Bath Salt Drugs and Molly Addictions

Bath Salt Drugs and Molly Addictions

Bath Salt Drugs and Molly Addictions

Bath Salt Drugs and Molly AddictionsNew York’s Electric Zoo Festival held over Labor Day weekend made headlines in 2013 not because the electronic music was great, but because it shut down early after two people died from drug overdoses.[i]  That same weekend a University of Virginia student died at a Washington, D.C. rave, and a 19-year-old woman died in a Boston club, where three other people also overdosed.[ii]

All seven, including those who died within a week of one another, had consumed “Molly,” a pill sold at parties and concerts that is supposed to be pure Ecstasy. The pills they took actually contained cathinones, man-made drugs found in “bath salts.” Bath salts have nothing to do with actual bath salts. They are hallucinogens legally sold in little packets in convenience stores and over the Internet, sometimes packaged as plant fertilizer, plant food, cell phone cleaner, pond cleaner, insect repellant, vacuum bag cleaner, and jewelry cleaner.[iii] The packages are usually marked “not fit for human consumption” so that they can be sold legally.[iv] Before state and federal legislatures began cracking down on bath salts, minors were buying these drugs more easily than they could buy cigarettes.

Molly was marketed as something new and hip about ten years ago,  and has been celebrated in music by Kanye West, Rihanna, Madonna, and Jay Z. Miley Cyrus’ notorious song at the MTV Awards show featured lyrics about “dancing with Molly,” and how “We can’t stop, we won’t stop the molly party.”  State and federal legislatures, however, are increasingly the ones posed to stop the party,  as deaths from Molly and bath salts increase and the unpredictability of these drugs increasingly signal a threat to public health.

What are Bath Salt Drugs? What is Molly?

Molly is a drug sold at raves, clubs and concerts as pure Ecstasy.

Molly usually comes as pink and blue pills that cost $5 to $35 each. According to the U.S. Drug Enforcement Agency, 80% to 90% of these pills are not pure Ecstasy and many contain no Ecstasy at all.  Most Molly pills contain methylone or other ingredients found in bath salt drugs.  The reason drug dealers substitute these ingredients is that they can be easily purchased online from Asia and Europe at a much cheaper price than Ecstasy. One kilogram of methylone costs $3,000 to $5,000, but one kilogram of Ecstasy costs ten times that amount.[v]

In chemical terms, Ecstasy is 3, 4-methylenedioxy-N-methylamphetamine (MDMA) with a molecule.[vi]

Most Molly pills contain methylone or 3, 4-methylenedioxy-N-methylcathinone, which is similar to Ecstasy except for the addition of one β-ketone group.[vii]

Methylone is one of the ingredients found in hallucinatory drugs sold over-the-counter in small packets of powder usually labeled “bath salts.”

The two other active ingredients in bath salt drugs are most often mephedrone and methylenedioxypyrovalerone or MDPV. The chemical formula for mephedrone is 2-methylamino-1-(3, 4-methylenedioxyphenyl) propan-1-one.

MDPV has the chemical name of (RS)-1-(Benz[d] [1, 3] dioxol-5-yl)-2-(pyrrolidin-1-yl) pentan-1-one.

Mephedrone, MDPV and methylone are classified as cathinones.  They are man-made chemicals that imitate a substance in the Catha edulis plant called khat, which is widely used on the Arabian Peninsula and Eastern Africa.[viii] Synthetic versions of khat are nothing new – they have been around since the 1910s.  What’s new is how quickly new versions of khat are being created in order to circumvent drug laws.

How do Bath Salt Drugs and Molly Affect the Brain?

