What Bath Salt Withdrawal Is Like
In the past decade, bath salts have risen in popularity, especially among club-goers.1 Bath salts abuse began in Europe in 2009 and by 2010 was seen in the United States.2 The name is misleading—even though they look similar, the substances referred to as “bath salts” are not the calming crystals you put in your bath to relax.
Bath salts may be marketed in packages that look innocuous—often labeled as “plant food” or “jewelry cleaner” to disguise their intended use. They may also have “not for human consumption” printed on the package to further avoid drug laws.1
Can You Get Addicted to Bath Salts?
Bath salts are synthetic cathinones. These are dangerous, manmade substances with chemical similarities to cathinone, a naturally occurring stimulant found in the khat plant. Khat is grown in certain countries, like Yemen, where it is popular to chew on the leaves of the plant to experience its stimulant effects.1 Although khat consumption may be viewed by many as natural or relatively harmless, the drug does carry a potential for tolerance, dependence, and addiction—just like bath salts.
Consuming khat increases a person’s risk for heart attack, dilated cardiomyopathy (disease of the heart muscle), gum disease, and ulcers.1 And the dangers are increased with synthetic versions of cathinones. While bath salts are chemically similar to khat, they are typically much stronger, more unpredictable, and a lot more dangerous.3
Cathinones are Schedule I controlled substances, meaning that they have a high potential for abuse and have no accepted medical uses. Many states have moved to ban or schedule synthetic cathinones, as well. Synthetic cathinones include a number of drugs, including methylenedioxypyrovalerone (MDPV) and mephedrone.4
So, why do people abuse natural and synthetic cathinones? These drugs are sought after for their stimulant and psychedelic effects.
Users of bath salts may experience similar effects as those produced by amphetamines, cocaine, khat, LSD, and MDMA. In fact, bath salts are often sold as cheaper alternatives to these drugs.3,5
Potential effects include:6
- Intense pleasure.
- Increase in energy.
- Short-term improvements in focus.
- Heightened sexual stimulation.
- Increased feelings of empathy.
- Visual hallucinations.
- Distorted perception of time.
People who use bath salts may build up a tolerance to the effects and use more and more of them over time. The typical dose of bath salts ranges between 5 and 30 mg, but over time, some people develop high tolerances, and some may consume more than 200 mg of bath salts in one sitting.7
As a person’s tolerance increases, and they continue to use larger and larger amounts, they run the risk of becoming physiologically dependent. This is when the body has come to rely on a drug to maintain a semblance of normalcy and avoid withdrawal.
Dependence often develops alongside addiction, or substance use disorder. This is a mental disorder wherein an individual continues using a drug compulsively despite all the havoc it creates or is likely to create on their physical and mental health, relationships, and personal life.
What Are the Risks of Using?
Phenethylamines, which include amphetamines, increase the activity of dopamine, serotonin, and norepinephrine in the brain. Bath salts, which are synthetic phenethylamines, do the same. Excess amounts of dopamine and serotonin in the brain are linked to psychotic symptoms, which are commonly associated with bath salts intoxication.2
The effects of bath salts are not limited to psychotic symptoms. Beyond the symptoms often associated with psychoses—paranoia, delusions, hallucinations—bath salts can have a number of other psychological effects, including the following:6
- Feelings of unease
- Catatonia (inability to respond or move normally)
- Panic attacks
- Suicidal ideation
Physical risks of bath salts use include the following:6
- Cold/blue fingers
- Cardiac arrest
- Liver failure
- Renal failure
- Serotonin toxicity
If you overdose on bath salts, your symptoms might need to be managed in a hospital or medical environment so that you are stabilized and any serious or life-threatening symptoms are managed.9 If this occurs, you may be referred to detox and treatment after your acute symptoms are managed.
What Are the Withdrawal Symptoms?
Heavy or chronic use of synthetic cathinones can lead to the development of tolerance, dependence, cravings, and the onset of a withdrawal syndrome after abruptly cutting off use.1,3,10
After stopping use, reports show that some users experience a withdrawal syndrome, which includes symptoms such as:7
- Abnormally low energy levels.
- Inability to feel pleasure.
- Sleep disorders.
A retrospective study of 1,633 patients exposed to bath salts or other synthetic stimulants between 2010 and 2011 found that the most common withdrawal symptoms reported by users were:10
- Tachycardia (rapid heart rate).
