Recent years have seen an unprecedented growth in number and availability of new synthetic psychoactive drugs in the US and worldwide. In 2014, 101 new psychoactive drugs were identified, worldwide. Such drugs are often sold as “legal” highs or “research chemicals” over the internet or in head shops.

Among these new drugs, “bath salts” appear to be one of the more commonly used in the US. “Bath salt” use has been associated with numerous adverse cardiac, psychiatric, neurological, gastrointestinal and pulmonary outcomes. In 2011, the use of bath salts was responsible for over 20,000 emergency room visits in the US and poisonings and deaths related to use have been occurring at large dance festivals. Increases in bizarre behavior linked to use of the “bath salt” known as Flakka (alpha-PVP) has increasingly been appearing in headlines. ”Bath salt” use appears to be prevalent, yet, despite this, little is known about the epidemiology of this drug in the US.

A recent study, published in The American Journal of Addiction by Joseph J. Palamar, PhD, MPH, a CDUHR affiliated researcher and an assistant professor of Population Health at NYU Langone Medical Center (NYULMC), is among the first nationally representative studies in the US to examine self-reported use of bath salts.

The study, “‘Bath Salt’ Use Among a Nationally Representative Sample of High School Seniors in the United States,” used data from Monitoring the Future (MTF), a nationwide ongoing annual study of the behaviors, attitudes, and values of American secondary school students. The MTF survey is administered in approximately 130 public and private schools throughout 48 states in the US. Roughly 15,000 high school seniors are assessed annually. Dr. Palamar’s study utilized MTF responses from 2012 to 2013, examining data from a total of 8,604 students who reported their sociodemographic data, alcohol and drug use.

Results suggest that 1.1% of high school seniors reported using bath salts in the last 12 months. A third (33%) of students who used bath salts reported using only once or twice, which suggests experimentation is most common among users; however, frequent use was also common among users with an alarming 18% of users reporting using 40 or more times in the last year.

Students who resided with fewer than two parents, who earned over $50 per week from sources other than a job, or who go out 4-7 nights per week for fun, were at significantly increased risk for use. Lifetime use of each of the 11 illicit drugs assessed by MTF was a robust risk factor for use. More than 90% of bath salts users reported lifetime use of alcohol or marijuana, and use of powder cocaine, LSD, crack and heroin was at least ten times more prevalent among bath salt users.

Even though use did not significantly change between the two years examined in the study, according to MTF, perceived risk associated with use increased dramatically from 25% in 2012 to 39% in 2013. While rates of use in the US prior to 2012 are unknown, numerous media reports about the dangers associated with use (e.g., prior to 2012) might have served as a deterrent against use. Dr. Palamar also pointed out that “bath salts” can wind up as adulterants in drugs such as ecstasy (MDMA, “Molly”) so it is possible that many club and festival attendees who use “Molly” may be unintentionally using these potentially dangerous drugs.

“While these results suggest bath salt use is not particularly prevalent among teens in the US, it is important that we continue to monitor new drugs such as ‘bath salts’ in order to inform prevention and quickly detect potential drug epidemics,” said Dr. Palamar.