Cathinones or bath salt drugs and Ecstasy are unusual in that they work as both stimulants and hallucinogens. However, cathinones differ from Ecstasy in that they do not make you empathic and mellow.[ix] People are more likely to become agitated, violent and paranoid taking bath salt drugs, according to Dr. Jeff LaPoint of Kaiser Permanente.[x]

Bath salt drugs affect the monoamine neurotransmitters in the brain.  These nerve cells act as dopamine and norepinephrine reuptake receptors, which means they increase the levels of the “feel good chemicals” –serotonin, dopamine and norepinephrine.

The word “Molly” comes from “molecule,” supposedly referring to the MDMA molecule. [xi] MDMA is chemically similar to a combination of methamphetamine and mescaline, and like cathinones, it causes a higher than normal release of serotonin and dopamine.

What Are the Typical Effects of Bath Salt Drugs and Molly?

If a Molly pill actually contains Ecstasy, someone who took it feels a distorted sense of perception and time, while his or her senses of hearing, touch, sight, smell and taste may be enhanced. Ecstasy produces feelings of empathy and decreased anxiety, but it can also cause increased muscle tension, faster heart rate and increased blood pressure, teeth clenching and grinding, sleep problems, drug cravings, and loss of appetite. [xii]

Bath salt packages usually contain mephedrone, MDPV and methylone or chemical derivatives of them.  You never know which one you are buying and in what purity or amount, so their effects are unpredictable.  In general, bath salt drugs cause hallucinations, increased heart rate and blood pressure, chest pain, and hallucinations.[xiii] Unwanted side effects can be suicidal thinking, self-mutilation, delusions, anxiety, psychosis, chest pain, paranoia, “excited delirium,” or “toxic delirium.”[xiv] Symptoms of excited delirium include agitation, disorientation, psychosis, bizarre behavior, superhuman strength, and elevated body temperature, a condition is associated with cocaine, methamphetamine, PCP and Ecstasy.  Toxic delirium is a medical term meaning mental disorientation as a result of poisoning.[xv]

Effects of bath salt drugs can last up to two hours and usually peak around the 90-minute point.  The “coming down” phase lasts two to four hours.

Both Ecstasy and bath salt drugs can cause a condition known as “Suicide Tuesday,” extreme depression that lasts several days after the drug experience that occurred over the weekend.[xvi]

What is the Legal Status of Bath Salt Drugs and Molly?

In a piece for Time Magazine, the famous Dr. Mehta Oz described how he disguised himself with a ski hat and glasses to buy bath salts from a local “head shop.”

“I’m telling you first as a father, and then as a doctor,” he wrote, “that the ease of that transaction chilled me.”

He was writing in 2011, and since then it has become harder to obtain bath salts over the counter.  Forty-three states and Puerto have outlawed their sales.[xvii] Great Britain, Finland, Australia, Germany, Denmark, Sweden, Croatia, Belgium, Lithuania, Romania, Italy and Ireland have passed similar bans.[xviii]

In 2011, Attorney General Eric Holder put mephedrone, MDPV and methylone on the list of controlled illegal substances on a temporary basis. In 2012, mephedrone and MDPV were permanently placed on the list, and the ban on methylone was temporarily extended.[xix] In 2012 Congress passed the Synthetic Drug Abuse Prevention Act which classifies 26 kinds of synthetic marijuana and cathinones, including MDPV and mephedrone, as Schedule I Controlled Substances. Schedule I substances have the highest potential for abuse and are illegal to use, even for medical purposes.   If you are caught possessing, selling or otherwise dealing in Schedule I Controlled Substances, you face the most severe fines and jail sentences under drug laws.

The problem is that as soon as one drug is banned, an analogue –or one that is the same as the old one except with minimal changes– comes on the market. The Synthetic Abuse and Labeling of Toxic Substances (SALT) Act of 2013 addresses the analogue issue.   New York Senator Chuck Schumer is co-sponsoring the Protecting Our Youth from Dangerous Synthetic Drugs Act that would attach the same penalties to dealing in analogues as those on the original drugs.[xx]

Molly or any drug containing Ecstasy are Schedule I Controlled Substances.

