Mephedrone (chemical name: 4-methylmethcathinone or 4-methyl ephedrone) is a synthetic cathinone, indicating that it is a man-made drug that is similar to the cathinones found in the khat plant and used by people indigenous to Africa as a stimulant. The effects of the drug are very similar to the effects of a combination of cocaine or amphetamines and ecstasy. This means that the drug produces increased energy, feelings of euphoria, increased sociability, and increased feelings of empathy.
Mephedrone is commonly found in items that are labeled as “bath salts,” and it is listed as a Schedule I controlled substance by the United States Drug Enforcement Administration (DEA). It can be manufactured overseas or in makeshift labs within the country. It is typically sold in pill or powder form.
Street names for mephedrone include M-smack, MCAT, meow meow, drone, bubbles, and meph. When mephedrone is contained in substances that are labeled as “bath salts,” street names include vanilla sky, white lightning, white dove, and flakka.
The DEA reports that young urban-dwelling males are the most common abusers of mephedrone. The drug typically acts rapidly, and its effects occur between 15 and 45 minutes after it has been ingested. It is most commonly taken orally or snorted.
Using mephedrone results in a massive increase in the neurotransmitters serotonin and dopamine in the central nervous system. Once the person stops using the drug, the situation is reversed, and there is a massive depletion of these neurotransmitters.
The Effects of Mephedrone Use
- Feelings of euphoria that affect the entire body
- Tactile sensations, such that individuals feel more sensitive to touch
- Stimulation and increased energy, including increased talking and pressured speech, increased feelings of energy, racing thoughts, and hyperactivity
- Teeth clenching
- Loss of motor control and coordination
- Nystagmus that leads to visual problems, such as blurriness or problems focusing on objects (vibrating vision)
- Decreased appetite
- Overheating and sweating
- Increased body odor
- Difficulty urinating
- Increased heart rate, increased blood pressure, and vasoconstriction
- Bluish or cold fingers and lips (associated with vasoconstriction)
Psychological and Cognitive Effects
- Feelings of extreme happiness and sociability
- Increased perception of empathy
- Racing thoughts
- An altered experience of time, such that time appears to speed up
- Potential manic behavior
- Increase in anxiety
- Grandiose behaviors and thoughts
- Increased libido
- Increased ability to appreciate music
- Compulsive cravings to reuse the drug in order to maintain the effects
Crash Effects (as a result of a neurotransmitter depletion after use is stopped)
- Extreme sleepiness
- Apathy and hopelessness
- Appetite increase
- Slow and confusing thought patterns
- Weight loss
- Psychosis (hallucinations and/or delusions)
- Increased potential to develop delirium (confusion, psychosis, lethargy, or hyperactivity)
- Respiratory problems
- Increased potential for heart attack
- Increased potential for stroke
- Increased potential to develop seizures
- Increased potential to develop suicidal thoughts
- Increased potential to become violent or hostile
- Increased overdose potential, which could be potentially fatal
There are cases in the research literature of fatalities due to overdosing on mephedrone. The drug is relatively easy to overdose on, as individuals who use it will often tend to binge on the drug. Moreover, mephedrone users tend to use the drug in conjunction with other drugs, such as alcohol, other central nervous system depressants like opiates, and even other stimulants. This increases the risk of an overdose on mephedrone or an overdose on the other drug.
Symptoms of overdose include:
- Numbness in the limbs
- Bluish fingers, toes, feet, or hands
- Chest pains, irregular heartbeat, or sweating
- Ringing in the ears
- Anxiety and/or paranoia
Overdoses can occur at 250 mg or more of the drug in some individuals. Overdoses on mephedrone are often treated with IV fluids and benzodiazepines. Anyone who is suspected of overdosing on mephedrone should receive immediate medical attention.
