Bath Salt Use: A Case Report and Review of the Literature

The new recreational designer drugs known as “bath salts” are synthetic cathinones (e.g., mephedrone, 3,4-methylenedioxypyrovalerone, methylone) that are being abused as stimulants. Bath salts have similar effects as amphetamine, cocaine, and MDMA (3,4-methylenedioxymethamphetamine, also known as ecstasy). Cathinone is a naturally occurring phenylalkylamine alkaloid present in the khat plant that has been used for centuries, but in Western countries, they are primary used by “young clubbers.” In this review, the pharmacology and neurotoxicity of bath salts will be discussed and the prevalence and pattern of bath salt use will be presented. The U.S. Poison Control Center received an increasing number of calls regarding bath salt intoxication in 2011, which led to an emergency temporary ban in September 2011. Despite the ban, the use of bath salts has continued. Multiple reports have described the clinical features of bath salt intoxication and withdrawal symptoms, as well as the potential for abuse and the development of dependence. There are reports of bath salts causing hallucinations, delirium, and psychosis. For patients presenting with bath salt intoxication, management includes using medications for behavioral control and other symptomatic support. In this review, we will report the use of bath salts in a patient with a history of schizophrenia and comorbid methamphetamine dependence. His clinical course will be discussed. In order to prevent the further abuse of bath salts, we need to encourage the continuing ban on the sale of bath salts and also educate both clinicians and patients about the risks of using such drugs.