In the January edition of the journal Pediatric Emergency Care, doctors at the Yale School of Medicine Matthew Thornton and Carl Baum coauthored an article on the legal status of synthetic drugs, including synthetic cathinones — commonly known as “bath salts,” although they have no relationship to the salts in the bathtub — which have gained popularity in recent years. The News sat down with Thornton to discuss the history of the drugs, dangers for users and future legal status.

Q. Can you talk a bit about the history of bath salts and synthetic drugs similar to them?

A. Essentially, bath salts are actually called synthetic cathinones. Cathinones are a class of drugs that have been known since ancient times in the Middle East and northern Africa for many different things and are still actually very common in countries like Yemen and Djibouti. Synthetic cathinones started coming out as early as the 1920s, and a lot of derivatives were actually initially trying to get us to use it for medical use, but were unsuccessful because they had pretty bad side effect profiles. They have been tinkering with them for decades but never really [found] enough effective medical uses.

It’s kind of unclear exactly when synthetic cathinones first gained popularity, but they dated back as far as 2007, on Internet forums, where recreational drug users have mentioned them — primarily in the U.K. and the rest of Europe, not so much in America. [They] came to America in late 2009, and what we saw was a peak in the synthetic cathinone use in 2010, and then really 2011 was the year that we saw the most. Poison control got over 6,000 calls in 2011 about synthetic cathenones and similar substances. Then, in 2012, it dwindled to almost 2,700, and in the year 2013, it [was] just about 1,000. We think that the peak has actually kind of passed.

Q. How has the legal status of synthetic drugs like bath salts and salvia changed since they were first introduced into America?

A. What [the government] started to do at the beginning was that they made certain bath salts into [Drug Enforcement Administration] drugs of abuse. Essentially what that means is they were determined to have no accepted medical uses in the U.S. and a very high potential for abuse. What the scientists behind the drugs themselves realized is all they had to do was change minor formulas to make completely different drugs. They kind of circumvented that legislation by saying, “Well, fine, I’ll add a little extra amino acid or some different element here or there, and it will make a whole new drug with basically the same effects.” In the summer of 2012, President Obama signed a law that was called the Synthetic Drug Abuse Prevention Act. Essentially what that did is amend the verbiage, [and] basically by changing the wording of the law, they were able to say that this whole class of drugs and any minor changes, they’re all illegal whether it’s specifically mephederone or another drug like that or any kind of small variations that you could put onto it.

Q. Your article mentions that drugs like cocaine, ecstasy and marijuana have become less pure in recent years. What is the reason for that, and what implications does that have for the demand for synthetic drugs?

A. The people who sell these drugs realize that they can essentially lace drugs with different materials, and make it much more cheaply. By so doing they have kind of realized that they can sell the same products to different people, but do it a lot, and for a lot less money. So it’s not all what the consumers thought it was. Some recreational drug users were worried that the reports that were coming out about these really bad side effects. So actually, people who had been using these drugs for years and years were all of a sudden getting these side effects that were actually more the effects of whatever it was being laced with than the drug itself. There was this kind of thought among the general population that the synthetic drugs might actually be safer because they’re not being laced with these potentially dangerous other things.

Q. Is taking synthetic drugs more dangerous than taking them in their pure forms?

A. I wouldn’t say that any of these drugs are safe to use, certainly. I think they have the same potential to be dangerous. The main factors are kind of how much you’re taking, how quickly you’re taking it, what the period of time you’re taking it over is, that tends to have the most detrimental effects. Ordinarily, people report using very small doses, and still ending up very sick. That’s kind of one of the main things — I don’t think you can really say one is different from the other because the truth is that the potential for abuse is really high among all these drugs, so really I think you’re not really safe taking a bet on either one.

Q. Do you think the popularity of synthetic drugs will increase in the future?

A. That’s an interesting question. I don’t think that you’re going to see the bath salt craze continue to peak. I think that bath salts are kind of running out, but I think that the question you raise is a good one because we now see that the molecular makeup of drugs is something that’s very easy for people to manipulate. I think you’ll see the next class is probably going to be something that we don’t even know yet. I think that we will continue to see synthetic drugs in one form or another kind of popping up all over the place. My hope is that the word spreads quickly enough so that we can help these people who are coming in with overdoses. And on the legislative side they’re going to have to figure out the kind of best way to crack down on the manufacturing of these drugs as well, and of course the selling of them. For instance, bath salts that two to three years ago you could pick up in a gas station, a head shop, or anything like that, now you’d have to buy them illegally. They were pretty good about this and really getting on it quickly and stopping it from progressing any further. I think that it’ll be our job to kind of keep these things at bay as much as possible.