1. Adverse Effects of Spice and Bath Salts
Designer Drugs
Adverse Effects of
Spice and Bath Salts
Prepared: 20 July 2011

2. Spice Products
Each Spice product may contain one or more synthetic cannabinoid compounds with differing potencies. The compound(s) are sprayed on herbal materials and smoked to receive the marijuana-like compounds into the body and produce the marijuana-like effects. Spice products are manufactured by unknown, unregulated sources. 2

3. Synthetic Marijuana-Like Compounds
Spice
Synthetic Marijuana-Like Compounds
Sold as herbal incense – not for human consumption
Products contain various synthetic cannabinoid compounds (compounds that produce marijuana-like effects) - some are much more potent than marijuana
According to the DEA, placement of these synthetic cannabinoids into Schedule I of the CSA was necessary to avoid an imminent hazard to the public safety. This action imposes criminal sanctions and regulatory controls on the manufacture, distribution, possession, importation, and exportation of these synthetic cannabinoids. 3

4. 01 March 2011: 5 Substances Temporarily Scheduled for One Year
Included in the DEA Notice:
JWH-018
JWH-073
JWH-200
CP-47,497
CP-47,497 C8 homologue
HU-210 previously scheduled
Only 6 compounds on the DEA list:
There are 100+ of these synthetic compounds-
“A Moving Target”
Although 5 more commonly used synthetic marijuana-like compounds have been listed as controlled substances, the underground chemists can, very easily, switch to other similar synthetic cannabinoid compounds to get around the Schedule I Controlled Substances Act status. In doing so, the effects of these and other synthetic cannabinoid compounds, are unknown and unpredictable when ingested. There are no controlled human use studies so information on adverse effects has come from a number of sources such as Poison Control Centers, Emergency Room reports and various antidotal sources. Trying to identify the “active ingredient” used to produce the marijuana-like effects of Spice products is like chasing a “Moving Target”.

5. Spice Adverse Effects
Used for its psychoactive and hallucinogenic effect
Some reports of relaxation and sedation, but less euphoria than cannabis
Report of rapid tolerance leading to increased dose
Withdrawal, including “internal unrest, tremor, palpitation, insomnia, headache, diarrhea, nausea, vomiting”
Report of “imperative voices (being told to act a certain way) as well as recurrent paranoid hallucinations”
Report of tachycardia and loss of consciousness
Not FDA approved for human consumption
No oversight of manufacturing process
Could have multiple chemicals with unknown potency mixed with herbs
5-200x more potent than THC in marijuana
Psychotic symptoms
Two references are listed which report Spice Adverse Effects. The Navy Times article interviewed a 3rd year psychiatry resident, LCDR David Hurst who reported first-hand observations of 17 Navy and Marine Corps patients who reported having used Spice products short-term and others for over 18 months. “They were all paranoid that the government was after them, …with delusions.” “ All had flat facial expressions, a hallmark of psychosis.” Each of the patients were brought to the Emergency Room and later entered the Psychiatric Ward for treatment with antipsychotic medications. Several saw improvement over 3-8 days and others remained in a psychotic condition, thus leading to the conclusion that Spice products may lead to serious, potentially long-term mental disorders.
Toxicology Letters 197 (2010)
Navy Times News, 06 June 2011, Psych Resident: Spice’s Effects could be Serious, Long-Lasting

6. Bath Salts / Plant Food Products
Here are other examples of “Not for Human Consumption” products that contain designer drug stimulants. These are legal products, not falling under FDA or Controlled Substances Act regulations. DEA is gathering data on the adverse effects from their use, to determine whether to emergency schedule these stimulant compounds as an imminent danger to the public safety.

7. Mephedrone (4-methylmethcathinone)
Present in products marketed as plant food and bath salts – not for human consumption
Chemically related to amphetamine
Effects similar to Ecstasy reported - euphoria, well-being, increased alertness
Widespread use in the UK
Not scheduled in the US

8. Mephedrone Adverse Effects
Intense alertness, euphoria
Empathy, talkativeness
Intense sensory input
Sexual arousal
Perceptual distortions
Hallucinations
Severe paranoia
Aggression
Panic attacks
Headache, tremors, blurred vision, seizures
Anxiety, agitation, aggression, depression, psychosis
Tachycardia, elevated BP, chest pain
Body temperature lability
Nausea, vomiting, diarrhea
Renal dysfunction, urinary retention
Psychopharmacology, DOI: /s x. Published online 12 Nov 2010.
U.S. DOJ DEA. Office of Diversion Control. Accessed at

9. MDPV (methylenedioxypyrovalerone)
Present in products marketed as bath salts and plant food – not for human consumption
Pure white to light brown clumpy powder
Chemically related to amphetamine – very strong stimulant
Effects similar to cocaine and amphetamines

10. MDPV Adverse Effects Rapid heartbeat High blood pressure Insomnia
Stomach cramps
Grinding teeth
Increased body temperature, chills, sweating
Pupil dilation
Headache
From Wikipedia
Bloodshot eyes
Kidney pain
Ringing in the ears
Dizziness
Overstimulation
Breathing difficulty
Agitation
Panic attacks

11. MDPV Case Reports Few published case reports
Incoherent self-employed chemist arrested in March 2008 for DWI1
Acute liver failure in 28 year-old male2
Numerous anecdotal reports from Emergency Departments for adolescents with acute psychotic events who admitted to taking MDPV, aka Bath Salts
35 patients, in MI, presented to ED from Nov 10-Mar 11
Toxicity symptoms; agitation, tachycardia, delusions/hallucinations. 17 patients hospitalized and 1 death3
Multiple substances may have been used; plus manufacturing practices could have hazardous contaminants along with MDPV
The three references provide several case reports on the adverse effects from the use of the stimulant designer drugs, MDPV and mephedrone. The Morbidity and Mortality Weekly Report, 20 May 2011, is one of the first public health investigations of emergency room (ER) cases from the use of “bath salts”. Michigan ERs reported 35 patients from 13 Nov 2010 to 31 March 2011 with 17 patients requiring hospitalization and one who died. Of the 17 patients who were hospitalized; 9 patients were admitted to the ICU, 5 to a general floor, and 3 directly to the psychiatric unit. All the patients exhibited clinical findings consistent with intoxication from the use of stimulants causing cardiovascular, neurological, and psychological symptoms. Patients had hypertension, racing, irregular heartbeat, tremors, delusions, paranoia, and some exhibited violent behavior. In the end, the individuals were incapacitated for days from using a $20 packet of “Not for Human Consumption” “bath salts” containing MDPV, a designer stimulant .
1Microgram Journal, Vol 7, No 1 (March 2010); accessed at
2Ir J Med Sci, Vol 180 (Nov 2010), No 1,
3Morbidity and Mortality Weekly Report, Vol. 60, No. 19, (May 20, 2011),