What are the Medical Uses of Bath Salt Drugs?

As Schedule I Controlled Substances, methylone and other analogues of khat have no medical uses. They are even difficult to obtain for the purpose of study.

Scientists have investigated the potential of Ecstasy as a drug that could help people suffering from terminal cancer and post-traumatic stress syndrome.[xxi]

What Drugs Interact with Bath Salt Drugs and Molly?

Since these drugs are illegal and very recent, there are few scientific studies of their interactions with other substances.  Officials at the White House’s Office on National Drug Policy have called them “an unpredictable risk to public health.”[xxii]

It is known that alcohol may dampen the effects of drugs like the ones in bath salts, and cocaine and other stimulants increase their effects.[xxiii]

Which People Should not Take Bath Salt Drugs or Molly?

No one should experiment with bath salts or Molly because you never know exactly what you are buying and in what purity. These drugs are not regulated or standardized, and many of the pills and packets are full of harmful fillers or stimulants.

People with undiagnosed mental illnesses or heart conditions or those in fragile health are particularly at risk for dangerous reactions, overdoses, and side effects. People with histories of alcoholism or drug abuse are at higher risk of becoming addicted to any kind of drug, including stimulants like bath salt drugs or Molly.

What are the Risks of Taking Bath Salt Drugs?

The greatest risk of experimenting with these drugs is their unpredictability.

As a spokesperson for the Drug Enforcement Agency said, “If these kids knew this was rat poison, they wouldn’t be buying it. But they’re marketing it in colorful tablets, and they’re being told it’s okay to put in their drinks.”[xxiv]

No one knows the long-term effects of taking bath salt drugs. However, substances most similar to these drugs, including Ecstasy, cause addiction and cognitive and memory defects after repeated use.[xxv] Long-term use of Ecstasy is linked to physical changes in the brain and impairment of both cognitive and memory functions. Some experts believe that the brain damage Ecstasy causes is permanent.[xxvi] Repeated long-term use of Ecstasy is also linked to kidney and liver damage.[xxvii]

People have died from taking bath salts.  A 20-year-old man from Staten Island named Matthew Rybarczyk went into convulsions, spiked an extremely high temperature and died after taking bath salts at a rave.  His grandmother, who stayed with him at the hospital, called it “a horrible death.”[xxviii]  Dickie Sanders, age 21, died in November 2010 after ingesting bath salts. He was the son of two doctors.[xxix]

People high on bath salts have acted in violent ways, harming themselves and others. An Indiana man climbed a flagpole and jumped into traffic, and a Pennsylvania man broke into a monastery and stabbed a priest to death.[xxx] David Stewart killed himself, his wife and five-year-old son in the state of Washington after a police pursuit on an Interstate highway.  Giovanni Leask of Austin, Texas, attacked the paramedic treating him for injuries he suffered jumping off a bridge while high on bath salts.[xxxi]

Do Bath Salt Drugs Show up on Urine Tests?

Standard urine tests given at work and schools do not detect the active ingredients in bath salt drugs.  However, you can order a specialized version to test for these drugs, and emergency room doctors frequently do.[xxxii]  Tests that can detect bath salt chemicals use gas chromatography-mass spectrometry.[xxxiii]

What Are Bath Salt Drugs and Molly Overdoses?

Many people who overdose or have bad reactions to bath salt drugs die at home or at a party before they can receive medical treatment. Usually, they have combined these drugs with other substances, most often other stimulants such as methamphetamine or energy drinks. Body temperatures as high as 108 degrees have been reported.[xxxiv] The most common cause of death is dehydration, being overheated, or cardiovascular events, but paradoxically, some people have died from retaining too much water.  They “over-drink” to compensate for becoming overheated.

