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There are many new psychoactive substances (NPS) flooding the United States, especially synthetic marijuana (usually referred to as Spice or K2) and synthetic cathinones (often known as bath salts). These new synthetic drugs are extremely dangerous because they are chemically similar to the substances they mimic, but different enough to be technically legal in many places, including in several states. They are completely untested and unregulated, so side effects can be unpredictable and extremely harmful. Dosing the drug can be nearly impossible.
Synthetic cathinones like bath salts are some of the most harmful drugs created and abused in recent years. One version of a synthetic cathinone, called methylone, was found to be so harmful that the Drug Enforcement Administration (DEA) put the substance in Schedule I just a few years after it appeared in the US. Methylone is one of the most addictive versions of a synthetic cathinone spreading across the world, so it is important to know what happens to a person when the drug is abused and how abuse of methylone is being treated.
Methylone is a designer drug that acts on the brain much like MDMA or ecstasy. The substance releases a flood of dopamine and serotonin to increase alertness, excitability, and physical energy. However, according to the National Institute on Drug Abuse (NIDA), methylone may not have the same toxicity as the other amphetamine-based stimulants, meaning the drug may not have the same potential for addiction as MDMA.
This was based on a study involving rats that monitored the levels of neurotransmitters released by the brain over time. The study found that repeated, high doses of both methylone and mephedrone, another synthetic cathinone, did not deplete serotonin in the brain in the same way that MDMA did. However, the initial studies on similarities between methylone, MDMA, and mephedrone are small and do not involve humans, so understanding how addictive and toxic new chemicals like methylone are can take time.
It is still unknown if methylone and related chemicals are addictive or predominantly toxic. The rats in the study mostly did not escalate their abuse of methylone. This makes the drug unique from other chemicals that could lead to bingeing behavior like meth or cocaine.
Because of the intensely energetic high it brings, methylone is one of the many chemicals that may be found in bath salts or sold on its own. It is made in a clandestine lab in large batches, so methylone is often much less expensive than cocaine, MDMA, or even methamphetamine.
Although methylone is not a well-understood substance of abuse, the drug has killed people because of its intense side effects when it has been accidentally taken instead of ecstasy at raves, concerts, or parties. When it is intentionally abused, methylone is abused as bath salts or Molly, a drug chemically similar to MDMA.
The United Nations Office on Drugs and Crime (UNODC) reports that methylone has been found in Europe since 2005, a few years before the substance appeared in US illicit drug markets. The UNODC reported methylone as an analogue for ecstasy or MDMA since it was a component in Molly.
The DEA reports that methylone was first found on the illicit drug market in the US in 2009, and it was placed on Schedule I in 2013. Before this chemical was banned, however, it was considered legal to import since it was not specifically controlled by the federal or many state governments until the DEA ban.
Because it was sold legally, young people had access to this potent stimulant, which led to many toxic side effects and overdoses. Although methylone is no longer legal in the US, other synthetic cathinones are legal at the federal level. After the devastating effects of bath salts on a few dozen people around the country, many states have moved to ban anything that could be considered a synthetic cathinone.
Although some older adults abuse synthetic cathinones like methylone, the market is predominantly adolescents who gain access to these drugs through convenience stores or the internet. Young adults may abuse them in social settings like at raves, concerts, or clubs.
A DEA lab first identified methylone as a harmful, intoxicating substance in 2009 in four drug reports. By 2012, there were 4,066 reports involving methylone intoxication. Methylone is now an illegal chemical in the US, but adolescents continue to abuse this drug. A 2017 NIDA survey found that 0.5 percent of 8th grade students, 0.4 percent of 10th grade students, and 0.6 percent of 12th grade students in the US abused bath salts at some point in the past year, some of which may have contained methylone.
When a person takes a substance, like bath salts or Molly, which contains methylone, the initial effect will be like an amphetamine high. Symptoms include:
The comedown effects from amphetamines, including MDMA or synthetic cathinones like methylone, include intense depression and fatigue. These symptoms may lead to taking more of the drug to relieve the psychological discomfort, although the previously mentioned study involving rats showed this may be less likely with methylone than ecstasy.
The toxic effects reported with methylone include moderate symptoms like:
Signs of severe side effects to the point of overdose on methylone include:
Both methylone and related chemicals do not have a large impact on the brain’s monoamine system, or on important, mood- and attention-related neurotransmitters like serotonin, dopamine, and norepinephrine. As a result, methylone may be less addictive, but the selective depletion of dopamine at high doses can be extremely toxic and detrimental.
Abusing synthetic cathinones like methylone can change how neurotransmitters are managed to the point that mental illness can be triggered, which may be long-lasting or even become permanent. Mental health problems that co-occur with abuse of methylone and other cathinones include:
Since methylone is a relatively new intoxicating substance, there are currently no known substances that could act as medication-assisted therapy (MAT), so the detox process will involve management of withdrawal symptoms through other means. The most intense withdrawal symptom will be cravings because methylone changes how dopamine is released in the brain, and it can take time for this important neurotransmitter to be produced organically by the brain again.
An addiction specialist will assess someone entering addiction treatment for methylone to determine how long they have abused this drug, if they have any co-occurring disorders or chronic health issues that may be affected by treatment, and how serious withdrawal symptoms may be. This will inform whether the person can safely detox at home with a few physician checkups or if they must be hospitalized. Once detox has been safely completed, it is important to continue into a rehabilitation program that provides behavioral therapy.
NIDA recommends several potential approaches to behavioral therapy:
During rehabilitation, it is important to monitor the person for signs of relapse, as cravings from methylone abuse may resurface and trigger compulsive behaviors.
Mental illness can be the cause of methylone abuse, or it may be triggered by these drugs. For a potent stimulant like methylone, long-lasting psychosis, paranoia, aggression, and depression from dopamine depletion are more likely to be triggered by substance abuse than lead to abuse of the drug.
It is important to treat acute symptoms like suicidal ideation and psychosis in a hospital setting with appropriate psychiatric medications. During rehabilitation, a psychiatrist should be involved to help with ongoing management of any mental health conditions that have ongoing symptoms.
While methylone is still not a well-understood drug, its impact on the thousands who have abused it in the US so far has been devastating. It is certainly toxic and likely to be addictive.
Getting treatment for a loved one who abuses a potent and dangerous drug like methylone is crucial. They are at risk of overdose and death because of this substance. Rehabilitation programs are creating programs to specifically address abuse of synthetic cathinones like methylone. Evidence-based treatment is available today to end methylone abuse.