There have been increasing reports in the popular and scientific media of the use of drugs called “Bath Salts”. These drugs have nothing to do with ordinary bath salts but are synthetic ring substituted cathinones. The main drugs encountered are mephedrone, methylone and 3,4-methylenedioxypyrovalerone (MDPV). Most reports involve the drug mephedrone, which has been popular in Europe but “Bath Salt” cases are also seen in North America. These drugs have sympathomimetic effects and the reported deaths have had similar histories to other stimulant drugs. This review examines the use of “Bath Salts”, particularly mephedrone and its clinical effects and toxicology, along with reported autopsy findings.
KarchS.B.Karch's Pathology of Drugs.4th Ed.Boca Raton: CRC Press; 2009. 736 p.
2.
EdeleanoL.Ueber einige derivate der phenylmeth-acrylsäure und der phenylisobuttersäure [About some of the phenyl derivatives of methacrylic acid and phenyl isobutyric acid].Berichte der deutschen chemischen gesellschaft.1887 Jan-Jun; 20(1): 616–622.
3.
MilroyC.M.Ten years of ‘ecstasy’.J R Soc Med.1999 Feb; 92(2): 68–72.
4.
DaviesS., WoodD.M., SmithG.Purchasing ‘legal highs’ on the Internet-is there consistency in what you get?QJM.2010 Jul; 103(7): 489–93.
5.
SchmidtM.M., SharmaA., SchifanoF., FeinmannC.“Legal highs” on the net-Evaluation of UK-based Websites, products and product information.Forensic Sci Int.2011 Mar 20; 206(1-3): 92–7.
6.
MorrisK.UK places generic ban on mephedrone drug family.Lancet.2010 Apr 17; 375(9723): 1333–4.
7.
VardakouI., PistosC., SpiliopoulouCh.Drugs for youth via Internet and the example of mephedrone.Toxicol Lett.2011 Mar 25; 201(3): 191–5.
8.
Saem de Burnaga SanchezJ.Sur un homologue de l'éphédrine [On a counterpart of ephedrine].Bull Soc Chim Fr.1929; 45: 284–6.
9.
Kapka-SkrzypczakL., KulpaP., SawickiK.Legal highs-legal aspects and legislative solutions.Ann Agric Environ Med.2011 Dec; 18(2): 304–9.
10.
SareJ.How the media helped ban mephedrone.BMJ.2011; 342: d1138.
11.
BBC:News US & Canada [Internet].London: British Broadcasting Corporation; c2012. Miami face-chewer had only marijuana in system; 2012 Jun 27 [cited 2012 Aug 13]. Available from: http://www.bbc.co.uk/news/world-us-canada-18620868.
12.
MaurerH.H.Chemistry, pharmacology, and metabo-lism of emerging drugs of abuse.Ther Drug Monit.2010 Oct; 32(5): 544–9.
13.
PedersenA.J., ReitzelL.A., JohansenS.S., LinnetK.In vitro metabolism studies on mephedrone and analysis of forensic cases.Drug Test Anal.2012 May 9. doi: 10.1002/dta.1369. [Epub ahead of print]
14.
ProsserJ.M., NelsonL.S.The toxicology of bath salts: a review of synthetic cathinones.J Med Toxicol.2012 Mar; 8(1): 33–42.
GriffithsP., LopezD., SedefovR.Khat use and monitoring drug use in Europe: the current situation and issues for the future.J Ethnopharmacol.2010 Dec 1; 132(3): 578–83.
17.
PearsonJ.M., HargravesT.L., HairL.S.Three fatal intoxications due to methylone.J Anal Toxicol.2012 Jul; 36(6): 444–51.
18.
MurrayB.L., MurphyC.M., BeuhlerM.C.Death following recreational use of designer drug “Bath Salts” containing 3,4-Methylenedioxypyrovalerone (MDPV).J Med Toxicol.2012 Mar; 8(1): 69–75.
19.
RossE.A., ReisfieldG.M., WatsonM.C.Psychoactive “Bath Salts” Intoxication with Methyl-enedioxypyrovalerone.Am J Med.2012 Jun 8. [Epub ahead of print]
20.
