Bath Salts Overdose

Crystal bath salts spilling out of a small bag

Bath salts, or synthetic cathinones, are a group of designer drugs that are used as a cheap and easily accessible substitute for other illicit drugs such as amphetamines, cocaine and MDMA. Use of bath salts in large quantities or in combination with other drugs can lead to an overdose. 

Bath salts have stimulant effects like amphetamines and cocaine, resulting in euphoria and increased energy, but also have psychoactive properties like MDMA. As the effects of bath salts wear off, they produce unpleasurable effects and may result in the use of larger quantities of the drug, often resulting in toxic effects.

How Do Bath Salts Overdoses Occur?

Bath salts are often produced in street labs and sold by local dealers or over the internet. The lack of regulation over the manufacturing process results in most users being unaware of the dosage of the drug used. Besides the variability of dosage, packages sold as bath salts may contain a single synthetic cathinone or multiple different types of synthetic cathinones with different biological effects. A lack of knowledge about the amount and the type of drug being used may result in an inadvertent overdose. Using high doses and frequent use of bath salts may result in more adverse effects. 

Toxic outcomes, including overdose, may also be determined by the route of administration. Snorting or taking the drug via intravenous injection are associated with a higher likelihood of producing adverse effects due to the rapid increase in drug levels in the blood produced by these methods. Although consuming large amounts of bath salts are known to cause an overdose, it is likely that bath salts may induce toxicity at low doses especially in first-time users.

Bath salts may also contain adulterants such as caffeine, lidocaine or amphetamines that may increase their toxic effects. Bath salts are very commonly used with other substances such as alcohol and illicit drugs like opioids, cocaine, MDMA and cannabis. Most emergency room visits due to the use of bath salts also involve another substance.

Side Effects of Bath Salts Overdose

Bath salts or synthetic cathinones are synthesized to mimic the effects of amphetamines, cocaine and MDMA. The side effects produced by bath salts are similar to these drugs and involve excessive activation of the sympathetic nervous system (fight or flight response). Bath salts generally also produce psychological effects due to the increased release of the neurotransmitters dopamine and serotonin. 

Some of the physical symptoms of a bath salt overdose include:

  • Sweating
  • Palpitations and increased blood pressure
  • Chest pain
  • Myocardial infarction
  • Seizures
  • Dizziness
  • Dilated pupils and blurred vision
  • Hyperthermia
  • Hypertension
  • Rhabdomyolysis or breakdown of skeletal muscle tissue
  • Hyponatremia or decreased blood sodium levels

Some of the psychological symptoms of a bath salt overdose include:

  • Confusion
  • Extreme agitation and aggression
  • Unpredictable behavior with the potential to cause self-harm and harm to others
  • Paranoia
  • Hallucinations
  • Psychosis
  • Anxiety
  • Panic attacks

Dangers of Bath Salt Overdose

One of the most common symptoms of a bath salt overdose includes agitation and aggression. These effects may lead to bizarre behaviors, violence, homicidal behavior, self-mutilation and suicide. 

Besides behavioral effects, bath salt intoxication may also result in cardiovascular complications including myocarditis involving inflammation of the heart muscle. This can lead to arrhythmias, cardiac arrest and death. Bath salts can also lead to the breakdown of muscle tissue that may, in turn, lead to kidney failure. Coma, liver damage and kidney failure have also been reported. 

If a bath salt overdose is suspected, call 911 immediately. Receiving immediate medical attention can limit the damaging effects of bath salts and help save a person’s life.

Bath Salts Overdose Statistics

Data collected between the years 2009-2013 by the National Survey on Drug Use and Health found that only 0.048 % of individuals aged between 12-34 years had used psychostimulant designer drugs (synthetic cathinones and phenethylamines). A survey conducted at various nightclubs in New York showed that 1.1% of the patrons had used the synthetic cathinone, mephedrone.

In a different study conducted in 2015 on the basis of self-reported use of designer drugs at electronic music parties in New York, 6.9% of the surveyed individuals reported using bath salts.  Bath salts were responsible for 22,904 visits to the emergency room in 2011, according to a Substance Abuse and Mental Health report, and 67% of these cases also involved another substance.

Bath Salt Related Deaths

The leading causes of death due to bath salt overdose include hypertension, hyperthermia, seizures, cardiovascular toxicities and kidney failure. Cardiovascular complications include arrhythmias and myocarditis that may result in infarction. 

Hyponatremia involving low blood sodium levels can lead to the passage of fluids from the body to the brain, and cause brain edema. This can either lead to seizures or disrupt respiration and circulation. Hyponatremia-induced brain edema has also been reported to be responsible for deaths caused by bath salts. 

Bath Salts Overdose Treatment

Treatment of a bath salt overdose generally involves supportive care, but admission to intensive care may be necessary. Blood pressure, blood glucose levels, breathing rate and electrolytes should be continuously monitored throughout the treatment process.

Benzodiazepines can be useful for counteracting the symptoms of excessive activation of the sympathetic nervous system including agitation, psychosis, seizures, increased heart rate. Antipsychotics like haloperidol may also be necessary for the treatment of agitation and psychotic symptoms, but require judicious use since these drugs can lower the threshold for seizures. 

In extreme cases, hypertonic saline may be provided intravenously to treat hyponatremia, whereas mechanical ventilation may be necessary for the treatment of respiratory failure. Dehydration and other metabolic disturbances may be addressed with the help of intravenous fluids or dialysis to prevent kidney failure. 

Bath Salts Overdose Prevention

Bath salts are designer drugs that have a significant potential to cause addiction and must be avoided. Even at regular doses, many users experience intermittent adverse effects, with bath salts like MDPV (3,4-methylenedioxypyrovalerone)  being ten times more potent than cocaine. 

Bath salts are dangerous due to their high potential to induce toxic effects, their unregulated manufacture and the possibility of the presence of harmful adulterants. Use of other alcohol or illicit substances in combination with bath salts or the use of medications like benzodiazepines to combat the effects of the comedown should be avoided.

If you or a loved one suffers from an addiction to bath salts, the Recovery Village Ridgefield can help. The Recovery Village Ridgefield specializes in the treatment of substance abuse disorders co-occurring with mental health disorders. Call to speak to one of our caring admissions representative today.

Karila, Laurent, Bruno Megarbane, Olivier Cottencin, and Michel Lejoyeux. “Synthetic cathinones: A New Public Health Problem.” Current Neuropharmacology, January 2015. Accessed August 8, 2019.

Substance Abuse and Mental Health Services Administration. “The DAWN Report.” September 2013. Accessed August 8, 2019.

Palamar, Joseph J., Silvia S. Martins, Mark K. Su, and Danielle C. Ompad. “Self-Reported Use of Novel Psychoactive Substances in a US Nationally Representative Survey: Prevalence, Correlates, and a Call for New Survey Methods to Prevent Underreporting.” Drug and Alcohol Dependence, November 2015. Accessed August 8, 2019.

Kelly, Brian C., Brooke E. Wells, Mark Pawson, Amy Leclair, Jeffrey T. Parsons, and Sarit A. Golub. “Novel psychoactive drug use among younger adults involved in US nightlife scenes.” Drug and Alcohol Review, November 2013. Accessed August 8, 2019.

Prosser, Jane M., and Lewis S. Nelson. “The Toxicology of Bath Salts: A Review of Synthetic Cathinones.” Journal of Medical Toxicology, March 2012. Accessed August 8, 2019.

National Institute of Drug Abuse. “Synthetic Cathinones (‘Bath Salts’).” February 2018. Accessed August 8, 2019.