Medical Examiner confirms a death due to MDPV (aka "bath salts") use
January 19, 2012
The case is from Bangor, ME. The initial report quoted an emergency room doctor as saying at least three people in the Bangor area had died from “bath salts”. As per the DEA emergency scheduling action in September, there are at least three synthetic cathinone derivative drugs of concern:
The Administrator of the Drug Enforcement Administration (DEA) is issuing this notice of intent to temporarily schedule three synthetic cathinones under the Controlled Substances Act (CSA) pursuant to the temporary scheduling provisions of 21 U.S.C. 811(h). The substances are 4-methyl-N-methylcathinone (mephedrone), 3,4- methylenedioxy-N-methylcathinone (methylone), and 3,4- methylenedioxypyrovalerone (MDPV). This action is based on a finding by the Administrator that the placement of these synthetic cathinones into schedule I of the CSA is necessary to avoid an imminent hazard to the public safety.
I had a prior post (lost in the Sb hole, reposted) discussing a bit of frustration with the conflation of two different drug molecules under one street name. Particularly when it comes to the sensationalized media reports.
This is why I’m happy the most recent report is a confirmation from the medical examiner that MDPV was involved in this case in Maine.
The state medical examiner’s office has determined that a man who took bath salts and died at Eastern Maine Medical Center last July overdosed on the synthetic street drug.
Ralph E. Willis, 32, had consumed “a toxic level” of methylenedioxypyrovalerone, or MDPV, a key ingredient of bath salts, Mark Belserene, administrator of the medical examiner’s office, said Wednesday.
I am even more happy that the journalist, Nok-Noi Ricker, requested even more information:
Willis had 150 nanograms per milliliter of MDPV in his bloodstream, a body temperature of 103 degrees and an erratic heartbeat when he got to the emergency room — all side effects of the hallucinogenic stimulant — the report states.
This is great. Usually we have to comb through a very slowly developing and erratic Case Report literature to determine anything at all about real-world, in situ, drug levels, combinations and identities that lead to medical emergency and death. Nice to see a reporter tenacious enough to do the followup beyond the original (and sadly typical) level of “Person dead, Cops say it was [insert drug name here]”.
I am also happy that the journalist includes the caveats. This guy was combative and agitated, from the reporting. So, as another quoted expert mentions, we can’t necessarily conclude that this is all down to a simple equation between plasma levels of the drug and the resulting cardiac complications.
“There are so many factors that go into [a bath salts] death that have nothing to do with the level” of drugs ingested, Karen Simone, a toxicologist and director of the Northern New England Poison Control Center in Portland, said Tuesday. “Maybe it killed him, and maybe it didn’t.”
Physically restraining bath salts users who are severely agitated and in a state of excited delirium can be harmful and even life-threatening because they usually have increased heart rates and high blood pressure, Simone and Dr. Jonnathan Busko, an emergency room doctor at Eastern Maine Medical Center in Bangor, have said.
As I have been mentioning in the case of mephedrone/4-methylmethcathinone, the academic literature has been slow to develop. There are now three pretty interesting papers which take a look at neurochemical, toxicological and behavioral effects of 4-MMC including Kehr et al 2011, Baumann et al, 2012 and Hadlock et al, 2011.
All I’ve been able to drum up* with respect to MDPV is Fuwa et al (PDF). The abstract is in English and the Figures are pretty easy to work out but…any of my readers fluent in Japanese and want to give translation a go?
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*generally available. There were two adjacent posters at the recent ACNP meeting although I couldn’t really get a feel for whether they are close to publication or not. Stay tuned, there will eventually be some more data I would think.
DrugMonkey 
February 3, 2012 at 4:48 pm
Thanks for bringing the story about this unfortunate incident
One thing that’s been on my mind for years is that with most of these new “research chemicals, there’s often little or no clear info about dosages. If you’re smart and know where to look, you can usually get in the ball park but in some cases people are just shrugging their shoulders and doing the same amounts that they did with other drugs. If you’re lucky, that could work out fine just about every time and really, even if you aren’t if you’re unlucky maybe you’ll have a bumpy ride and then have a hard time sleeping later if you overdo it.
The scary thing is just how many of folks don’t realize that thery’ve they shouold be doing a match head instead of fat line. – they don’t know what 10 mg even looks like. They have no concept that just adding another 1/4 inch to those 2 lines pushed it from 10mg to 35mg. They also don’t have the slightest clue that this new drug they’re trying might come on for almost 90 min or doesn’t start to peak until 4+ hrs. So, when they can barely feel anything after an hour,they think the drug is weak or they took too little and lay out two more even bigger lines or they just wash down a 1/4 teaspoon.
Well it turns out that MDPV dosages are in the 5g-30 mg range. It isn’t that 50 mg is is going to kill you but 200 might come close and 200 mg does’t look like much to someone who’s been doing lots other powders. Keep that up for day or two and you could easily wind up in the ER or die.
So the obvious question is, just how much did thi guy MDPV dis this guy Willis take?
The report’s only reference to the dosage level is “Willis had 150 nanograms per milliliter of MDPV in his bloodstream”. I guess I don’t know how to accurately interpret that – don’t know enough about how to accurately convert that bit of data into a dosage. Do you? In addition, without any eye witnesses to say how much he consumed in total (i.e. was he on a multi-day run?), we can’t really figure out how much he may have already metabolized. If there’s some high tech way to calculate dosage levels, please let me know. IAC, it seems to me that finding out whether or not he actually overdosed (i.e. took so much MDPV that it alone couldn’t have killed him) might help get the word out about safe dosage levels and could possibly save lives.