People show up at emergency rooms so agitated that it can take several orderlies to restrain them. In an article advising paramedics how to handle emergencies related to bath salts, the author wrote, “Physical restraint is difficult because of patients’ decreased pain sensitivity, increased strength, and loss of rational thought.” He goes on to describe how a small female needed four paramedics to restrain her, and how police officers have reported that using Taser or pepper spray did not control these patients.[xxxv] The danger of such agitation to the patients is that some experience muscle breakdown that causes a release of chemicals that, in turn, causes kidney failure.

Dr. Jeffrey Narmi, an emergency room doctor in Pennsylvania who has treated patients suffering from reactions to bath salt drugs, said, “There were some who were admitted overnight for treatment and subsequently admitted to a psychiatric floor. These people were completely disconnected from reality and in a very bad place.”[xxxvi]

Doctors do not have an antidote for poisonings by bath salt drugs.  Usually, ER doctors put the person on basic life support and restrain them, if necessary. Besides agitation, paranoia and psychosis, other symptoms can be similar to overdoses from stimulants such as cocaine, including dilated pupils, involuntary muscle movements, and cardiovascular irregularities.[xxxvii] Some doctors use benzodiazepines or other sedatives or even general anesthesia in an effort to calm these patients.

Autopsies of people who died at raves and concerts after they thought they were taking pure Ecstasy in the form of a Molly pill later showed that they had actually ingested bath salt drugs.[xxxviii]

What Are Bath Salt Drugs and Molly Addictions?

Experts who follow trends in drug addiction compared the current popularity of bath salt drugs and Molly to the PCP craze of the 1970s. All of a sudden, they are seeing surges in the number of users and the number of Molly pills and bath salt packets seized by the DEA.[xxxix] On July 26, 2012, a nationwide crackdown resulted in 91 arrests and the confiscation of 559, 000 packages of bath salts. Between January 2012 and September 2013, the DEA seized 300 kilograms of these drugs under Project Synergy.[xl] In 2009, 26 lab reports regarding bath salts were filed with the DEA; in 2012, that number was 9,186.[xli]

Another statistic that points to an increase in the use of bath salts is the number of calls to poison control centers. In 2010, these centers received 304 calls about bath salts; in 2011, that number was 6,138.[xlii]

Another indicator of increased popularity of bath salts came from the Global Drug Survey, which found that only 26% of regular users of illegal drugs had tried Molly in 2012, but just one year later in 2013, that rate was 70%.[xliii]

Names on bath salt packages have been Purple Wave, Cloud Nine, Zoom, Kush Blitz, Lovey-Dovey, White Lightning, Euphoria,[xliv] Vanilla Sky, Bliss, and Ivory Wave.[xlv]

The usual way to ingest bath salts is to snort them through the nose, but some people mix them into food and drinks. One expert spotted “an alarming trend toward intravenous use.” The usual dose is 25 mg.[xlvi]

Most people who ingest bath salts also use alcohol, marijuana, amphetamines, LSD, opiates, benzodiazepines, and other designer drugs. One study of abusers of bath salts found they were 78% male and 66% under 35 years old, with the average age being 26 years old.[xlvii]

What is Bath Salt Drug and Molly Withdrawal?

Very little is known about bath salt addictions, because these products have only been available for less than a decade, and only widely used in the past two years. Some assume that since the drugs are stimulants, and chemically similar to Ecstasy, addiction is possible. Addiction would involve developing a physical tolerance to the drugs, which means you have to take more to get the same effect you used to achieve with a smaller dose. You would also experience drug cravings, drug seeking behaviors, and a withdrawal syndrome when you stop taking them. About 43% of people who use Ecstasy become physically dependent on the drug and go through withdrawal syndromes when they stop using it, according to research done in 2000 and 2006.[xlviii]

The withdrawal syndrome for Ecstasy may include symptoms like suicidal thinking, depression, anxiety, panic attacks, paranoia, dizziness, aches, irritability, and difficulty concentrating. People often become more emotional and sad, as a result of changes in serotonin levels in their brains.[xlix] Something similar would probably result in repeated, long-term use of bath salts or Molly pills containing cathinones.

