AMA House of Delegates

AMA house endorses national ban on "bath salts" synthetic drug

The dangerous drug, still legal in most states, has been compared to cocaine.

By — Posted July 4, 2011

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The American Medical Association House of Delegates adopted policy supporting a national ban on the synthetic drug commonly known as bath salts.

The drugs, sold under such names as Cloud Nine, Ivory Wave and Blue Silk, have been compared to cocaine and methamphetamine due to their addictive characteristics. They are known to cause paranoia, hallucinations and violent behavior and have been blamed for the deaths of several people across the U.S. They are still legal in most states, though many states have taken steps in 2011 to change that.

Some states have passed emergency bans on bath salts. A bill was introduced by Sen. Charles Schumer (D, N.Y.) in February to classify methylenedioxypyrovalerone (MDPV) and mephedrone, chemicals commonly found in the drugs, as controlled substances.

"The misuse of bath salts containing MDPV, mephedrone and related substances has led to deaths and hundreds of calls to poison centers nationwide," said Edward L. Langston, MD, then a member of the AMA Board of Trustees and a family physician. "Some states have already implemented emergency bans, and others have introduced legislation to ban these synthetic substances. The AMA's new policy supports a national ban on bath salts containing these harmful compounds so that they cannot be misused."


Dr. Langston

The AMA has broad policy condemning illegal drug use. In reference committee testimony on June 19, Hugh Taylor, MD, a family physician from Hamilton, Mass., and a delegate for the American Academy of Family Physicians, supported policy relating specifically to bath salts. He said AMA policy refers to "illicit drugs," and bath salts are not considered illicit because they're legal in most states.

John Schneider, MD, PhD, a delegate for the Illinois State Medical Society, said the Illinois delegation agreed that the AMA needed specific policy relating to bath salts. "We feel this happens to be a particularly important item at the present time and deserves specific support from the AMA," said Dr. Schneider, an internist from Flossmoor.

Gil Kerlikowske, director of the Office of National Drug Control Policy, issued a warning about the substances in February.

Schumer, in a statement he released when announcing his bill, said the Office of the Attorney General and the Drug Enforcement Agency are investigating the effects of the drugs. But "we cannot afford to wait while convenience stores, online merchants and smoke shops continue to sell this synthetic drug to anyone in the country, including teens and children," he said.

The American Assn. of Poison Control Centers said May 12 that poison centers across the country had taken 2,237 calls regarding bath salts in 2011, up from 302 calls regarding the substance in 2010.

Mark Ryan, director of the Louisiana Poison Control Center, said the substances were the worst he had seen in his 20 years at the center. Louisiana is one of the states that has approved an emergency ban on the drugs.

Back to top


Meeting notes: Public health

Issue: Increased awareness by physicians and the public of sickle cell disease and its treatment is needed.

Proposed action: A Board of Trustees Report called on the AMA to recognize sickle cell disease as a chronic illness; to encourage educational efforts on treatment and prevention; and to support newborn screening programs, genetic counseling and new research designed to speed the clinical implementation of new treatment. [Adopted]

Issue: Exposure to potentially harmful levels of mercury is prevalent in the population and has been implicated in a variety of secondary health effects such as cardiovascular morbidity, leukemia and reproductive toxicity. Approximately 188 cement kilns emit more than 11,000 pounds of mercury each year.

Proposed action: Direct the AMA to support modern and strict monitoring of mercury emissions from cement plants. [Adopted]

Issue: The Centers for Disease Control and Prevention has reported an increase in bloodborne infection transmissions caused by the shared use of fingerstick and point-of-care blood testing devices.

Proposed action: Encourage improved labeling of devices to make clear that multiple-use fingerstick devices made for single patients are intended for use only on single patients. [Adopted]

Issue: Pills are not easily identifiable by patients or physicians, which has led to harmful and sometimes fatal outcomes.

Proposed action: Strongly recommend to drug manufacturers that they put a consumer-friendly, unique identifier on the solid dosage forms and recommend that publishers of medication lists include a list of the identifiers. [Adopted]

Issue: Advertisers often alter photographs to enhance the appearance of models' bodies. Such alterations can contribute to unrealistic expectations of appropriate body image, particularly among children and adolescents.

Proposed action: Urge advertising associations to work with organizations that focus on child and adolescent health to develop guidelines discouraging the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image. The focus should be on ads that appear in teen-oriented publications. [Adopted]

Issue: Transgender patients commonly undergo hormone replacement therapy, during which they experience continuously elevated levels of testosterone, estrogen or other hormones over a period of months, years or even decades. Effects of short and medium terms of treatment have been studied, but the effects of long-term use are unknown.

Proposed action: Direct the AMA to encourage research into the impact of long-term administration of hormone replacement therapy in transgender patients. [Adopted]

Issue: At one year postpartum, almost 25% of women retained at least 10 pounds of the weight gained during pregnancy, according to a 2007 study. Additionally, more than half of all obstetrician-gynecologists surveyed considered their training on weight management to be "inadequate" or "nonexistent," said a 2006 report.

Proposed action: Encourage physician referrals of pregnant and recent postpartum patients for nutrition counseling. The policy also directs the AMA to advocate for the extension of health insurance coverage for nutrition counseling among such patients. [Adopted]

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story