TL neuro

August 12, 2013

Putting the bathsalts epidemiology in context

Filed under: Cathinones, MDPV — mtaffe @ 6:04 pm

Salon has an article up about “The zombie apocalypse that wasn’t: Bath salts!” in which author Alex Seitz-Wald plays on the straw man of the alleged face eating zombie on bathsalts. This, despite it being very clear from even the simplest Google exercise that the infamous “Causeway Cannibal” case in Florida turned out to not involve any substituted cathinone drug.

Criticizing the media’s penchant for sensationalism and their utter disregard for toxicity reports that might confirm drug identity in a case of bizarre behavior is one thing. But Seitz-Wald goes on to make a rather interesting assertion.

A year later, usage has plummeted and the drug that once had a gripping public mythology has almost completely fallen out of the discourse.

Whether a new drug trend has fallen out of the public discourse has very little to do with whether use has “plummeted” and everything to do with whether media interest has fallen. On this latter, he is no doubt correct although graphing Google search term data, as Seitz-Wald does, that involves the spike surrounding the events in Florida is a good way to obscure any real analysis of the search data. [Update 13Aug2013- Google search volume over the March-Jul interval of 2013 for “bathsalts” is exactly the same as over the Jan 2011 – May 2012 interval.]

Still, there are two bits of evidence raised in support of the notion that the use of bathsalts is going away.

First, the drop in calls reported by the American Association of Poison Control Centers. There were some 700 calls per month in May-Jul 2011, around 400 in Jun-Jul 2012* and under 100 per month in 2013 through July.

This is hardly strong evidence. Calls could be reduced because people are now more familiar with these compounds and can find information on the Internet. Perhaps users and/or sellers are sufficiently familiar as to avoid threatening medical emergencies that spark calls. Perhaps medical service providers are familiar with the drugs and are not themselves calling for information.

The second bit of evidence advanced by Seitz-Wald covers the epidemiology.

Usage of the drugs was never actually very high among teenagers, despite the media attention, according to data from the University of Michigan’s Monitoring the Future study, which researchers say is the only scientific data on usage among any age group. The study has surveyed drug use among 8th, 10th and 12th graders every year since 1991 and in 2012 found bath salt usage to be “very low,” with just 0.8 percent, 0.6 percent and 1.3 percent of students, respectively, in grades 8, 10 and 12, reporting experimenting with it. Compare that to 36 percent of high school seniors who say they’ve used marijuana, and 28 percent of 10th graders.

“Never actually very high” is all in the way you look at it. The first problem is that a comparison with marijuana involves the most popular illicit drug, the use of which is divided by some margin from most other drugs in the data. For example, the proportion of 12th graders who say they’ve used any illicit drug in the past year is 39.7% in 2012, this drops to 17% for “any illicit drug other than marijuana“.

Perhaps an even better comparison would be with drugs that seemingly most concern us such as Heroin (0.6% any, 0.4% with a needle), PCP (0.9%), Crack Cocaine (1.2%), Methamphetamine (1.1%), Crystal Methamphetamine (0.8%), Rohypnol (1.5%), GHB (1.4%) or Ketamine (1.5%). In this context, the bathsalts penetration in the 12 Grade population is right in the neighborhood of a lot of other drugs for which we have significant concern about adolescent use.

The fact that there is an apparent disconnect of the use percentages from the media hysteria over bathsalts is hardly any excuse to decide that bathsalts** are no problem at all.

Next we need to consider the historical context for the emergence of a relatively unknown drug. We have a perfect example in the case of MDMA, which we know from this vantage point of 2013 remained with us for decades (so far).

In 2012, some 3.8% of 12th Grade students reported past year use of MDMA.

MDMAvsBathSalts12GrThis was not always so, of course. The Monitoring the Future study only started tracking 12th Grade use in 1996, well after Ecstasy had emerged. Looking at use in college students and all Young Adults (19-28) we can see that for the most part annual use for these populations was under 1% from 1991-1994. Even this interval was long past the first emergence of MDMA in the US. Wikipedia dates this to the early 80s and the DEA first proposed that it be controlled as a Schedule 1 drug in 1984. This latter tells us that MDMA was at least on the radar of concern in the early 80s. Yet widespread use didn’t take off until about 1995 whereafter annual use rates climbed steadily to about 2000. After a sharp decline in popularity, annual prevalence for MDMA use in 12th graders has been relatively stable at somewhere around 4% for a decade.

For reference, the Bluelight MDPV Megathread was established in 2006 but of course there was very little media attention on this drug in the US until about 2010-2011. So we cannot say with any confidence whether any particular “bath salts” compound** will exhibit an MDMA-like trajectory or whether it will not.

It is difficult to make strong claims as to why any particular drug takes off in the recreational users, gaining broad use beyond a few aficionados. Likewise, it is difficult to determine when a drug will catch on. MDMA was first synthesized in 1912 and sort of rediscovered by Sasha Shulgin in the 1970s. Synthetic compounds which act with full agonist effect at the endocannabinoid CB1 receptor (THC is a partial agonist at this site) were known for at least a decade before cannabimimetic “incense” became broadly available in head shops and convenience stores in the past couple of years.

But nevertheless this history with MDMA also tells us that the very first epidemiological data point on bathsalts use rates cannot be judged in isolation.

Data in the figure were generated from the publications of the Monitoring the Future project.

UPDATE: The first Table in this review of scientific reports on MDMA illustrates the timeline for knowledge to accrue.
*2011, 2012 saw distinct summertime peaks. Perhaps related to the ambient temperature?

**One problem is that there are several drug entities that might be thought to be “bathsalts” by the survey respondents. MDPV is likely most popular in the US, with some methylone as well, but we rely don’t know. This may be analogous to clumping MDMA, Cocaine and Methamphetamine under one list, in the end analysis.


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