Pubdate: Mon, 30 Jul 2012
Source: Evening Tribune, The (NY)
Copyright: 2012 GateHouse Media, Inc.
Contact:  http://www.eveningtribune.com/
Details: http://www.mapinc.org/media/4473
Author: Christine Loman

FOR HOSPITAL WORKERS, BATH SALTS PROBLEMS GROW

'It's Really Crack on Speed'

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.

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.
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MAP posted-by: Jay Bergstrom