For hospital workers, bath salts problems grow

443499 Bath Salts main.jpg

Police remove boxes of evidence from Tebb’s Headshop on North Salina Street in Syracuse, N.Y., part of a statewide effort to target shops suspected of selling illegal synthetic drugs like bath salts, Wednesday, July 25, 2012. Federal, state and local law enforcement fanned out across the state today to raid shops suspected of selling illegal synthetic drugs, including “bath salts,” authorities said. (AP Photo/The Post-Standard, Lauren Long) NO SALES MAGS OUT, TV OUT, NO INTERNET



Hornell, N.Y. —

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.

The battle against bath salts

People are inventing so many new, legal ways to get high that lawmakers can’t keep up.

So law enforcers are taking new steps to target these synthetic drugs.

Those steps include coordinated raids. The latest was Wednesday, when federal agents arrested more than 90 people in a nationwide sweep of synthetic drug producers, distributors and retailers — including a number in Pennsylvania.

Across the country, agents seized more than five million packets of finished designer synthetic drugs, including substances marketed as bath salts, spice, incense, K-2 and plant food, according to the federal Drug Enforcement Administration.

They also recovered more than $36 million in cash in the sweep, code named Operation Log Jam.

“We struck a huge blow to the synthetic drug industry,” said James Chaparro, the acting director of the Office of Homeland Security Investigations. “The criminal organizations behind the importation, distribution and selling of these synthetic drugs have scant regard for human life in their reckless pursuit of illicit profits.”

In Pennsylvania, agents searched residences, convenience stores, gas stations, smoke shops and other similar businesses in several counties, including Montgomery and Philadelphia.

They seized more than 300,000 individual doses of synthetic marijuana and illegal bath salts, with an estimated street value of $1.25 million. They also recovered more than 50,000 pieces of drug paraphernalia related to the smoking or consumption of synthetic drugs and about $250,000 in cash and assets, according to the state Attorney General’s Office.

Over the past two years, the U.S. has seen a surge in the use of synthetic drugs made of legal chemicals that mimic the dangerous effects of cocaine, amphetamines and other illegal stimulants.

The drugs are often sold at small, independent stores in misleading packaging that suggests common household items. But the substances inside are powerful, mind-altering drugs that have been linked to bizarre and violent behavior across the country.

Law enforcement officials refer to the drugs collectively as “bath salts,” though they have nothing in common with the fragrant toiletries used to moisturize skin.

President Barack Obama signed a bill into law earlier this month that bans the sale, production and possession of more than two dozen of the most common bath salt drugs. But health professionals say that there are so many varieties of the drugs that U.S. lawmakers are always playing catch up.

“The moment you start to regulate one of them, they’ll come out with a variant that sometimes is even more potent,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

Emergencies related to the drugs have surged: The American Association of Poison Control Centers received more than 6,100 calls about bath salt drugs in 2011 — up from just 304 the year before — and more than 1,700 calls in the first half of 2012.

In Montgomery County, coroner Dr. Walter Hoffman said four deaths have been attributed to the use of bath salt drugs — including a 28-year-old man and 15-year-old girl from Pottstown who were killed in a motor vehicle accident. All four people who died from the drugs were under 30 years old, he said. Bucks County Coroner Dr. Joseph Campbell said that no deaths in Bucks County have been directly attributed to bath salt use.

A Quakertown father has attributed his son’s suicide to mental health problems following bath salt use. And authorities said an Upper Moreland teen was severely injured when he jumped from the top level of the Willow Grove Park mall parking garage after smoking an unidentified synthetic drug.

Many states have banned some of the most common bath salt drugs. For instance, in June 2011, Pennsylvania legislators banned the possession, use and sale of synthetic “designer” drugs.

But while U.S. laws prohibit the sale or possession of all substances that mimic illegal drugs, that’s only true if federal prosecutors can show they’re intended for human consumption. People who make these drugs work around this by printing “not for human consumption” on packets.

Despite the bans, bath salts producers are constantly tweaking their recipes to come up with new drugs that aren’t covered by state or federal laws. In fact, Mark Ryan, director of the Louisiana Poison Center, says there are so many different drugs out there that it’s almost impossible to know what people have ingested, or how long the effects will last.

