Synthetic legal intoxicating drugs: The emerging ‘incense’ and ‘bath salt’ phenomenon
ABSTRACTSynthetic legal intoxicating drugs (SLIDs), such as those commonly contained in products sold over the counter as “bath salts” and “incense,” have risen tremendously in popularity in the past few years. These drugs can have powerful adverse effects, including acute psychosis with delusions, hallucinations, and potentially dangerous, bizarre behavior.
KEY POINTS
- These products are sold under misleading names and deceptive labels to avoid regulation. Although several have recently been banned, many more are waiting to be brought to the market in a similar fashion.
- “Incense” products often contain synthetic cannabinoids; scientific research into their potential long-term effects in humans has been very limited.
- The potential for medical and psychiatric adverse events from synthetic cannabinoids may be heightened because of their full-agonist mechanism of action and because of the variable concentration and unregulated potency of these compounds in incense products.
- Bath salt intoxication, when encountered in the emergency department, may present as a psychiatric disorder or as a range of medical problems including cardiovascular issues, seizures, and hyperthermia.
SLIDs POSE A REAL CHALLENGE
SLIDs present a real challenge to law enforcement, governments, the public, and the addiction treatment community. There is currently no way to routinely test for these substances. Furthermore, any tests that are developed or laws that are enacted will be easily evaded, as there are many more synthetic substances waiting in the wings to be released.
Don’t be lulled into thinking that SLIDs are gone with the recent bans against some of the more common substances. More SLIDs are coming, and more morbidity should be expected in medical settings.
Doctors in emergency departments and other settings need to be prepared for the agitated and often psychotic presentation of SLID-intoxicated patients and should be ready with benzodiazepines, restraints, and a calm and reassuring manner. And for patients who present with psychotic symptoms, medical staff should also be ready to consider involuntary short-term commitment to an inpatient psychiatric unit.
Once they recover, patients need to be educated about the dangers of substances such as SLIDs that, because of their novelty, may be perceived as less dangerous alternatives to traditional illicit drugs.
