Q &A – Dr. Adi Jaffe PhD Interviewed By Tony O’Neil of The Fix

“A man was attacked on the side of the highway, authorities find the attacker eating a the victims face, and only after multiple bullet wounds is the attacker stopped.” This Zombie-like behavior is common in Hollywood scary movies, but as of late the new “Bath Salt” epidemic has turned places is like Miami into a real life Zombieland, or at least that’s what we have been told.

UPDATE: We now know that the assailant in this case (Rudy Eugene) had only traces of marijuana in his blood and no evidence of bath salts use. However he was previously diagnosed as schizophrenic and we know that especially for those at risk, marijuana use is associated with psychotic breaks.

What are “Bath Salts”?

Bath Salts are a street name given to a number of meth like drugs, so we’re not talking about your everyday Epson salt here. Although drugs like MDPV have just been made illegal, most of these substances seem to be cathinone derivatives and are central nervous system stimulants that act through interruption of dopamine, norepinephrine and to a more limited extent serotonin function.

It’s very important to note that research on this is still in its early stages and so reports are limited. However, it seems that at low to moderate doses the most common effects for MDPV can be thought of as either meth-like or like very strong adderall or ritalin – so users experience stimulation, euphoria, and alertness. Mephedrone seems to act more like MDMA (ecstasy) than meth, at least in early animal research with these drugs. At high doses however, and obviously there is no one regulating the dose since these drugs are sold as if not for human consumption, the effects can look like psychosis. These are not necessarily very different from meth induced psychosis which can include panic attacks, severe paranoia, self-mutilation, and violence.

There are several confirmed research reports (individuals who had only MDPV in their system) of people injecting or snorting MDPV and developing severe psychosis, “running wildly throughout the local neighborhood,” foaming at the mouth and being combative when approached. Worse still, these individuals can develop severe organ failure, require intubation (breathing tube insertion through throat), and at times die even in the face of extreme medical intervention.

How do Bath Salts affect the nervous system?

These drugs tend to be sympathomemetic, which means they induce sympathetic nervous system activation – the increased heart rate, temperature, etc. This is also where they can be most dangerous even when people don’t develop the possible psychotic effects (due to organ failure from the hyper activation).

Can one become addicted to Bath Salts?

I think that there’s no question that this stuff can cause physical dependence. I personally know of a client at matrix here in west la who came in specifically for “over the counter stimulant addiction” to drugs like these. He was snorting, then injecting them and stayed up for days. Eventually he was hospitalized with severe agitation and mild psychosis. These high doses are almost certainly, based on what we know with meth and MDMA, also causing neurotoxicity (some of the effects irreversible).

What Harm Reduction model should be used for Bath Salts?

It seems that MDPV and mephedrone are indeed drugs worth worrying about, at least in so much as they are completely unregulated when sold “not for human consumption.” While their effects at low/moderate doses are not severe are can be thought of as related to those of other stimulants, at high doses they can be lethal and can certainly bring about serious negative psychological effects. I always think that there is some room for harm reduction when trying to get some control over abuse of such drugs. In this case, while it’s probably best to stay away completely, I would urge people who are going to use to be careful and not to use large amounts of this stuff before seeing how they react. The neurotoxicity and cardiac effects can be too extreme and may lead to severe irreversible consequences at high doses.

How can the media help resolve this epidemic?

Press coverage always makes more people aware of an issue than they were before the topic was covered. In this case, especially if we can sneak in some of the above harm-reduction messages along with the overall “don’t use this stuff” text we normally see, we might be able to use the opportunity to save some lives. I think, as I’ve said before, that people (especially kids) are going to be on the lookout for ways to change their experience no matter what. The question is how we react when they do things we don’t like and how does our reaction affect their future behavior.

I think that we can use the real information – possible death and psychosis, especially when snorted or injected – to alter the ways people use Bath Salts, allowing for a campaign that isn’t only looking to stop the use of the drug but that is focused on minimizing consequences. However it seems that the press isn’t covering the range of possible effects but is choosing instead to focus on the most outrageous. These types of scare tactics haven’t worked too well in the past for curving drug use, but it doesn’t hurt TV ratings so I don’t expect it to stop.

Will banning bath salts help?

I believe that in this case, as we can already see, we are once again going to be playing a cat and mouse game that congress seems happy to play. They’ll outlaw more components of Bath Salts (MDPV, mephedrone, and methylone apparently already are controlled) but new ones will continue to come out. To me, the question is whether we believe we will one day ban all psychoactive substances we have issue with or whether we will be successful in developing a strategy for dealing with their abuse in a way that helps recognize and intervene early.

I think that the banning approach makes it less likely that people with abuse problems, or even acute medical problems, will contact authorities for help. Worse yet, it makes it nearly impossible for us to get a handle on safer use practices for a specific drug as they all get replaced by new variations – often ones that are even more dangerous.

Although the press has made the Bath Salt epidemic much more like a Hollywood production than reality, there are issues that need to be addressed. I just don’t believe in scaring the public into action, I’d prefer if popular media were just honest with the public about these drugs so that people can draw their own conclusions.