“Cocaine is cocaine and meth is meth. We know what these things do,” he said. “But with these new drugs, every time the chemist alters the chemical structure, all bets are off.”

These drugs include synthetic marijuana substitutes, also known as “herbal incense.”

At one Doylestown store, the packages were marked “not for human consumption.” When the owner was asked if she knew people smoked the product, she said she doesn’t know anything about what customers do with it.

A man leaving the store with a vial of the synthetic “incense” in his hand said he smokes it because he’s on probation for a DUI charge.

“Before (my DUI), I would not have tried any of this stuff,” said the man, who asked that he not be identified. “Even switching over to this stuff now that I can’t smoke weed is demeaning to me.”

The most common bath salt drugs, like MDPV and mephedrone, were first developed in pharmaceutical research laboratories, though they were never approved for medical use. During the last decade, they became popular as party drugs in Europe. As law enforcement began cracking down on the problem there, the drugs spread across the Atlantic Ocean.

The most dangerous synthetic drugs are stimulants that affect levels of both dopamine and serotonin, brain chemicals that affect mood and perception. Users, who typically smoke or snort the powder-based drugs, may experience a surge in energy, fever and delusions of invincibility.

Hospital emergency rooms, doctors and law enforcement agencies across the country have struggled to control bath salt drug users who often are feverish and paranoid. Hospitals in Bucks and Montgomery counties said they’ve had cases of suspected bath salts abuse, but they aren’t tracked separately from other drug overdoses.



The spread of Spice: Colleges, NCAA deal with the problem of synthetic marijuana


Former Auburn running back Mike Dyer testifies as a prosecution witness April 11, 2012, during the trial of former teammate Antonio Goodwin.

BIRMINGHAM, Alabama – Like countless other col­lege basketball players, Lamar Jack couldn’t wait for the 2012 season to begin.

The redshirt freshman forward was working out with his Anderson (S.C.) University teammates last September, going through preseason conditioning drills, when something went terribly wrong.

After complaining of cramps and blurred vision, Jack collapsed. He was rushed to the emergency room, where his body tem­perature was extremely el­evated.

Four days later, he died at the age of 19.

After an autopsy, Ander­son County coroner Greg Shore told the Anderson In­dependent Mail that Jack’s death was the result of “acute drug toxicity (that) led to multiple organ failure.”

Toxicology tests revealed that Jack had ingested the chemical JWH-018, which is used to make synthetic marijuana.

“This drug certainly triggered this young athlete’s death,” Shore said, “and that is tragic.”

Synthetic marijuana, which was sold legally over the counter in Alabama until last year under such names as K2 and Spice, has become the latest front in the war on drugs waged by athletics organizations such as the NCAA and federal agencies such as the DEA.

“Poison center experts say these substances are among the worst they have ever seen,” said Rick Dart, the president of the American Association of Poison Control Centers. “People high on these drugs can get very agitated and violent, exhibit psychosis and severe behavior changes and have harmed themselves and others.”

‘Like a heroin high’

The National Center for Drug-Free Sport, which administers drug-testing programs for the NCAA and for more than 200 colleges and universities, first spotted synthetic marijuana on its radar about two years ago.

One of the center’s vice presidents, Andrea Wickerham, said it “crept into athletics a little more than a year ago” through reports from some of the center’s university clients.

“We were hearing from them what they were hearing from their student-athletes” about the use of synthetic marijuana on campus, Wickerham said. “The schools were asking us, ‘What do you know? What are you seeing?’ ”

Based on anecdotal evidence from the center’s clients, the effects of synthetic marijuana have ranged from increased heart rate and blood pressure, Wickerham said, to “horrible examples of seizures and convulsions.”

She added that part of synthetic marijuana’s danger is “it’s an illicit street drug. You don’t know what you’re buying. What’s really in it?”

Synthetic marijuana products consist of dried leaves from traditional herbal products that have been treated with chemicals, supposedly to mimic the effects of marijuana, but they can be much stronger.

“The high is not in the least like a marijuana high,” Wickerham said. “It’s like a heroin high or an Ecstasy high, in a bad way.”