Again, mephedrone is commonly abused in conjunction with other drugs of abuse. When taken with central nervous system depressants, such as alcohol, opiate drugs, and even cannabis products, the drugs counteract the effects of each other. This means that an individual is more likely to use the central nervous system depressant or mephedrone to excess. This can lead to potential overdose issues and produce other severe issues, such as cardiac arrest, stroke, and/or seizures. Combining stimulus and central nervous system depressants also leads to issues with poor emotional control and poor judgment, which can result in serious problems.
Individuals who combine mephedrone with other stimulant drugs, such as cocaine, methamphetamine, or Ritalin (methylphenidate), enhance the effects of these drugs. This can lead to an increased potential to experience a stroke, seizures, dehydration, psychosis, and hostility and agitation.
Because the drug has no medicinal uses, any person who is suspected of using mephedrone should be suspected of abusing it. There are research studies to suggest that long-term use of the drug can produce physical dependence, so the first step in treatment of an individual who is abusing mephedrone is to initiate a medical detox (withdrawal management) protocol.
There are no medications designed to treat the withdrawal syndrome associated with mephedrone abuse, and at the time of this writing, the exact withdrawal syndrome associated with mephedrone does not appear to be well defined. The research suggests that the withdrawal syndrome from mephedrone is similar to the withdrawal syndrome from other stimulants and consists of the following:
- Difficulty sleeping or excessive sleeping
- Issues with attention, concentration, and memory
- Apathy, depression, or anxiety
- Potential tremors
- Psychotic symptoms
In case studies, the withdrawal syndrome from mephedrone lasted between one and four weeks. The approach to withdrawal management is addressing the symptoms that occur in the particular individual. During the withdrawal management process, the individual should also be placed in a formal treatment protocol that should consist of:
- Treatment for any co-occurring mental health disorders
- Participation in substance use disorder therapy in individual sessions, group sessions, or both
- Support from peers and family
- Continued medical management of any ongoing issues
- The use of complementary and alternative treatments when they are deemed appropriate for the individual
There are no national specialized groups to address recovery from mephedrone abuse, and individuals should be able to participate in standard substance abuse therapy and peer support groups for addictive behaviors (e.g., 12-Step groups). There may be local groups that specialize in support for individuals with stimulant abuse issues. Check with a local community health center to see if any specialized groups exist in the area.
An important aspect of recovery is learning relapse prevention techniques. Substance use disorder therapy, support group participation, and other formalized interventions have some standardized approaches to ongoing recovery. The basic approach to relapse prevention includes:
- Psychoeducation that provides the individual with an understanding of why cravings occur
- Instruction about the general triggers that affect nearly everyone in recovery
- Identifying personal triggers
- The development of a plan to recognize triggers, deal with them, and avoid them when possible
- Building a very strong support network that can include family, peers from support groups, therapists, and others to assist during rough times
Although some medications may be able to address cravings associated with triggers, the best long-term solution to relapse prevention is to develop behavioral strategies to avoid the use of alcohol or drugs in the future. Cravings can be elicited by numerous factors, including stress, excitement, reminders of past substance use, boredom, hunger, and fatigue.
Techniques used to prevent relapse and deal with cravings include:
- Learn that cravings are time-limited and will eventually go away. Individuals can document the length and intensity of their cravings to help them get a sense of control over them.
- Understand that cravings never kill anyone, even though they may feel very emotionally intense.
- Use distraction to deal with cravings. Getting involved in some other activity like meditation or exercise can be an effective tool against cravings.
- Learn stress management peaks such as diaphragmatic breathing, progressive muscle relaxation, or meditation, can help to deal with stress that might induce cravings.
- Learn specific techniques like urge surfing where instead of concentrating on the positive aspects of mephedrone use during a craving, one begins to concentrate on all the negative aspects associated with their use of the drug.
Again, there are no specific relapse prevention techniques for mephedrone abuse, but relapse prevention techniques that have been demonstrated to work for all types of substance use disorders can be specifically applied to fit the needs of the individual.