The MEDTOX Drug Abuse Recognition (DAR) Hotline has been peppered with calls about ingestion and abuse of bath salts over the last several months. The first Hotline calls were fielded in June of 2010; volume hit a peak this month. Abuse of bath salts and particular strains of powdered plant food has now been reported by a number of media outlets, as well as by state and federal law enforcement agencies. This activity is real and it represents a notable public safety threat. Readers should be sensitive to this substance abuse and be prepared for bad outcomes for some users. Our staff believes the problem warrants a special "be on the lookout" advisory for our readers.
Ivory Wave, Red Dove, and Vanilla Sky are the more common forms of these products. Nominally marketed and sold as bath salts, these substances are not intended for human consumption. These products are nothing more than compounds or mixtures of esoteric designer drugs. These powders usually contain methylmethcathinone (aka: mephedrone or 4-MMC) and/or methylenedioxypyrovalerone (aka: MDPV). These drugs are powerful mood-altering stimulants that can provoke effects that are not unlike cocaine and methamphetamine. By sporting a stamp or advisory on their packaging that says "not for human consumption," manufacturers have skirted federal drug control laws. These drugs have no known medicinal use in the United States. As a result, they would likely fall into DEA Schedule I if they were the subject of regulation and enforcement.
Methylmethcathinone (4-MMC) is a designer drug take-off of the primary ingredient in a plant-based stimulant found in Africa called Khat. 4-MMC acts as a central nervous system stimulant by manipulating transporter systems involving dopamine and norepinephrine. The drug is alleged to have some modest ability in causing users to feel more social and interactive. MDPV, on the other hand, is a more brazen stimulant drug. Users of this drug point to powerful energy boosts and activity while high. When taken in larger doses, MDPV can lead to muscle spasm and a dystonia seen with methamphetamine abuse. As time wears on with an MDPV high, users may begin to engage in meaningless repetitive motions and behaviors (tweaking). Some high dose users have experienced hallucinations and profound paranoia.
In combination, these drugs can have added stimulant effects. DAR symptoms will present as a classic case of C.N.S. stimulant influence. Pupils will be dilated, quite possibly so dilated that they could be classified as "rimmed." Reaction to light will be slow. Heart rate and Romberg internal clock will be accelerated outside the range of normal. Blood pressure and body temperature will be elevated. Skin will appear flushed and the mouth will be dry. Speech will be fast and thoughts and dialog will jump back and forth between subjects and discussions. Because these are both powerful stimulants, there is the potential for seizures and other nervous system disorders when these drugs are taken. There is substantial potential for chronic, even addictive, use of these drugs.
Although these drugs are packaged and bear some resemblance to bath salts, they are relatively easy to prepare and ingest to get high. The white bath powders can be snorted or smoked. Preparation of these salts is quite similar to preparation of powdered methamphetamine or cocaine for "snorting." 
In fact, insufflation is the most common method of ingestion for these compounds. There have been reports of some users who have resorted to smoking the drugs, which is the swiftest way of pushing a drug into the bloodstream. The length of a high can vary substantially. Experiences so far tend to indicate a rather modest span of effects that last for 3-4 hours. Users report that when a high starts to abate, those effects drop off very quickly. Afterwards, users also report feeling out of sorts, slightly blue, or depressed. This experience is routinely cited by cocaine and methamphetamine users who can often feel wrung out or exhausted following extended periods of use.
4-MMC may also appear as a stand-alone product in certain brands of foreign made plant food. Coming from places such as Russia and Cameroon, these substances are typically packaged in small plastic baggies for individual use. Like the bath salts, the plant food drugs are ostensibly branded "not for human consumption." But they too are prepared and snorted in a fashion identical to ingestion of cocaine and methamphetamine.
Abusable bath salt products pose a threat to patients and participants in drug court and drug rehabilitation programs. Although technically legal to possess, their use as mind-altering substances will violate terms and conditions of treatment and probationary agreements; use of these drugs may also be a trigger to relapse. Apart from readers recognizing the physical signs and symptoms of someone who may be abusing 4-MMC and MDPV, there are a number of labs that can provide forensic drug testing services for these substances. Readers should be careful when selecting a lab for testing of unusual designer drugs however. Laboratories that lack fundamental certifications and qualifications (SAMHSA & CAP) may rush to market and develop what is thought to be a reliable and defensible drug test, only to find later in court that the testing assay was poorly conceived and subject to false interpretations and dubious final results. A worst-case scenario may even bring a legal claim or lawsuit because of actions taken as a result of a flawed testing process. Like Spice (K2 etc.) lab testing, bath salts (4-MMC and MDPV) analysis and choice of a laboratory is a matter of buyer beware.
(Readers interested in more information about 4-MMC and MDPV and bath salt drug testing may do so by responding to Mr. Andrew Gilberts by email at agilberts@medtox.com) 
