsters will self-administer AAS to the point of death. AAS also have adverse effects, one of which is that in markedly supraphysiological doses (i.e., doses far above natural levels of testosterone secretion, such as the doses used by bodybuilders and other illicit AAS users), they can accelerate apoptosis in many types of cells. This means that AAS can cause cells, including neuronal (brain) cells to die prematurely, faster than they would do under natural conditions.

CPDDBLOG: Your group recently published new information on the cognitive effects of these substances in Drug and Alcohol Dependence; what did your study find?

Dr. Pope: Given laboratory evidence of accelerated apoptosis of neuronal cells with supraphysiologic doses of AAS, we were concerned that long-term high-dose AAS abusers might show cognitive deficits from possible loss of brain cells. In a preliminary study, using a battery of computerized cognitive tests, we compared 31 AAS users with 13 non-AAS-using weightlifters. We found no differences on measures of attention, reaction time, or verbal memory, but the AAS users showed significant deficits compared to non-users on both of our two tests of visuospatial memory [e.g., remembering the appearance of an object and/or where it was located]. Ominously, when we looked within the AAS group, the degree of visuospatial deficit was significantly associated with total lifetime dose of AAS ingested.

CPDDBLOG: What next steps are you planning to take to follow up on this study?

Dr. Pope: We plan three followups: 1) continued cognitive testing of AAS users; 2) neuroimaging of long-term AAS users to seek structural and functional evidence of brain effects; and 3) a study administering high-dose testosterone to rats, which will then be tested for visuospatial deficits using the Morris Water Maze, and also examined for brain effects by serial neuroimaging and by histology.

CPDDBLOG: Thanks very much for these informative answers.

Additional information on AAS abuse and its effects can be found on the National Institute on Drug Abuse website and in a review and position statement on AAS use and abuse (co-authored by Dr. Pope) on the National Athletic Trainers Association (NATA) website (PDF).

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Beware of Alcohol on New Year's Eve

Although it ‘tis the season to celebrate, its also the season during which many people experience problems with alcohol. In past, CPDDBLOG highlighted research from Finland showing spikes in alcohol-associated deaths during the Christmas and New Year holidays. 

Now, a new research study from Australia documents a remarkable increase in the use of health system services by those intoxicated with alcohol during New Year celebrations.

The report analyzed ambulance, emergency room, and hospital admissions records collected in Melbourne from 2000-2009 to determine whether there were increases in alcohol-associated cases before, during, and after public holidays and major sporting events.

On New Year’s Eve, ambulance calls and emergency room visits involving alcohol intoxication increased by more than 4-fold, while hospital admissions involving alcohol intoxication increased by more than 3-fold those occurring on an average day (Figure). Of all the events analyzed by this study, New Year’s Eve effects were the largest.

Unfortunately, United States statistics also are grim. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), during the year-end holidays, death rates from alcohol-related crashes increase by 3-fold and 40% of traffic fatalities involve intoxicated drivers (PDF).

Thus, if you plan to consume alcohol over the New Year holiday, as the song goes, “you better watch out”.

Fortunately, more and more people are aware of these statistics and are doing things to reduce alcohol-related problems year round. NIAAA’s “Rethinking Drinking” website offers a number of tips to help determine whether one's alcohol consumption may be problematic as well as tips on how to reduce drinking.

For those trying to avoid drinking while attending parties at which there may be social pressure to consume alcohol, the New York Times recently published an article with useful strategies such as identifying oneself as a designated driver.

If you want to ring in the New Year in alcohol-free environments, the Office of National Drug Control Policy published an article including a link to a regional list of sober New Year’s Eve events.

We wish you and yours happy holidays and a happy and safe New Year! 

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Big News For Addiction Researchers--The Structural Merger is Off

The Office of the NIH Director, Francis Collins, just announced that the plan to create a structural merger of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is being abandoned.

Efforts will continue to functionally integrate the activities of these Institutes.

CPDDBLOG especially welcomes CPDD member’s thoughts on these issues.