December 19, 2011
The Case Against the Ban on ‘Bath Salts’ and Fake Marijuana
By: Maia Szalavitz
An incisive article on TIME.com points out the severe restrictions that emergency bans place on research than can be done to determine the actual risks and safety of new compounds. MAPS was founded in 1986 after such an irrational scheduling—that of MDMA. The tide is only now starting to turn—25 years later, we’re learning what emergency bans can do to hinder careful scientific investigation.
Originally appearing here.
No one would suggest leaving potentially dangerous, untested drugs on the market. But an outright ban hinders valuable research on compounds that could hold clues to treatments for diseases like Alzheimer’s.
Recently, the House passed legislation banning the synthetic stimulant drugs sold as “bath salts” or “plant food.” Easily bought online and in convenience stores in packets with labels like Ivory Wave or Blue Silk, the drugs have been associated with multiple hospitalizations and even death.
There has been little scientific study of the true risks of “bath salts,” which typically contain the drugs mephedrone or methylone. But anecdotally, they have been implicated in some scary outcomes. Rep. Charlie Dent (R-Pa.), who sponsored the House bill, which passed 317 to 98 in October, told the Washington Post earlier this month that there have been “horrific stories of individuals high on synthetic drugs.” He gave two examples: one of a Pennsylvania man who stabbed a priest after taking bath salts and another of someone who had jumped out of a window while under the drug’s influence. The DEA has temporarily banned the sale of these products.
The new law — which would also broadly and permanently prohibit the use of synthetic marijuana-related compounds — is intended to protect public health. Certainly, allowing these drugs to continue to be marketed without human testing or FDA approval is senseless. But an outright ban on the compounds may be equally absurd.
As alarming as the anecdotes of bath salt use are, they don’t prove that the drugs caused their users’ strange behaviors or deaths. They also say nothing about whether the substances are dangerous when taken in controlled settings at appropriate doses. But synthetic drugs seem to be in widespread circulation — last year, more than 1 in 10 high school seniors reported having at least tried “fake marijuana,” for example — and government limits threaten research that would begin to attempt to understand their real effects.
Take the findings from one new study. Researchers looked at the effects of mephedrone and methylone in the brain — in rats, not humans — and found that the substances behaved a lot like ecstasy (or MDMA). That’s interesting because the evidence has been mounting that MDMA is not as dangerous as previously thought and, more importantly, that it may hold significant therapeutic benefits for people with mental illnesses like post-traumatic stress disorder (PTSD) for which there are currently not many effective treatment options.
The rat study, published in Neuropsychopharmacology, further suggests that some of the negative effects of mephedrone and methylone may not be as severe as those of MDMA, at least under the conditions and in the animals used in the research.
MDMA, mephedrone and methylone all work by entering users’ brain cells. That distinguishes them from other drugs, including cocaine, marijuana and heroin, which don’t get into cells, but instead act in the synapses, the tiny spaces between brain cells through which the cells communicate. Cocaine, for example, blocks the activity of a protein channel called the dopamine transporter. That leads to more of the neurotransmitter dopamine — which is involved in pleasure and desire — being active in the synapse, a change that is believed to be responsible for the high.
In contrast, drugs like MDMA, mephedrone and methylone — and also methamphetamine — actually go through the dopamine transporter and into the brain cell. The end result is the same: more dopamine ends up in the synapse, leading to a stimulant-type experience, but the way in which it is achieved is different.
Drugs that get inside brain cells are more likely to damage them, at least under some circumstances. Both high-dose MDMA and high dose methamphetamine use have been linked to actual loss of nerve endings, an effect that is not seen with cocaine, marijuana or heroin. However, studies show that lower doses of these drugs (for example, in therapeutic settings) do not seem to cause these problems.
The new research found that while they all act in similar ways, mephedrone and methylone behave more like ecstasy than methamphetamine. “Methamphetamine acts in the same way as these drugs,” says Michael Baumann, a staff scientist at in the intramural research program of the National Institute on Drug Abuse and lead author of the study. “The difference is their selectivity profile, that is, which of the transporters the drugs are affecting.”
All the drugs target dopamine, but methamphetamine also affects another neurotransmitter called norepinephrine, which increases its stimulant effect — a profile that “makes it a very addictive drug,” says Baumann. In contrast, mephedrone, like ecstasy, affects the neurotransmitter serotonin at least as much as it affects dopamine. And since some serotonin neurons actually reduce the effects of dopamine, this may lower the addictiveness of the drugs and produce fewer stimulant effects, while promoting sociability and empathy.
Further, mephedrone doesn’t raise body temperature as much as ecstasy does, the study found. In humans, ecstasy-related deaths and negative effects on the brain seem to be associated with taking the drug in hot, crowded conditions, suggesting that body temperature is a critical part of the problem.
“I don’t want to give the impression that these drugs are safer than ecstasy,” says Baumann, explaining that much is still not known about them and more studies are needed. However, he suggests that the fact that the drugs didn’t cause as much hyperthermia as MDMA may help explain why it had less severe brain effects — like not depleting serotonin — at least in his study. One earlier paper using higher-dose mephedrone in more crowded rat conditions did show some serotonin depletion, however, again suggesting that the temperature and setting can matter in producing harm related to these drugs.
Recently, research on MDMA has suggested that when used in appropriate doses in safe settings, the drug may help people with treatment-resistant posttraumatic stress disorder and other mental illnesses. It may be possible that mephedrone and methylone, or related drugs, have some similar therapeutic potential. Banning them outright, however, severely restricts the research that can be done to determine their actual safety or harmfulness.
The recent legislation places these drugs in Schedule I, a category reserved for substances that have no medical use. The classification strictly controls research access, and means that most pharmaceutical companies won’t even consider trying to develop Schedule I drugs because of the extra expense involved and because they’re less likely to ultimately be government approved.
Opponents of the bill — who were mostly Democrats — pointed out that the legislation not only bans mephedrone and methylone, but also prohibits all compounds that act like marijuana in the brain that aren’t already illegal. That extremely broad legislation could further crimp pharmaceutical research in a family of compounds that many studies have already suggested hold promise for the treatment of pain and for treating or even preventing devastating, incurable conditions like Alzheimer’s and Parkinson’s disease.
No one would advocate for allowing untested drugs to be sold without regulation to kids or adults. But there is an alternative. Place these drugs in Schedule II, the category that contains substances like cocaine and the strongest opioid painkillers used in American medicine. This classification would allow the synthetic drugs to be studied, but not sold. Since it is not legal to prescribe unapproved drugs that don’t have a history of safe use, the shift would prevent any prescription sales and safely restrict them to the lab.
That would take untested drugs off the market without undercutting research into potential treatments for life-destroying diseases like Alzheimer’s. But it might prove slightly less satisfying to politicians whose manhood seems to be threatened if they don’t always take the toughest possible stance on drugs.
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