Wednesday, June 13, 2012

"Bath Salts" Symposium at the 2012 CPDD Annual Meeting

Symposium I at the 2012 College on Problems of Drug Dependence (CPDD) Annual Meeting in La Quinta, CA focused on a very hot topic in the news these days, “Bath Salt” abuse. In the week just prior to the Annual Meeting, the national media reported on a sensational case of human cannibalism thought to be associated with “Bath Salt” abuse.

The CPDD Symposium did not discuss that case, but focused on what is known scientifically about the many psychoactive substances found in preparations characterized as “Bath Salts”. Understanding what each of those substances can do physiologically is key to understanding their dangers and to determining how best to treat people who need medical assistance after being exposed to those substances.

Symposium presenters included Co-Chairs Michael Taffe from The Scripps Research Institute in La Jolla, CA and Annette Fleckenstein from the University of Utah, in Salt Lake City, UT. Also presenting were Jeffrey H. Moran, from the Arkansas Department of Health, Little Rock, AR, Terry Boos, from the Drug Enforcement Administration (DEA), Springfield, VA, and William Fantegrossi, from the University of Arkansas for Medical Sciences, Little Rock, AR.

Dr. Moran began the session by stating that when referring to bath salts, designer drugs, cathinones, K2, spice, etc., it is important to use scientific terms rather than the slang or street terms for these substances, since each preparation has distinct effects.

This can be challenging since laboratory analysis of 130 samples seized by the Arkansas Designer Drug Research Consortium documented the presence of 254 distinct chemical entities, in 48 different combinations. Substances included in these preparations were the cathinones methylenedioxypyrovalerone (MDPV), 4-methylmethcathinone (methylone, 4-MMC), 3,4-methylenedioxymethcathinone (mephedrone), as well as caffeine, lidocaine, methamphetamine, levamisole, benzocaine, and synthetic cannabinoids. Thus, the formulation of these designer drug preparations is highly heterogeneous. However, Dr. Moran noted that over 70% of the samples included MDPV. He indicated that the Arkansas Department of Health is working to develop clinical and toxicological testing capabilities to more quickly identify components of these complex preparations. 

He showed data documenting an explosion in the numbers of emergency room cases associated with abuse of these substances, and indicated that the data on use patterns and chemical compositions are incomplete because they do not account for cases that don’t end up in emergency rooms and hospitals.

Terry Boos from the DEA reported that 32 different cathinones have been identified to date in the designer drug market. He noted that cathinone and methcathinone have been Schedule I drugs for awhile and that MDPV, methylone, and mephadrone were placed temporarily on the Schedule I list in October 2011 because they pose an imminent hazard to public safety while having no approved medical or manufacturing purpose. Subsequently, MDPV seizures declined, but new analogs were synthesized and replaced MDPV. He characterized the market for these substances as being “dynamic”, and indicated that sophisticated marketing and sales operations are used to funnel product that to date seems to be almost entirely imported from international sources. He noted that under the analogue provision for Schedule I substances, individuals can be prosecuted for using or possessing substances that are not identical to but are substantially similar (e.g., minor chemical modifications of) to already scheduled substances.

Dr. Annette Fleckenstein then reported data from preclinical studies in rats designed to characterize neurochemical mechanisms of mephedrone, methamphetamine, MDMA, and methcathinone. She noted that very subtle structural modifications of these substances can yield profoundly different behavioral, neurochemical, and neurotoxicological effects. For example, methamphetamine and methcathinone induce persistent dopaminergic and serotonergic abnormalities, while MDMA and 4-methylmethcathinone (4-methylation of methcathinone) only induce serotonergic abnormalities.

Dr. William Fantegrossi presented data on the thermoregulatory and behaviorally activating effects of MDPV in mice, and showed that it causes hyperthermia at both cool (20C, 68F) and warm (28C, 82F) temperatures. Mice given MDPV at 20C increased their activity independent of the MDPV dose administered. By contrast, at 28C, activity increased at higher MDPV doses, but at the highest MDPV dose tested, activity level dropped and mice exhibited repetitive (stereotypic) movements. Thus, the effects of some of these compounds are dependent upon temperature.

Dr. Michael Taffe presented behavioral and physiological data from rats administered several of these compounds and similarly reported differential effects based on chemical structure. He then summarized the Symposium and likened the current epidemic of abuse of these compounds to the designer amphetamine abuse epidemic of the 1980’s, remarking that history seems to be repeating itself. He underscored the point that not all cathinones are the same and each confers a different set of health risks.

A newer post describing trends in "Bath Salts" use and its side effects can be found here.

CPDDBLOG welcomes CPDD member’s thoughts on these issues.

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