What Treatments are Available for Bath Salt Drug or Molly Abuse?

The vast majority of people who enter residential treatment are abusing a variety of drugs along with Molly or bath salts. The vast majority also have psychiatric comorbidities, or mental health problems that travel with but do not necessarily cause drug abuse. The most common comorbidity is depression, but many drug abusers are struggling with other undiagnosed conditions such as bipolar disorder, attention deficit disorder, posttraumatic stress syndrome, childhood sexual trauma, and other problems. For example, if a child has struggled and constantly failed at school because of undiagnosed attention deficit disorder, he or she is more likely to abuse drugs. The ADHD and the drug abuse are two separate issues that have to be treated in two separate medical protocols.

Abusers of drugs like Molly, Ecstasy and bath salts are often seeking a connection with other people through an alternative lifestyle of raves and parties. Although these drugs help them achieve a euphoric state in which they feel a mystical connection to others at a party, no authentic communication is taking place and no real relationships are being formed. When the party’s over, so are the connections. The psychological crash follows a few days later on “Suicide Tuesday,” when they feel depressed and unfulfilled. There may be another party on the next Saturday, but it does not solve the problem of social isolation, loneliness, and the need for love.

The state-of-the-art treatment for drug abuse is to enter a residential treatment center and to spend at least a month or so working through an intensive, individualized program. The first step is a medically supervised detoxification, in which your body becomes clear of all drugs, not just hallucinogens. Once chemical detoxification is complete, you enter phase two of treatment, which includes intense one-on-one psychotherapy with a counselor who can help you create a new lifestyle. You need time to explore career choices and fulfilling hobbies, and you need time to create healthy, positive relationships with others. You also need to learn how to handle stress and negative emotions such as loneliness and boredom without using drugs. All this is possible to learn during a good drug treatment program. When you return home, you usually remain in psychotherapy and family therapy, if necessary, and you usually attend self-help meetings in your local community.

How Can I Tell if I am Addicted to Bath Salt drugs or Molly?

If you can answer yes to any of the following questions, it is time for you to talk to a medical professional about your abuse of bath salts or Molly.

  • Is your social life all about using drugs?
  • Are you using other drugs along bath salts or Molly?  These drugs might be alcohol or medical drugs taken without a doctor’s description, as well as illegal drugs.
  • Is going to a rave or a party where Molly or bath salts are available the highlight of your life?
  • Do you know what “Suicide Tuesday” is like?
  • Do you experience depression and other withdrawal symptoms when you stop using drugs?
  • Have you tried and failed to quit using drugs?
  • Have you tried and failed to cut down on drugs?
  • Do your family members or loved ones criticize you for using drugs?
  • Does your drug use interfere with your performance at work or school?
  • Do you worry that your drugs may be contaminated?
  • Do you feel guilty or ashamed about using drugs?
  • Do you think that life is passing you by because you use too many drugs?
  • If money were no object, would you enter treatment for drug abuse?
  • Have you ever gotten in trouble with the law because you use drugs?
  • Have you ever driven under the influence of drugs or otherwise put yourself in physical danger when you were high?

[i] Mason, Kern. “Dancing with Molly,” Billboard, September 20, 2013.

[ii] Cavaliere, Victoria. Drug ‘Molly’ is taking a party toll in the United States. Reuters, September 28, 2013.

[iii] DUCKWORTH R. Bath Salts and Synthetic Marijuana: An Emerging Threat. Fire Engineering [serial online]. November 2012; 165(11):32.

[iv] McMillen, Matt. “Bath Salts: Problems Dangers and More,” The Web MD, http://www.webmd.com/mental-health/features/bath-salts-drug-dangers

[v] Campo-Flores, Arian and Zusha Elinson. “Club Drug Takes Deadly Toll,” The Wall Street Journal, September 25, 2013.

