Synthetic Cathinones (“Bath Salts”)

Abstract

Background Synthetic cathinones are popularly referred to in the media as “bath salts.” Through the direct and indirect activation of the sympathetic nervous system, smoking, snorting, or injecting synthetic cathinones can result in tachycardia, hypertension, hyperthermia, myocardial infarction and death. Objectives The chemical structures and names of bath salts identified by the State of Ohio Bureau of Criminal Identification and Investigation Laboratory are presented. Based on their common pharmacophores the authors review the history, pharmacology, toxicology, detection methods and clinical implications of synthetic cathinones. Through the integration of this information, the pharmacological basis for the management of patients using synthetic cathinones is presented. Discussion Synthetic cathinones activate central serotonergic and dopaminergic systems contributing to acute psychosis and the peripheral activation of the sympathetic nervous system. The over stimulation of the sympathetic nervous system contributes to the many toxicities reported with bath salt use. The pharmacological basis for managing these patients is targeted at attenuating the activation of these systems. Conclusions Treatment of patients presenting after using bath salts should be focused on reducing agitation and psychosis, and supporting renal perfusion. The majority of successfully treated synthetic cathinones cases have used benzodiazepines and antipsychotics along with general supportive care.

Characteristics of the use of 3-MMC and other new psychoactive drugs in Slovenia, and the perceived problems experienced by users

“…Both of our studies have found elements of psychological dependence with regard to mephedrone and 3-MMC. Binge use of mephedrone and its analogues is also a common phenomenon (Banks, Worst, Rusyniak, & Sprague, 2014;Katz et al, 2014). According to the results of our study, half of 3-MMC users have consumed 0.5 g of the drug in a single night, while more than a quarter have used more than 1.5 g in the same timeframe.…”

Electrophysiological Actions of Synthetic Cathinones on Monoamine Transporters

“…In addition, dysfunction of the adrenergic system is linked to medical conditions, such as depression, post-traumatic stress disorder, and hypertension (20). Behaviors modulated by monoamine neurotransmitter systems have been linked to synthetic cathinone use; for instance the components in bath salts can cause intense euphoria, alertness, increased concentration, heightened libido, as well as anorexia, anxiety, increased heart rate and memory problems (21–23). Whereas cardiovascular symptoms and stimulant effects caused by MDPV can be linked to the dopaminergic and adrenergic systems (23, 24), the emphathogenic symptoms induced by mephedrone and methylone are associated with the serotonergic system (22).…”

The α- and β-Adrenergic Antagonist Controversy with Sympathomimetic Agents

“…al. (1), published in response to our article on synthetic cathinones, or “bath salts” (2). While we applaud the authors attempt to shed some light on the controversial use of selective β-adrenergic receptor antagonists as treatment for toxicity produced by sympathomimetic agents such as the synthetic cathinones, several statement and claims made by Richards et al, require further clarification.…”