Emergency room workers say the patients can be scary when they come in. They exhibit strong hallucinations, psychosis and paranoia and, full of adrenaline, they are strong.
The number of patients who use bath salts jumped this year, St. James Mercy Hospital officials said. Since January, there have been eight cases; In June alone, there were four.
“It’s a very scary and unpredictable drug,” said Shannon Work, director of patient care services.
Bath salts are synthetic substances that often contain amphetamine-like chemicals, according to the National Institute on Drug Abuse. Stimulants, they have a “high abuse and addiction liability,” and have a high risk for side effects, the NIDA said.
Bath salts have made headlines around the country and the state over the last year, noted for the strange behavior they cause.
In June, a Utica woman, reportedly on bath salts, lunged at a police officer and screamed she wanted to “kill someone and eat them,” according to reports from The Associated Press.
Local medical professionals said bath salts cause users to become paranoid and sometimes psychotic.
“We had a few, they felt like they were being chased or they wanted to hide in a small room,” Work said.
Ann Domingos, director of Mercycare Addiction and Treatment Center of Hornell, said she had a patient, who had used bath salts, break all the mirrors in his house “because he was paranoid and he couldn’t look at himself.”
For emergency room staff, it is often not immediately clear what is wrong with a patient who comes in after using bath salts. Unless the patient or a family member tells staff bath salts were used, medical staff must treat the symptoms they see.
“Often folks are admitted psychiatrically thinking they’re psychotic when after a few days or even a week or so of treatment you find out, once they start to clear up and stabilize, that there was bath salt use,” said Lisa Hooker, manager of psychiatric nursing services. “And originally, that might just present as a psychotic processing and you wouldn’t necessarily pick that up.”
Bath salts are difficult to test for because one brand may differ chemically from another, said Alexander Garrard, a clinical toxicologist for Upstate New York Poison Control.
“This is a synthetic substance, unlike meth or Ecstasy. When you say ‘bath salts,’ there are a number of different chemicals under that name,” he said.
“In order to detect something, you have to know what you’re looking for.”
Poison Control advises medical care providers how to deal with bath salts exposures, he said. So far this year, Poison Control has had 313 calls on bath salts; last year, it only had 118.
But medical professionals don’t necessarily need to know someone is on bath salts in order to give them treatment, Garrard said.
Work said doctors first stabilize patients’ vitals and then try to calm them using sedation.
“It’s a poison control nightmare … even after doses of sedation in an emergency setting, oftentimes it’s just enough to get them where we need them to be,” Work said.
At the same time, emergency room workers are also trying to deal with patients who are also paranoid or combative.
“The biggest problem is that these patients are very difficult to manage. They can be violent and unpredictable,” Garrard said.
Patients are sedated and sometimes restrained in order to minimize the harm they could cause, both to others and themselves.
“The real risk is self-harm because of the paranoia. Running out into traffic, jumping out a window,” Hooker said. “It kind of triggers that fight or flight for people and I think that’s a lot of where you see aggressive or assaultive behaviors.”
The drug can be ingested, smoked, snorted or injected. Work said some users develop cysts, necrosis or infections at injection sites.
Symptoms also seem to last longer with bath salts than other substances.
“Typically with some other drugs, like cocaine, you see the patient start to come down after several hours, and with bath salts we’re seeing it’s a period of days or even weeks before you start to see the psychosis and the side effect start to clear out,” Hooker said.
Treatment for bath salts addiction is similar to treatment for any other addiction, Domingos said.
She said bath salts users typically have problems with other controlled substances.
“I believe it’s generally the same population. If you’re going to try bath salts, you have tried other things,” Domingos said. “It would be rare, I think, for somebody to start out (and use bath salts).”
Long term consequences from bath salts are still unclear, perhaps because one brand of the drug can differ chemically from another. Work said she’s seen high blood pressure and Domingos has had patients in treatment report difficulties with their vision.
“One went two weeks in treatment closing one eye because he couldn’t see,” she said.
Laws banning the sale of bath salts were added nationally and on the state level this year. Part of the problem is that legislation isn’t addressing possession, said Norman McCumiskey, Steuben County Drug Free Communities coordinator.
“Laws are banning the sale of bath salts in stores throughout New York State,” he said. “In spite of that, they suspect a lot of these stores are still selling (bath salts).”
Last week, police raided head shops across upstate and central New York, including a store near Elmira, in a series of raids connected to bath salts, reports from The Associated Press said.
Earlier this month, New York Attorney General Eric Schneiderman’s office filed lawsuits in 12 counties accusing 16 stores of violating state labelling laws.
“People that want it can still get it,” McCumiskey said.
For bath salt users, it can be a slippery slope into addiction.
“Patients report things like, ‘That was horrible, that was awful. I can’t wait to go do it again,'” Hooker said. “They get such vivid hallucinations, paranoia, but you can’t explain the process of ‘That was horrible, I can’t wait to go do it again,’ and get your head around that process.”
One time is enough to see serious medical consequences.
“It’s really crack on speed, so to speak. It’s another level,” Domingos said.