Until the chemicals used to make these products were outlawed in more than 30 states, including Alabama, and banned by the DEA, they were available over the counter at retail outlets such as gas stations, convenience stores and tobacco shops and often marketed as herbal incense.

Synthetic marijuana made headlines in the SEC twice during the past academic year. Last October, LSU suspended three football players: defensive backs Tharold Simon and Tyrann Mathieu, who went on to be a Heisman Trophy finalist, and running back Spencer Ware.

Those players missed one game against Auburn after they tested positive for synthetic marijuana in a school-administered drug test, reported at the time. Wickerham said she talked to LSU officials who confirmed that report.

In April, former Auburn tailback Mike Dyer testified at the trial of former teammate Antonio Goodwin, who later was found guilty of armed robbery and sentenced to 15 years in prison. Dyer testified that, on the night of the robbery, he met Goodwin and co-defendants Shaun Kitchens and Dakota Mosley at a party at teammate DeAngelo Benton’s house and that the players were smoking Spice.

Dyer also testified that, during his two years at Auburn, he “consistently” smoked Spice and found it “way stronger” than traditional marijuana.

“Auburn’s not alone,” Wickerham said. “We’re seeing high numbers in terms of positive test results.”

Wickerham wouldn’t provide those numbers, but they came from a blind study of about 2,000 samples from student-athletes in all NCAA sports. That study is part of the research being done by the UCLA Olympic lab as the NCAA moves toward including synthetic marijuana as one of the street drugs for which it tests at NCAA championships.

The NCAA currently conducts drug testing at its championship events in all three divisions at least once every five years, and testing occurs at certain championships every year. The NCAA also tests about 11,000 Division I and II student-athletes in all sports at random throughout the year, but only the screening at championships tests for street drugs.

The NCAA added “synthetic cannabinoids (eg. Spice, K2, JWH-018, JWH-073)” to its list of banned street drugs — a list that includes but isn’t limited to marijuana and heroin — in 2011.

“I’m hopeful the NCAA will begin testing for it (at championships) in the fall of 2013,” Wickerham said. “The missing piece now is what does the lab recommend as the threshold level (for a positive test).”

synth-mj.jpgSome of the products that fall under the broad category of synthetic marijuana that were sold legally over the counter until 2011.

Mary Wilfert, the NCAA’s associate director of health and safety, said it takes time to develop a drug-testing protocol in this case because synthetic marijuana “is not a standardized substance. There are many compounds that go into these products. We’re not testing for products. We’re testing for chemical substances.”

More than 90 percent of Division I schools conduct their own drug-testing programs. SEC schools already have begun testing their student-athletes for synthetic marijuana. Ten of the league’s 14 schools responded to multiple requests from The Birmingham News for basic information on the subject. Spokesmen for Kentucky and Vanderbilt responded but said their schools don’t reveal such medical information.

All eight schools that provided information — Alabama, Auburn, Arkansas, Georgia, LSU, Mississippi State, South Carolina and Texas A&M — said they test for synthetic marijuana and their penalties for a positive test are the same as for traditional marijuana. Those penalties vary from school to school.

Of the schools that responded, Alabama was the first to test for synthetic marijuana, beginning in the fall of 2010. Auburn began testing for it Aug. 1, 2011.

Texas A&M and Mississippi State were the only schools that responded to a question about the number or percentage of student-athletes who had tested positive for synthetic marijuana. They said they’ve each had one positive test.

Increasing usage

Statistics from the American Association of Poison Control Centers suggest usage continues to grow in the general population. The AAPCC reported that the number of calls about synthetic marijuana use to poison centers in the United States grew from 2,906 in 2010 to 6,959 in 2011. Those centers had logged 3,372 such calls through June 30 of this year.

Using its emergency scheduling authority, the DEA prohibited the possession and sale of five specific chemical agents contained in synthetic marijuana in March 2011.

“This emergency action was necessary to prevent an imminent threat to public health and safety,” the DEA said.

In October 2011, the state of Alabama followed suit when Dr. Donald Williamson, state health officer, signed an emergency order making the possession or sale of chemical compounds typically found in synthetic marijuana substances unlawful.

