Psychoactive Bath Salts

Aka: Psychoactive Bath Salts, Bath Salts Intoxication, PABS, Methylenedioxypyrovalerone, MDPV, Ivory Wave, Vanilla Sky, Energy-1, Plant Fertilizer, Legal Cocaine

1. Mechanism
   1. Synthetic designer drug (Illicit Drug)
   2. Methylenedioxypyrovalerone (MDPV) is active ingredient in Psychoactive Bath Salts
   3. MDPV is related to pyrovalerone and alpha-pyrrolidinophenones
      1. Inhibit Norepinephrine and Dopamine reuptake
      2. Act as CNS stimulants
      3. Appear to have worst characteristics of LSD, PCP, MDMA, Cocaine and Methamphetamine
   4. Addictive potential
      1. Tolerance, withdrawal and craving with long term use
   5. Marketing claims
      1. Stimulant
      2. Alertness enhancer
      3. Aphrodesiac
2. Pharmacokinetics
   1. Lowest effective dose: 3-5 mg intranasally, per-rectum or intravenous
   2. Average dose 5-20 mg
   3. Peak rush effect at 1.5 hours after oral ingestion
   4. Duration of 3-4 hours with "harsh crash"
   5. Entire course from intake may last 8 hours
3. Signs
   1. Sympathetic stimulation
      1. Tachycardia
      2. Hypertension
      3. Hyperthermia
      4. Seizures
      5. Arrhythmias
      6. Vasoconstriction
      7. Mydriasis
   2. Altered Level of Consciousness
      1. Anxiety
      2. Severe Panic Attack
      3. Agitation
      4. Paranoia
      5. Hallucinations
      6. Psychosis
      7. Violent Behavior or aggressive behavior
      8. Self-destructive behavior or self-mutilation
      9. Insomnia
      10. Anorexia
      11. Depressed mood
4. Labs
   1. No current lab tests detect Psychoactive Bath Salts
5. Precautions
   1. Polysubstance overdose with bath salts may occur
      1. Coingestion occurs in 94% of cases (often with Cocaine)
      2. May confuse the presentation
6. Management
   1. ICU monitoring
   2. Intravenous fluids
   3. Physical Restraints may be needed
   4. Benzodiazepines IV
      1. Sedation
      2. Seizure managament
   5. Supportive care
7. Complications
   1. Overdose is a significant risk with packages containing as much as 500 mg
   2. Cerebrovascular Accident or cerebral edema
   3. Respiratory distress
   4. Rhabdomylolysis
   5. Arrhythmias, Myocardial Infarction or cardiovascular collapse
   6. Deaths have been reported
8. Resources
   1. U.S. DEA Site
      1. http://www.deadiversion.usdoj.gov/drugs_concern/
9. References
   1. Ross (2011) N Engl J Med 365(10): 967-8