DarganP.I., SedefovR., GallegosA., WoodD.M.The pharmacology and toxicology of the synthetic cathi-none and mephedrone (4-methylmethcathinone).Drug Test Anal.2011 Jul-Aug; 3(7-8): 454–63.
21.
WinstockA., MitchesonL., MarsdenJ.Mephedrone: still available and twice the price.Lancet.2010 Nov 6; 376(9752): 1537.
DickD., TorranceC.MixMag drug survey.MixMag2010; 225: 44–53.
24.
BruntT.M., PoortmanA., NieinkR.J., van den BrinkW.Instability of the ecstasy market and a new kid on the block: mephadrone.J Psychopharmacol.2011 Nov; 25(11): 1543–7.
25.
DarganP.I., AlbertS., WoodD.M.Mephedrone use and associated adverse effects in school and college/ university students before the UK legislation change.QJM.2010 Nov; 103(11): 875–9.
26.
Mixmag:The World's dance music & clubbing destination [Internet].London: Development Hell Ltd.; c2011. Mixmag's drug survey: the results; 2012 Mar 14[cited 2012 Aug 13]. Available from: http://www.mixmag.net/drugssurvey.
27.
WinstockA.R., MitchesonL.R., DelucaP.Mephedrone, new kid for the chop?Addiction.2011 Jan; 106(1): 154–61.
28.
WoodD.M., DaviesS., PuchnarewiczM.Recreational use of mephedrone (4-Methylmethacathi-none 4-MMC) with associated sympathomimetic toxicity.J Med Toxicol.2010 Sep; 6(3): 327–30.
29.
ReganL., MitchelsonM., MacdonaldC.Mephedrone toxicity in a Scottish emergency department.Emerg Med J.2011 Dec; 28(12): 1055–8.
TorranceH., CooperG.The detection of mephedrone (4-methylmethcathinone) in 4 fatalities in Scotland.Forensic Sci Int.2010 Oct 10; 202(1-3): e62–3. Epub 2010 Aug 4.
WikströmM., ThelanderG., NyströmI., KronstrandR.Two fatal intoxications with the new designer drug methedrone (4-methoxymethcathinone)J Anal Toxicol.2010 Nov; 34(9): 594–8.
35.
LusthofK.J., OostingR., MaesA.A case of extreme agitation and death after the use of mephedrone in The Netherlands.Forensic Sci Int.2011 Mar 20; 206(1-3): e93–5. Epub 2011 Jan 11.
36.
KriikkuP., WilhelmL., SchwarzO., RintataloJ.New designer drug of abuse: 3,4-Methylenedioxypyrova-lerone (MDPV). Findings from apprehended drivers in Finland.Forensic Sci Int.2011 Jul 15; 210(1-3): 195–200.
37.
CawrseB.M., LevineB., JuferR.A.Distribution of methylone in four postmortem cases.J Anal Toxicol.2012 Jul; 36(6): 434–9.
38.
PendersT.M., GestringR.E., VilenskyD.A.Intoxication delirium following use of synthetic cathinone derivatives.Am J Drug Alcohol Abuse.2012 Jul 11. [Epub ahead of print]
39.
MashD.C., DuqueL., PabloJ.Brain biomarkers for identifying excited delirium as a cause of sudden death.Forensic Sci Int.2009 Sep 10; 190(1-3): e13–9. Epub 2009 Jun 21.
40.
MilroyCM“Ecstasy” associated deaths: what is a fatal concentration ? Analysis of a case series.Forensic Sci Med Pathol.2011 Sep; 7(3): 248–52.
41.
MilroyC.M., ClarkJ.C., ForrestA.R.Pathology of deaths associated with “ecstasy” and “eve” misuse.J Clin Pathol.1996 Feb; 49(2): 149–53.
42.
RojekS., KlysM., StronaM.“Legal highs”-Toxicity in the clinical and medico-legal aspect as exemplified by suicide with bk-MBDB administration.Forensic Sci Int.2012 May 28. [Epub ahead of print]
43.
WoodD.M., HunterL., MeashamF., DarganP.I.Limited use of novel psychoactive substances in South London nightclubs.QJM.2012 Jun 19. [Epub ahead of print]