What makes bath salts abuse and withdrawal especially risky is the fact that the manufacturing of synthetic cathinones is unregulated, so they may be cut with harmful ingredients that can have dangerous effects that you can’t predict.3
Using bath salts can place you at risk of overdose. Studies report that the most common clinical sign of a bath salts overdose is agitation. Other commonly reported symptoms are headaches, palpitations, chest pain, and seizures. If you or someone you love has overdosed or is at risk of overdosing on bath salts, get medical attention as soon as possible to avoid further harm.
Are There any Withdrawal Risks?
Depending on your situation and how long you abused bath salts, anhedonia (the inability to feel pleasure), cravings, and an unusually low level of energy can last for several weeks.7
Given that cravings can quickly lead you to use drugs again, you may be at risk for relapse even after you stop using the drug. You can help prevent falling back into a cycle of drug use by entering into a detox program and continuing on into addiction treatment.
Is There a Safe Way to Detox?
There are certain risks associated with bath salts withdrawal that make detoxing under supervision a safer option than going it alone. If you are wondering what type of treatment you should seek for bath salts detox, the answer is, it depends.
Your doctor or an addiction treatment professional may recommend an inpatient environment for you to detox in if you need supervision and support at a more intensive level—for example, because of a risk of violence, lack of support, polysubstance dependence, or other issues that may complicate your withdrawal process and increase your medical, mental health, or relapse risks.11 Inpatient detoxes have varying intensities and include the following:11
- Hospital. If your condition is severe, you are at risk for seizures (e.g, you’re also detoxing from alcohol or sedatives), or you know you will need intensive medical attention throughout the detox process due to a chronic medical condition, detox in a hospital setting may be needed.
- Inpatient medical detox: This is ideal if you have an underlying medical or mental health condition that needs attention while you are in withdrawal. You may be able to withdraw in a standalone detox program or at the start of a longer inpatient rehab stay.
- Social detox. An environment where support but no medication is offered may work for you if you don’t have any underlying medical or mental health conditions but still need the sober environment and guidance of professionals to avoid relapse. Always make sure that if you choose this program type that the center has a plan for referral to a higher level of medical care in the case it is needed, e.g., a medical emergency arises.
If you haven’t been using long and have no other known medical or psychological issues, outpatient detox may be an option for you. You’ll need to speak with a medical professional to make sure you are a good candidate for this type of detox. This option is generally suitable for you if your addiction is relatively less severe and if you have a stable, strong network family and friends who can help you move through treatment.
There is no one size fits all when it comes to detox; one of these settings may work better for you than for another person. Listen to your body and assess your needs so that when you are ready to detox, you can find a treatment center that will be the best fit for your life.
- Prosser, J. M., & Nelson, L. S. (2012). The Toxicology of Bath Salts: A Review of Synthetic Cathinones. Journal of Medical Toxicology, 8(1), 33–42.
- UpToDate. (2017). Acute amphetamine and synthetic cathinone (“bath salt”) intoxication.
- National Institute on Drug Abuse. (2018). Synthetic Cathinones (“Bath Salts”).
- US Department of Justice. (2011). Synthetic Cathinones (Bath Salts): An Emerging Domestic Threat.
- Drug Enforcement Administration. (n.d.). Bath Salts or Designer Cathinones (Synthetic Stimulants).
- University Hospital Case Medical Center. (n.d.). Overview and Treatment of Bath Salts Intoxication and Opioid Withdrawal.
- Coppola, M., & Mondola, R. (2012). Synthetic cathinones: chemistry, pharmacology and toxicology of a new class of designer drugs of abuse marketed as “bath salts” or “plant food”. Toxicology Letters, 211(2), 144-149.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Wood, D. M., Davies, S., Greene, S. L., Button, J., Holt, D. W., Ramsey, J., & Dargan, P. I. (2010). Case series of individuals with analytically confirmed acute mephedrone toxicity. Clinical Toxicology, 48(9), 924-927.
- Warrick, B. J., Hill, M., Hekman, K., Christensen, R., Goetz, R., Casavant, M. J., … & Aleguas, A. (2013). A 9-state analysis of designer stimulant, “bath salt,” hospital visits reported to poison control centers. Annals of emergency medicine, 62(3), 244-251.
- Substance Abuse and Mental Health Services Administration. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 134131. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.