Are "bath salts" the next generation of stimulant abuse?

"Bath salts" are stimulants with high abuse potential that are known to contain agents such as 3,4-methylenedioxypyrovalerone and 4-methylmethcathinone (mephedrone). They are marketed locally and through online retailers as legitimate products in order to evade legal control and facilitate widespread distribution. They have been present in Europe since 2007 but are now becoming a burgeoning presence in American hospitals. Though preliminary efforts are underway in the United States to restrict their usage and distribution, there remains a general unawareness on the part of physicians regarding the drugs' physiological effects. While they mimic the effects of other known stimulants, they are not detected on standard urine screens. We present a clinical case that illustrates a typical pattern of usage along with a description of their basic chemistry, appearance, methods of delivery, withdrawal and intoxication characteristics, treatment recommendations, and areas for further research.