Synthetic Cathinones (Bath Salts): Legal Status and Patterns of Abuse

Objective: To review the current legal status and patterns of abuse of bath salts. Data Sources: A literature search was conducted through MEDLINE (1950-December 2011), PubMed (1966–December 2011), EMBASE (1966-December 2011), and International Pharmaceutical Abstracts (1970-December 2011) using the search terms bath salts, mephedrone, and methylenedioxypyrovalerone to identify articles on the legal status of bath salts and on studies focusing on patterns of abuse of bath salts. The GovTrack.us Web site was searched to determine the status of federal bills regarding bath salts. The National Association of Boards of Pharmacy and Drug Enforcement Administration Web sites and the Federal Registerwere also examined to identify legislation on bath salts. Study Selection and Data Extraction: Case reports and studies regarding bath salts were examined. Federal laws involving bath salts were also evaluated. Data Synthesis: The Department of Justice issued a final order in the Federal Register, temporarily placing the 3 synthetic stimulants, mephedrone, methylenedioxypyrovalerone, and methylone, under Schedule I of the Controlled Substances Act. Literature evaluated included case reports, retrospective studies, surveys, toxicology data, and chemical analyses studies. Information in the literature demonstrated that bath salts are highly abused, and common adverse effects include hypertension, tachycardia, and psychiatric symptoms. Conclusions: Psychoactive substances recently sold as bath salts have been placed in Schedule I of the Controlled Substances Act. Pharmacists can play an important role in raising awareness on the dangers of bath salts abuse through patient counseling and community outreach programs. The evidence on legal status and patterns of abuse clearly demonstrates that bath salts contain dangerous substances that should be permanently controlled.