[vi]”MDMA The Facts,” InfoFacts National Institute of Drug Abuse, see http://www.drugabuse.gov/sites/default/files/mdma10.pdf

[vii] Cozzi NV, Sievert MK, Shulgin AT, Jacob P, Ruoho AE (September 1999). “Inhibition of plasma membrane monoamine transporters by beta-ketoamphetamines”. European Journal of Pharmacology 381 (1): 63–9.

[viii] Penders T. How to recognize a patient who’s high on “bath salts”. Journal Of Family Practice [serial online]. April 2012; 61(4):210.

[ix] Campo-Flores, Arian and Zusha Elinson. “Club Drug Takes Deadly Toll,” The Wall Street Journal, September 25, 2013.

[x] Ibid.

[xi] Smith, Tovia. “Scrutiny of Molly After Four Concert Deaths,” National Public Radio, September 9, 2013.

[xii] “MDMA The Facts,” InfoFacts National Institute of Drug Abuse, see http://www.drugabuse.gov/sites/default/files/mdma10.pdf

[xiii] “Synthetic Drugs,” The Office of National Drug Control Policy, The White House, see http://www.whitehouse.gov/ondcp/ondcp-fact-sheets/synthetic-drugs-k2-spice-bath-salts

[xiv] Ibid, see also McMillen, Matt. “Bath Salts: Problems Dangers and More,” The Web MD, http://www.webmd.com/mental-health/features/bath-salts-drug-dangers

[xv] DUCKWORTH R. Bath Salts and Synthetic Marijuana: An Emerging Threat. Fire Engineering [serial online]. November 2012; 165(11):32.

[xvi] Smith, Tovia. “Scrutiny of Molly After Four Concert Deaths,” National Public Radio, September 9, 2013.

[xvii] “Synthetic Drug Threats,” The National Conference of State Legislatures, see http://www.ncsl.org/issues-research/justice/synthetic-drug-threats.aspx

[xviii] Ibid.

[xix] Sacco, Lisa and Kristin Finklea. “Synthetic Drugs: Overview and Issues for Congress,” A 22-page pamphlet, Congressional Research Service, September 2013, see http://www.fas.org/sgp/crs/misc/R42066.pdf

[xx] Fox, Alison. “Proposed Law Change Targets Drug ‘Molly’,” The Wall Street Journal, September 25, 2013.

[xxi] See   Cloud, John. “Ecstasy Shows Promise in Relieving PTSD,” Time Magazine, July 20, 2010; and Slater, Lauren. “How Psychedelic Drugs Can Help Patients Face Death,” The New York Times, April 20, 2012.

[xxii] “Synthetic Drugs,” The Office of National Drug Control Policy, The White House, see http://www.whitehouse.gov/ondcp/ondcp-fact-sheets/synthetic-drugs-k2-spice-bath-salts

[xxiii] Sazalvitz, Maia. “Four Myths About the Drug Molly,” Time Magazine, September 3, 2013.

[xxiv] “Dangerous Drug Molly,” CBS News Baltimore, September 18, 2013.

[xxv] Hadlock, GC et al. Mephedrone: Neurophamacologic Effects of A Designer Stimulant of Abuse. The Journal of Pharmacology and Experimental Therapeutics, 2011: 339, pg. 530-536.

[xxvi] Kolata, Gina. “Scientists Studying the Drug Ecstasy Decipher Its Destructive Secrets,” New York Times, February 7, 1989.

[xxvii]  “Ecstasy Drug Guide,” the Partnership for a Drug-Free America, see http://www.drugfree.org/drug-guide/Ecstasy

[xxviii] Campo-Flores, Arian and Zusha Elinson. “Club Drug Takes Deadly Toll,” The Wall Street Journal, September 25, 2013.

[xxix] Oz M. Evil Lurking at Your Corner Store. Time [serial online]. April 25, 2011; 177(16):54.

