AN ALARMING NEW STIMULANT, LEGAL IN MANY STATES

Dr. Jeffrey J. Narmi could not believe what he was seeing this spring
in the emergency room at Schuylkill Medical Center in Pottsville,
Pa.: people arriving so agitated, violent and psychotic that a small
army of medical workers was needed to hold them down.

They had taken new stimulant drugs that people are calling "bath
salts," and sometimes even large doses of sedatives failed to quiet them.

"There were some who were admitted overnight for treatment and
subsequently admitted to the psych floor upstairs," Dr. Narmi said.
"These people were completely disconnected from reality and in a very
bad place."

Similar reports are emerging from hospitals around the country, as
doctors scramble to figure out the best treatment for people high on
bath salts. The drugs started turning up regularly in the United
States last year and have proliferated in recent months, alarming
doctors, who say they have unusually dangerous and long-lasting effects.

Though they come in powder and crystal form like traditional bath
salts - hence their name - they differ in one crucial way: they are
used as recreational drugs. People typically snort, inject or smoke them.

Poison control centers around the country received 3,470 calls about
bath salts from January through June, according to the American
Association of Poison Control Centers, up from 303 in all of 2010.

"Some of these folks aren't right for a long time," said Karen E.
Simone, director of the Northern New England Poison Center. "If you
gave me a list of drugs that I wouldn't want to touch, this would be
at the top."

At least 28 states have banned bath salts, which are typically sold
for $25 to $50 per 50-milligram packet at convenience stores and head
shops under names like Aura, Ivory Wave, Loco-Motion and Vanilla Sky.
Most of the bans are in the South and the Midwest, where the drugs
have grown quickly in popularity. But states like Maine, New Jersey
and New York have also outlawed them after seeing evidence that their
use was spreading.

The cases are jarring and similar to those involving PCP in the
1970s. Some of the recent incidents include a man in Indiana who
climbed a roadside flagpole and jumped into traffic, a man in
Pennsylvania who broke into a monastery and stabbed a priest, and a
woman in West Virginia who scratched herself "to pieces" over several
days because she thought there was something under her skin.

"She looked like she had been dragged through a briar bush for
several miles," said Dr. Owen M. Lander, an emergency room doctor at
Ruby Memorial Hospital in Morgantown, W.Va.

Bath salts contain manmade chemicals like mephedrone and
methylenedioxypyrovalerone, or MDPV, also known as substituted
cathinones. Both drugs are related to khat, an organic stimulant
found in Arab and East African countries that is illegal in the United States.

They are similar to so-called synthetic marijuana, which has also
caused a surge in medical emergencies and been banned in a number of
states. In March, the Drug Enforcement Administration used emergency
powers to temporarily ban five chemicals used in synthetic marijuana,
which is sold in the same types of shops as bath salts.

Shortly afterward, Senator Bob Casey, Democrat of Pennsylvania, asked
the agency to enact a similar ban on the chemicals in bath salts. It
has not done so, although Gary Boggs, a special agent at D.E.A.
headquarters in Washington, said the agency had started looking into
whether to make MDPV and mephedrone controlled Schedule I drugs like
heroin and ecstasy.

Mr. Casey said in a recent interview that he was frustrated by the
lack of a temporary ban. "There has to be some authority that is not
being exercised," he said. "I'm not fully convinced they can't take
action in a way that's commensurate with the action taken at the state level."

Senator Charles E. Schumer, Democrat of New York, introduced federal
legislation in February to classify bath salts as controlled Schedule
I substances, but it remains in committee. Meanwhile, the drugs
remain widely available on the Internet, and experts say the state
bans can be thwarted by chemists who need change only one molecule in
salts to make them legal again.

And while some states with bans have seen fewer episodes involving
bath salts, others where they remain fully legal, like Arizona, are
starting to see a surge of cases.

Dr. Frank LoVecchio, an emergency room doctor at Banner Good
Samaritan Medical Center in Phoenix, said he had to administer
general anesthesia in recent weeks to bath salt users so agitated
that they did not respond to large doses of sedatives.

Dr. Justin Strittmatter, an emergency room doctor at the Gulf Coast
Medical Center in Panama City, Fla., said he had treated one man
whose temperature had shot up to 107.5 degrees after snorting bath
salts. "You could fry an egg on his forehead," Dr. Strittmatter said.

Other doctors described dangerously elevated blood pressure and heart
rates and people so agitated that their muscles started to break
down, releasing chemicals that led to kidney failure.

Mark Ryan, the director of the Louisiana Poison Center, said some
doctors had turned to powerful antipsychotics to calm users after
sedatives failed. "If you take the worst attributes of meth, coke,
PCP, LSD and ecstasy and put them together," he said, "that's what
we're seeing sometimes."

Dr. Ryan added, "Some people who used it back in November or
December, their family members say they're still experiencing
noticeable paranoid tendencies that they did not have prior."

Before hitting this country, bath salts swept Britain, which banned
them in April 2010. Experts say much of the supply is coming from
China and India, where chemical manufacturers have less government oversight.

They are labeled "not for human consumption," which helps them skirt
the federal Analog Act, under which any substance "substantially
similar" to a banned drug is deemed illegal if it is intended for consumption.

Last month, the drug agency made its first arrests involving bath
salts under the Analog Act through a special task force in New York.
Undercover agents bought bath salts from stores in Manhattan and
Brooklyn, where clerks discussed how to ingest them and boasted that
they would not show up on a drug test.

"We were sending out a message that if you're going to sell these
bath salts, it's a violation and we will be looking at you," said
John P. Gilbride, special agent in charge of the New York field
division of the D.E.A.

The authorities in Alton, Ill., are looking at the Analog Act as they
prepare to file criminal charges in the death of a woman who
overdosed on bath salts bought at a liquor store in April.

"We think we can prove that these folks were selling it across the
counter for the purposes of humans getting high," said Chief David
Hayes of the Alton police.

Chief Hayes and other law enforcement officials said they had been
shocked by how quickly bath salts turned into a major problem. "I
have never seen a drug that took off as fast as this one," Chief
Hayes said. Others said some people on the drugs could not be subdued
with pepper spray or even Tasers.

Chief Joseph H. Murton of the Pottsville police said the number of
bath salt cases had dropped significantly since the city banned the
drugs last month. But before the ban, he said, the episodes were
overwhelming the police and two local hospitals.

"We had two instances in particular where they were acting out in a
very violent manner and they were Tasered and it had no effect," he
said. "One was only a small female, but it took four officers to hold
her down, along with two orderlies. That's how out of control she was."