Update:
I spent some time combing through at least 20 of the articles in the Bangor News about the spreading use of “Bath Salts” (cathinone related drugs) in Maine over the last year. I’m sure that the incident that happened with that with Willis was disturbing for the cops and others. But the more I read and the more people that were quoted (mostly law enforcement) and the more comments from the citizens that I read, it became clear that the reaction to whatever is actually happening up there in Maine has spun far out of control and borders on hysteria.
You made a key point: there is a very little medical data about these drugs. Let’s face it, most cops are not well versed in medical information about the drugs they known about for your years but in the case of the “bath salts”, they’re just filling in that the void based on emotional reactions two one or two random experiences and a bunch of rumors and tall tales. As far as I could tell, there was little basis in fact for almost every they said. But stick a microphone or a reporterer in front of them and they just start riffing about crazed & violent drug monsters, though in fact, there appears to have been only been one very violent incident.
The only bit of rational thinking I found in all of those Bangor Daily News articles was the one you included in your post from the emergency room doctor, Dr.Jonnathan Busko and Karen Simone, a toxicologist and director of the Northern New England Poison Control Center in Portland. Worth repeating:
“There are so many factors that go into [a bath salts] death that have nothing to do with the level of drugs ingested. Physically restraining bath salts users who are severely agitated and in a state of excited delirium can be harmful and even life-threatening because they usually have increased heart rates and high blood pressure.”
What’s worrisome to me is that in that same article a police Sgt. says that that multiple deputies restrained Willis and forced him into a “suicide smock” and the autosy report stated that “Physical force was used including strikes and baton.” There was information about his life and recent history that made it likely that he wasn’t i great health overall and no doubt, the drugs(s) made his system less stable but it also seems very likely the additional extreme emotional stress and extreme physical treatment were very likely contributing factors to his death that night. Was it was strictly an overdose? As you also posted in your blog, Karen Simone: “Maybe it killed him, and maybe it didn’t”
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April 2, 2012 at 3:01 pm
I feel very strongly that police brutality is more to blame than bath salts in the unfortunate death of Ralph E. Willis. The desire of the Maine police to cover this fact up almost drips off the page of the news article written in the Bangor Daily News about the matter, which I invite any interested party to read. The fact police admitted to beating the man prior to his death was not even mentioned in the first half of the article, and even then many of his injures are ascribed to him “banging his head and extremities on the wall,” an act I suspect was invented to cover up the beating he took with night sticks and the injury he sustained in having his head propelled through the window of a police cruiser. I fell bad that the truth of this man’s story will never be told, and that such monsters, who would not only scare and beat a man to death, but then cover it up by defaming his name, are put into positions of trust in our society.
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April 6, 2012 at 8:46 am
“feel very strongly” is not the same as having any evidence. but be that as it may, this blog’s main interest in these matters is in tying recreational drug substances to any causal role in medical emergency and death. Episodes such as this one will gradually emerge. From the better ones (i.e., where drug identity is confirmed) we can get an idea of what are common variables and what are individual variables. If the MDPV-related deaths *always* involve baton strikes to the head, well, that would tend to point in your direction. If the cases vary in the degree of police involvement/brutality, well we need to readjust our stance. Very likely, MDPV intoxication will be found to interact with *exertion* such as that involved in fighting off the cops or running away from the cops…
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May 31, 2012 at 7:18 am
As a journalist and journalism teacher, I am shocked at the terrible coverage surrounding “bath salts.” Shame on the media at every level, and shame on stupid people for not knowing how to tell news from propaganda.
First off, how many people actually died from Bath Salts? I have read everything out there, and I cannot get the truth. I want scientific confirmation that this chemical, and only this chemical, caused death- blood tests and all.
Committing suicide is not an OD. Period. People kill themselves all the time while sober. Bad journalism. Also, cops beat people up all the time and kill them, sometimes we are lucky enough to catch it on film (did you einsteins already forget about Oscar Grant?) and the cops still get off. Now, we can just scapegoat instead of admitting what is really going on. No doubt bath salts are no good, but why not let the facts speak for themselves? Why do we need to lie?
Please, no more articles that they “bath salts” cause death unless you have facts!
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May 31, 2012 at 7:50 am
I have read everything out there, and I cannot get the truth. I want scientific confirmation that this chemical, and only this chemical, caused death- blood tests and all.
This post describes a bit of the puzzle. The CaseReports and confirmations of ME tox results will trickle along as well. Eventually, we’ll see controlled data from animal studies.
The question for you is whether you are willing to accept the obvious conclusion or whether you still seek at all turns to deny that a specific compound could be at fault.
I say this not because I know your position with breadth but because it sounds like a familiar one from the MDMA issue. It is fine to be skeptical. It is not fine to be denialist.
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February 18, 2013 at 1:52 am
I’m thinking we need to educate our kids against human consumption because it kills. Its for bathing only.
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February 18, 2013 at 2:07 am
Mdpv has amphetamine like affects, hallucinations, swelling of the brain and vascular accidents or strokes. Chemical its 3,4-methylenedioxy ring-substituted analog of the compound pyrovalerone -a psychoactive drug developed in the 1960’s for the clinical treatment of chronic fatigue or lethargy. This is what they put in bath salt ,that is for soaking human body. Not for human consumption. This is just crazy to me.
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February 18, 2013 at 8:33 am
These drugs have nothing to do with bathing, annie. It is just a fig leaf to pretend the stuff isn’t being sold for human consumption.
The pharmacology data so far actually make MDPV seem more similar to cocaine in action than it is to amphetamine.
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