[xxx] Wood D. Bath salts: police and hospitals befuddled by new drug craze. Christian Science Monitor [serial online]. March 13, 2012.

[xxxi] DUCKWORTH R. Bath Salts and Synthetic Marijuana: An Emerging Threat. Fire Engineering [serial online]. November 2012; 165(11):32.

[xxxii] Penders T. How to recognize a patient who’s high on “bath salts”. Journal Of Family Practice [serial online]. April 2012; 61(4):210.

[xxxiii] Rust KY, Baumgartner MR, Dally AM, Kraemer T (2012). “Prevalence of new psychoactive substances: A retrospective study in hair”. Drug Testing and Analysis 4 (6): 402–408.

[xxxiv] Penders T. How to recognize a patient who’s high on “bath salts”. Journal Of Family Practice [serial online]. April 2012; 61(4):210.

[xxxv] Goodnough, Abby and Katie Zezima. “An Alarming New Stimulant, Legal in Many States.” The New York Times, July 16, 2011. See also DUCKWORTH R. Bath Salts and Synthetic Marijuana: An Emerging Threat. Fire Engineering [serial online]. November 2012; 165(11):32.

[xxxvi] Goodnough, Abby and Katie Zezima. “An Alarming New Stimulant, Legal in Many States.” The New York Times, July 16, 2011.

[xxxvii] Miller M. Bath salts-a new way to get high? Harvard Mental Health Letter [serial online]. September 2011; 28(3):8.

[xxxviii] Campo-Flores, Arian and Zusha Elinson. “Club Drug Takes Deadly Toll,” The Wall Street Journal, September 25, 2013.

[xxxix] Goodnough, Abby and Katie Zezima. “An Alarming New Stimulant, Legal in Many States.” The New York Times, July 16, 2011.

[xl] “Updated Results From DEA’s Largest-Ever Global Synthetic Drug Takedown Yesterday,” The U.S. Department of Justice, the U.S. Drug Enforcement Agency, June 6, 2013, see http://www.justice.gov/dea/divisions/hq/2013/hq062613.shtml

[xli]Leger, Donna. “Police Report Growing Abuse of the club drug Molly,” USA Today, September 25, 2013; see also Campo-Flores, Arian and Zusha Elinson. “Club Drug Takes Deadly Toll,” The Wall Street Journal, September 25, 2013.

[xlii] Sacco, Lisa and Kristin Finklea. “Synthetic Drugs: Overview and Issues for Congress,” A 22-page pamphlet, Congressional Research Service, September 2013, see http://www.fas.org/sgp/crs/misc/R42066.pdf

[xliii]Fox, Alison. “Proposed Law Change Targets Drug ‘Molly’,” The Wall Street Journal, September 25, 2013.

[xliv] Wood D. Bath salts: police and hospitals befuddled by new drug craze. Christian Science Monitor [serial online]. March 13, 2012.

[xlv] McMillen, Matt. “Bath Salts: Problems Dangers and More,” The Web MD, http://www.webmd.com/mental-health/features/bath-salts-drug-dangers

[xlvi] Penders T. How to recognize a patient who’s high on “bath salts”. Journal Of Family Practice [serial online]. April 2012; 61(4):210.

[xlvii] Ibid.

[xlviii] Stone, AL, Storr, CL and Anthony, JC. Evidence for all hallucinogens dependent C. syndrome developing soon after onset of hallucinogenic use during adolescence. The International Journal of Methods in Psychiatric Research, 15:116-130, 2006; and Cottler, LB et al. Ecstasy Abuse and Dependence among Adult and Young Adults, Human Psychopharmacology, 16:599-606, 2001.

[xlix] Lieb R, Schuetz CG, Pfister H, von Sydow K, Wittchen H “Mental disorders in ecstasy users: a prospective-longitudinal investigation.” Drug Alcohol Depend 2002; 68: 195-207.

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