Between October 2010 and October 2011, the Regional Poison Control Center at Children’s Hospital of Alabama reported receiving 101 calls from people exposed to K2 or Spice. Three victims were 6 to 12, 35 were teenagers and 32 were in their 20s.

“These substances have been wrongly presented as a safe and legal alternative to marijuana,” Williamson said. “We want the public to be aware of the toxic effects and other dangers associated with synthetic marijuana use.”

Earlier this month, President Barack Obama signed into law the Synthetic Drug Abuse Prevention Act of 2012, which specifically identified a number of synthetic cannabinoids and made their use, possession or distribution illegal.

Wickerham of the National Center for Drug-Free Sport said her organization and others like the NCAA have been playing catch-up on this problem. One reason student-athletes say they’ve used synthetic marijuana, in addition to it being legal until recently, was their belief that their schools didn’t test for it or that those tests couldn’t detect it.

The NCAA has educated its schools about the dangers of synthetic marijuana through newsletters and forums, but it still is gathering information on the subject.

Every four years, the NCAA conducts a drug-use survey of student-athletes in which they’re allowed to respond anonymously. About 20,000 completed surveys are returned. The most recent survey, in 2008-09, did not ask about the use of synthetic marijuana.

The next one, in 2012-13, will.

“There just seems to be an explosion in the last few years of people developing synthetic mood-altering drugs,” Wilfert said. “It’s not something we’d seen before.”


Homemade drugs frustrating police in Grand Forks

GRAND FORKS, N.D. (AP) — When Andrew Spofford was arrested by Grand Forks police last month, he told them he is a “hobby chemist.”

Police say the end result of his chemistry was a synthetic drug that appears to have killed two teens in the area and sent several others to the hospital with overdoses.

It’s a growing problem for law enforcement as investigators struggle to identify a myriad of new synthetic drugs. Knowledge of basic chemistry has allowed drug “cooks” to make small molecular changes to existing drugs, creating new substances and keeping the cooks a step ahead of investigators.

“We are seeing a continued influx of changing of chemical compounds that make up various drugs or substances being ingested throughout the state,” said Drew Evans, senior special agent with the Minnesota Bureau of Criminal Apprehension. “They are changing at the molecular level into something it wasn’t before, but may have similar effects or different effects.”

His agency investigated the East Grand Forks, Minn., death of Elijah Stai, 17, of Park Rapids, on June 15. The agency’s labs concluded Stai had ingested a psychedelic substance called 25iNBOMe, which law enforcement officials allege Spofford cooked. The same batch of drugs allegedly killed Christian Bjerk, 18, of Grand Forks on June 10 or 11.

The chemistry recipes Spofford may have used to alter the original drug shipped from Europe could have easily been found on the Internet, said David Pierce, chairman of theUniversity of North Dakota chemistry department.

“Using organic chemicals to make up drugs is the most variable type of chemistry out there,” he said. “They are performing standard chemistry transformations but are doing it in an uncontrolled environment.”

Spofford told investigators he cooked the drug in his home, and had sold a “sheet” that included 60 to 100 hits for $500 at one point.

Pierce said that by ordering the drug from Europe, Spofford would have been able to bypass many steps he may not have had the knowledge or tools to make. The small chemical alterations Spofford would have had to do could have been complicated, taking anywhere from 20 minutes to three days.

Pierce compared the process to baking in the kitchen. The chemical reactions are dependent on exact quantities. The cook has to have exact measurements and use the exact amount of heat. He also has to know how long the chemicals have to react over a certain period of time and at a particular temperature.

“It’s not easy to do all chemical transformations; many are difficult to do,” Pierce said. “If they are cooking this stuff they can probably do general reactions they might be able to learn from the Internet, but whether they can do that in any kind of a way to be safe, all bets are off.”

Evans said these small changes make it difficult for the crime labs to distinguish the chemical makeup. The labs base their findings off of previously defined standards. The constant changes made by drug cooks force investigators to start over to determine what standard to work from.

“It’s unchartered territory and complicated for scientists to do this that do it for a living,” Evans said.